Patients coming in for very late abortion - over 26 menstrual weeks' gestation - are almost always seeking services for termination of a desired pregnancy that has developed serious complications. This usually means the discovery of a catastrophic fetal anomaly or genetic disorder that guarantees death, suffering, or serious disability for the baby that would be delivered if the pregnancy were to continue to term. Occasionally a woman presents at this stage for pregnancy termination because of her own severe medical illness or a psychiatric indication. (See "A Special Note About Fetal Anomaly")
At this point, termination of pregnancy is considered a far more dangerous procedure and carries with it serious risks of complication. That is why pregnancy termination at this stage requires more experience and skill in the operating physician. It also requires scrupulous attention to procedures that reduce the risk of complication.
The first step for third trimester patients is the same as for second trimester patients at 20 weeks or more. The main difference here is that more precautions are taken to reduce the special risks for more advanced pregnancy termination.
Instead of changing the laminaria once on the third day, for example, the laminaria may be changed twice. An additional day of laminaria treatment is rarely, but possibly, necessary.
One of the main differences for third trimester patients having a pregnancy terminated for fetal anomaly is that they may wish to have an intact fetus that they can examine and hold as part of the grief process. For many of these patients, it is not a fetus - it's a baby. The woman and her family may request special procedures such as special religious ceremonies, genetic studies, formal autopsy, private cremation, or private burial. We can arrange for any or all of these special procedures upon request.
While these procedures or ceremonies can be arranged upon request, we do not expect or require any patients or families to go through any special rituals, ceremonies, or grief process at Boulder Abortion Clinic. Dr. Hern believes that the patient's own family, physician, and religious counselors are better prepared to provide these kinds of support at home in most cases.
All third trimester abortion patients are carefully observed in the recovery room for a period of up to two hours before being discharged to the care of a family physician, unless a patient desires return to Boulder Abortion Clinic for her follow-up examination.