Only 12% of pregnancy terminations in the United States are done after 12 weeks LMP .
Dilatation and Evacuation (D&E) accounts for 95% of these procedures. D&E requires considerable skill by the physician and more dilatation of the cervix than a first trimester abortion but is basically an expansion of the vacuum aspiration technique described earlier. Ultrasound staging of the pregnancy is essential.
Termination of pregnancies that are advanced beyond 15 weeks require two visits to the clinic on consecutive days because it is necessary to prepare the cervix over several hours using multiple laminarias, frequently in addition to misoprosol. Patients and their drivers must stay that night within 30 minutes of the clinic. Laminarias are absorbent seaweed sticks about two inches long that are inserted in the cervical canal. The laminarias swell as they absorb moisture and slowly expand and dilate the cervical opening over several hours or overnight. A second or third application of laminarias may be necessary.
Patient must be firm in her decision to terminate her pregnancy before proceeding with inserting the laminarias. The patient cannot change her mind once laminaria has been inserted because of the risk of infection. The contents of the uterus must be evacuated within 48-72 hours.
To perform the abortion, the physician uses suction as in first trimester procedure; and special forceps to remove fetal parts that are too large to pass through the suction tube. The procedure is usually completed within 20-30 minutes and is performed under deep intravenous conscious sedation plus local anesthesia of lidocaine and vasopressin.
Major complications are rare, even in the second trimester. They occur in less than 1% of D&E. The risk increases with the gestational age of the pregnancy. Complications include heavy bleeding, incomplete abortion, cut or torn cervix, a perforation in the wall of the uterus, and anesthesia related problems. All serious complications require immediate hospitalization and may require surgery, including hysterectomy; blood transfusion; IV antibiotics; and rarely cause death. The mortality rate associated with 100,000 D&E abortions dropped from 10.4 during 1972-76 to 3.3 during 1977-82.
The experience and skill of the physician and the improved techniques we use today make this procedure much safer than 20 years ago. With thirty years of excellence providing abortion services at the All Women’s Clinic, our safety record is much better than the reported national average.
Late Second Trimester Abortion is used in only 2% of terminations. As with childbirth, when medicines are used to initiate labor, there is a risk of rupture of the uterus. The risk of any and all complications with an early second trimester termination increase progressively with increases in the gestational age of the pregnancy.
Our current method of late second trimester abortion involves inserting multiple laminarias into the cervical canal and the serial placement of misoprosol so that the fetus and placenta are expelled as in a vaginal delivery. With the generous use of medications (twilight or conscious sedation anesthesia) to relieve discomfort, most patients do not feel or remember very much of the process. An additional D&C or D&E may be required. This procedure is generally completed within two days and has practically eliminated the use of Saline Induction.
SALINE INDUCTION is rarely performed. Under local anesthesia, the physician passes a needle through the abdomen into the uterus, withdraws some amniotic fluid through the needle and injects saline solution or less commonly, a prostaglandin, to induce uterine contractions. Hours later, the patient goes into labor and expels the fetus. Approximately 75% of the times this occurs within 24 hours.
These methods are rarely used. They carry a higher risk of morbidity and mortality, and like the Saline Induction, must be performed in the hospital.
Click here to go back to list of featured services
You may contact us at any of the following phone numbers:
Toll free: (800) 867-1693. Local calls: (954) 772-HELP (4357) or (954)772-0933.
You also may text your message to: (954) 805-5821
All calls are kept strictly confidential
Our address is: 2100 E Commercial Blvd, Fort Lauderdale, Florida 33308-3822
[Click here to go back to top]
[Click here to go back to the Home Page