How Is Second Trimester Abortion Performed? / Orlando Womens Center.

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How Is Second Trimester Abortion Performed? / Orlando Womens Center.

The two most common methods used to perform a Second Trimester Abortion are 1) Surgical Dilation and Evacuation (D&E) and 2) Medical Abortion Pill Procedure.

Both methods are highly efficient and safe in terminating a Second Trimester Abortion pregnancy. They are performed with minimal morbidity and mortality by Physicians and Medical Staff who have the skill, knowledge and technical expertise.

Second Trimester Abortion procedures have risks associated with them. Due to advanced surgical and medical techniques, they have a 11 to 14 times less risk of maternal death compared to full term deliveries.

Second Trimester Abortion Definition

The Second Trimester of pregnancy is defined as the number of weeks between 14 and 28 weeks gestation. The second trimester is divided up into early (13 to 20 weeks) and late (21.3 to 28 weeks).

Percentage Of Second Trimester Abortions That Are Performed In The World:

Second Trimester Abortions make up between 10 and 15% of the total number of abortions performed in the World.

Second Trimester Terminations of pregnancy are the cause for approximately ⅔ of maternal morbidity and mortality.

The majority of maternal deaths from abortion procedures are due to:

  • Abnormal bleeding and
  • Pelvic infection

The Modern Day Second Trimester Abortion Performed, is aimed at reducing the rate of maternal bleeding and pelvic infection.

Is the State-Of-Art Second Trimester Abortion Procedure Performed Today Safe?

The answer is a resounding yes that Second Trimester Abortion Procedures today are safe.

A shot of penicillin, taking viagra or having a wisdom tooth pulled carries a higher incidence of morbidity and mortality compared to Second Trimester Abortions that are performed by medical personnel who are well trained and experience.

How Are Second Trimester Abortion Procedures Performed To Prevent Delivery Of A Viability Pregnancy (Live Fetus)

For women who are found to be 21 weeks or greater, fetal intracardiac injection, intrafetal injection or amnioinfusion should be performed to stop the fetal heart immediately or within 24 hours or less.

Digoxin, Potassium Chloride, 1% Lidocaine hypertonic saline and injection of air into the fetal heart are all methods utilized to cause fetal demise within the intrauterine cavity.

This alleviates the potential stress of patients, their families and the medical staff of being confronted with the remote possibility of delivery of a live birth.

The Surgical Procedure For Second Trimester Abortion is Dilation and Evacuation (D&E)

The Surgical D&E Procedure involves initially getting 1) accurate dates of the pregnancy by Sonogram (Ultrasound), 2) a 1 to 4 day preparation of the cervix (entrance to the lower part of the Uterus) and 3) special surgical abortion instruments designed to dilate (open) the cervix if required and gently evacuate (manually remove) the pregnancy tissue.

The surgical operation generally takes 5 to 30 minutes to complete.

The most important part in preparing for the Second Trimester Surgical D&E Procedure is to adequately prime the cervix. This consists of using medications that dilate and soften the cervix. It allows the safe removal of the pregnancy tissue.

The medications used for cervical preparation are:

  1. Laminaria- this is sterile seaweed shaped in the form and length of a matchstick. When inserted inside the cervix the Laminaria absorbs water and slowly opens, expands and cervix.
  2. Misoprostol tablets – It is a Prostaglandin E1. It causes Uterine contractions. This causes the cervix to soften and open.

Second Trimester Surgical Abortion Complications:

Adequate cervical preparation significantly reduces the incidence of the following second trimester surgical complications:

  • Cervical lacerations and tears
  • Uterine perforation (puncture of hole into the wall of the uterus)
  • Incomplete abortion (pregnancy tissue retained in the uterus)
  • Retention of large blood clots or heavy vaginal bleeding
  • Pelvic Infection
  • Sepsis (bacteria that gets into the maternal blood)
  • Hysterectomy
  • Maternal Death

Long term second trimester abortion complications are extremely rare. They include:

  • Chronic pelvic pain
  • Severe pain with intercourse
  • Infertility due to scarring of the fallopian tubes due to Pelvic Inflammatory Disease (PID)

How Is The Second Trimester Abortion Pill Procedure Performed?

The Second Trimester Abortion Can be Performed using Cytotec (Misoprostol) alone or using the most common method where the combination of Mifepristone (Mifeprex, Mifegyne, RU 486, French Pill) and Cytotec are used.

Combining Mifepristone and Misoprostol are able to 1) shorten the induction to delivery time (decrease abortion process), 2) obtain a higher abortion completion process and 3) reduce the amount of Misoprostol required to complete the termination of pregnancy.

Diminishing the amount of Misoprostol that is required to carry out the Second Trimester Abortion Pill Method consequently reduces the incidence of side effects and complications associated with using Misoprostol.

How Does The Second Trimester Medical Abortion Pill Procedure Work To Terminate A Pregnancy?

Mifepristone works by blocking the hormone Progesterone from attaching to the Progesterone Receptors on the Uterus. It is known that prior to labor at term, there is a rapid and significant drop in the amount of Progesterone in the woman’s body. The logic of how and why this occurs prior to the commencement of labor is unknown.

The decrease in Progesterone causes the following to occur:

  • increase synthesis (production) of prostaglandins in the lining of the Uterus. This causes Uterine contractions
  • Increase in intrauterine pressure
  • Softening and opening of the Cervix and vaginal bleeding. This is caused by the breakdown of blood vessels and pregnancy tissue that is responsible for supplying nutrients and oxygen to the fetus

Second Trimester Abortion Complications Associated With Abortion Pill

Side effects associated with taking Mifepristone are the following:

Headaches, nausea, vomiting, low back pain, abdominal pain, vaginal bleeding and a 0.2 to 0.4 chance of going into labor prior to taking the Misoprostol tablet.

Common side effects associated with taking Misoprostol are the following:

Shivering, chills, mild skin rash, itchy palms, headaches, nausea, vomiting, low grade temperature, lower back pain, abdominal cramps, diarrhea, and vaginal bleeding.

Other complications and side effects that occur with using Misoprostol for Second Trimester Abortion procedures may include:

  • Failed abortion
  • Cervical tears
  • Incomplete Abortions (pregnancy tissue remains inside the Uterus). May require surgical curettage.
  • Uterine perforation
  • Heavy vaginal bleeding
  • Uterine Infection
  • Severe lower abdominal pain

Hospitalization may be required due to the following:

  • Heavy vaginal bleeding requiring blood transfusion
  • Surgical laparotomy or laparoscopy
  • Treat with IV antibiotics due to severe pelvic infections

Long term complications:

  • Severe pelvic pain
  • Infertility

Second Trimester Abortion Bleeding That Begins After Taking The Abortion Pill:

Pain and bleeding normally begins 30 mins to 2 hours after taking the first dose of Misoprostol. This may be given vaginally, taken orally or placed between the cheek and gum (buccally) or underneath the tongue (sublingually). The given dosage, frequency, interval and route of administration vary.

The vaginal bleeding may be mild, moderate or heavy. The closer one is to delivering the pregnancy tissue, the greater the abdominal discomfort and the heavier the vaginal bleeding becomes.

Once the pregnancy tissue passes in or through the vagina, the moderate to severe abdominal discomfort and heavy vaginal bleeding stops.

The placenta (after birth) generally passes within 5 to 10 minutes after the pregnancy tissue passes. It may take up to 1 to 2 hours for it to pass. In less than 5% of Patients, surgical evacuation of the Uterus may be required to remove the afterbirth.

The majority of patients are able to relieve their pain and discomfort by using over-the-counter pain medication (Tylenol, Motrin, Aleve, etc.). A small percentage of women require narcotics for pain relief.

Heavy vaginal bleeding is defined as using more than 2 pads an hour for 2 hours in a row. This calls for immediate medical evaluation

Heavy vaginal bleeding is normally resolved by surgical removal of the pregnancy tissue from the intrauterine cavity. This generally prevents severe anemia or hypovolemic shock.

It is rare that hospitalization is required to undergo a blood transfusion due to a heavy loss of blood volume.

Second Trimester Abortion Pill Procedures Failed

Rarely does a second Trimester Abortion Procedure not work. The average time of delivery after taking the first dose of Misoprostol is 6 to 18 hours.

More than 99% of patients complete the medical induction procedure in 24 hours or less. There is smaller than a 1% chance of developing complications or side effects.

If the Abortion Pill Procedure is not successful, a Second Trimester Surgical D&E Procedure can be performed.

Surgical D&E Fails

It is highly unusual for a Surgical D&E to fail When it does happen, there are 2 choices:

  • Hysterotomy- Process is similar to a C-section
  • Hysterectomy- Surgical removal of the Uterus

Second Trimester Abortion After Care

After the Surgical or Abortion Pill Second Trimester Abortion Procedures are successfully done, the after care for both are similar.

All patients are encouraged to do the following

  • Bedrest for 24 hours
  • Monitor for heavy bleeding, severe pain or temperature greater than 100.4. If the later 2 are not controlled by Tylenol, Ibuprofen or Aleve, then patients are encouraged to call the second trimester abortion facility immediately
  • Antibiotics are prescribed to prevent a pelvic infection
  • Most women are able to return to school or work the following day
  • No prolonged standing, heavy lifting or engaging in contact sports for 3 to 5 days
  • Nothing should be inserted into the vagina (tampons, penis, etc) for 3 to 5 days.

Second Trimester Abortion Procedure Birth Control

Ovulation may occur as early as 5 days after the abortion process is completed. Sperm may live up to 5 days after the sexual event.

All women should be counseled and offered some method of birth control prior to being discharged from the medical office.

Birth control pills are normally prescribed and on the 2 to 4 week follow-up visit, a longer acting method of birth control (IUD, Depo-Provera Injections or Progesterone Pellets) may be considered and initiated for Patients who elect to use them.

Another method of birth control that is profoundly proficient in preventing a unintended pregnancy is the use of the Emergency Contraceptive (Morning After) Pill.

The most common medication used for Emergency Contraception is the hormone Progesterone called Levonorgestrel. In the U.S., the dose is a 1.5 mg tablet.

Levonorgestrel works by preventing or delaying the onset of ovulation.

Emergency Contraception does not cause an abortion. It is not the Abortion Pill.

The Morning After Pill may be purchased over-the-counter under the Plan B brand at most local Pharmacies (CVS, Walmart, Walgreens, etc.)

Taking the Morning After Pill )Levonorgestrel 1.5 mg tablet) Immediately after the unprotected event, is the most effective time to take the Emergency Contraceptive Pill to prevent pregnancy.

There are medical studies showing that Levonorgestrel may be effective when taking it up to 5 days after the unprotected event.

Second Trimester Abortion Procedure Cost

The price for a Second Trimester Abortion Procedure may range from $0 to $35,000. The price depends on several factors:

  • Geographical region in the country
  • The number of weeks pregnant – the greater the number of weeks, the more expensive the procedure
  • VIP and Exclusive service for the ultimate in privacy
  • Patients who meet qualifications to receive funds from private donors or non-profit organizations

In Summary;

Second Trimester Abortion Procedures are performed using the Surgical or Abortion Pill Process. They are carried out in a highly efficient and safe manner by experienced and highly qualified Physicians and their Medical Staff.

Second Trimester Abortions represent 10 to 15% of the total number of Abortions performed around the World.

There will always be a requirement to perform Second Trimester Abortions because of 1) maternal medical and fetal indications, 2) postponement in having the abortion procedure performed and 3) women being oblivious thet are pregnant the second trimester.

After evaluating the moral, ethical, social, religion, family, age and financial issues involved with pregnancy, women should have the choice to have a Second Trimester Abortion Performed.

Dr James S Pendergraft Orlando Abortion Clinic, www.womencenter.com.

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