Abortion in Second Trimester (14–24 weeks)

What does the second-trimester procedure/tests include?

The following tests are being performed during the second-trimester abortion procedure:-

• Blood tests to assess and evaluate the blood count, iron levels, chromosomal and genetic conditions. 
• Urine tests to check for the presence of glucose and protein. You would experience a burning sensation while urinating if you have a urinary tract infection(UTI).
• Ultrasound tests to see the progression of your baby through measuring the femur length, head size, and estimating fetal age. It also helps in assessing the fetal anomalies and the placenta position.

A surgical evaluation of the uterus is done for the 20-26 weeks of pregnancy. The doctors prioritise the patient’s safety throughout the procedure with proper follow-up care and instructions. 

2nd-trimester Abortion Methods

The following are the methods for MTP in the second trimester. 

• Dilation and curettage(D&C):

D&C is a surgical procedure and is also called vacuum aspiration or suction curettage. It is usually performed up to 16 weeks of gestation. During the procedure, the cervix is dilated and a thin instrument is used to remove the tissue from the inside of the uterus(curettage). 

• Dilation and Evacuation (D&E):

The D&E is also known as a procedural or surgical abortion and is the most widely used method for above 16 weeks or pregnancy. The D&E procedure consists of two parts: evacuation of the products of conception (with suction, extraction forceps, and curettage) and preparation of the cervix(dilating the cervix with osmotic, pharmacologic, and/or mechanical dilators). 

• Induction abortion

It is a less common method and works through injecting substances, such as saline solution, urea, or potassium chloride, to induce labour.  

Surgical Abortion at 2nd Trimester

Pre-Operative Instructions

You will receive information regarding the procedure, undergo an examination and ultrasound, and may be given oral pain/anxiety medications in a private examination room. The doctor may also prescribe antibiotics and painkillers. It is crucial that you adhere to your doctor’s instructions. 

Depending on your gestational age and medical history, cervical softening and dilating are carried out with medication and/or tiny dilating sticks, known as laminaria or Dilapan. Made from a unique seaweed substance, laminaria are thin sticks that widen when they absorb moisture from your body. Dilapan are synthetic sticks that function similarly. To help your body get ready for the surgery, the dilators will remain in your cervix overnight, allowing cervical dilatation to occur gradually.

You might return for a second day of pre-op, where new dilators will be inserted and the old ones removed, depending on your gestational age. Additionally, you can get an injection that causes fetal death inside your uterus. You will be conscious throughout the dilator insertion. The physician will:-

• Give you anxiety and/or painkillers to ease the discomfort
• To see within your vagina, insert a speculum
• Use gauze dipped in soap to clean the cervix.
• Apply local anesthesia, a numbing medication, to the cervix.
• Put laminaria (also known as Dilapan) into your cervix, the uterine opening. It takes five to ten minutes to introduce a laminaria.

You will be allowed to rest for a short while after the treatment. You may also experience spotting and cramps. If you take painkillers or anti-anxiety medications, someone has to drive you home. You are advised to rest at home until the effects of the medications wear off. After your pre-op visit, it is advised that you spend the remainder of the day relaxing at home. On the day before your surgery, avoid eating or drinking anything after midnight.

Surgical Appointment

The medicine will be injected intravenously (IV) into your arm once you are in the treatment room, to induce anaesthesia or loss of consciousness. The majority of patients fall asleep and do not remember the process. Once you’re comfortable, the doctor will remove the laminaria and use gynecological devices and mild suction to empty your uterus under ultrasound monitoring. Although the surgery will probably only take 15 to 30 minutes, you will spend around an hour in the operating room.

Recovery

The hospital staff will monitor you for roughly two hours in the recovery room. You might get some spotting and cramping. The entire process and recovery period at the hospital often takes six to eight hours.  You shouldn’t drive until the effects of the medicines wear off. You should be able to resume your regular activities, including work and school, the next day. 

Is Surgical Abortion at 2nd Trimester Safe?

Surgical abortion at 2nd trimester is considered one of the safest medical procedures. However, a few of the rare complications, include the following:-

• A blood clot in the uterus can be painful and requires a repeat suction procedure
• Infection, which is treatable
• Excessive bleeding that needs a transfusion
• Perforation of the uterus may cause excessive blood loss and pain
• A tear in the cervix that can easily be repaired with a suture
• Sometimes a retained pregnancy tissue that requires a repeat suction procedure

Second Trimester Abortion - What MTP Act Says?

In India, women have the right to terminate their pregnancy during the second trimester and up to 24 weeks gestation, provided a qualified doctor deems it appropriate. However, certain conditions must be met, including:

• Abortion is permissible if there is a threat to the life of the mother or if the fetus has severe abnormalities.
• The woman’s or her legal guardian’s consent is mandatory, especially if the individual is a minor or has mental abnormalities.
• Abortion is allowed in cases of pregnancy resulting from rape or incest, when there is a risk to the woman’s physical or mental health, or if the fetus has severe abnormalities.
• Qualified medical practitioners with specific credentials are authorized to perform abortions in India. It’s worth noting that the Medical Termination of Pregnancy (MTP) Act is a federal law, but individual states may have their regulations regarding abortion. Some states may impose additional restrictions, such as mandatory counseling, waiting periods, or parental consent.

It is important to note that abortion laws change over time, and individuals seeking abortion should seek advice from a healthcare provider or legal professional for the most up-to-date information on this.