THIRD TRIMESTER ABORTION
Patients coming in for third trimester abortion (later abortions) are often 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. (Please see Fetal Anomalies for more information on our care for patients with desired pregnancies.) Sometimes a woman presents at this stage for pregnancy termination because of her own severe medical illness or a psychiatric indication.
We believe that the techniques developed by Dr. Hern have resulted in a procedure that is safer than continuing the pregnancy to term with a goal of live birth, and our safety record supports that belief. However, termination of pregnancy at this late gestation still carries with it serious risks of complication. That is why the procedure requires more experience and skill in the operating physician. It also requires scrupulous attention to procedures that reduce the risk of complication.
Four-day Outpatient Procedure
- First day: preoperative care. Fetal demise is induced
- Second day: fetal demise is confirmed, and a single laminaria is placed in the cervix.
- Third day: The laminaria is removed, and multiple laminaria are placed in the dilated cervix under local anesthesia.
- Fourth day: procedure.
An ultrasound exam is performed to confirm the gestational age, as well as the measurements in the fetus which may differ significantly from what is expected in the presence of some anomalies. When possible, we confirm the presence of anomalies.
We perform lab tests including hematocrit (to assess for anemia) and blood typing (to assess if Rhogam is needed to prevent Rh sensitization).
One of our expert counselors will review what to expect during the week, as well as confirming your decision and providing resources for support after your third trimester abortion procedure.
Induced Fetal Demise
An injection is done on the first day that stops the fetal heart. This injection is done through the patient’s abdomen, into the fetus, under local anesthesia. The injection itself usually takes less than a minute, although the strict attention to sterile technique means that the patient will be in the procedure room for longer than that.
Laminaria are placed into the cervix using a speculum. Most patients feel mild or no discomfort with the first laminaria. We have been able to accommodate patients who have a difficult time with speculum exams, and have experience with pediatric patients. Patients usually feel mild or no cramps while they have one laminaria in their cervix.
When multiple laminaria are being placed on the third day, we first numb the cervix with local anesthesia.
On the third trimester abortion procedure day, we start with placing an IV and often provide some medication for anxiety if patients request it. The laminaria and gauze are removed, and the amniotic membrane is ruptured (“breaking the water”). The amniotic fluid is drained as completely as possible.
Medications such as misoprostol and pitocin are used to help the uterus contract and help the cervix dilate until it is open enough to perform the procedure. During this time, our patients rest in rooms near the procedure rooms, often with a family member or friend with them. We use IV medications to keep our patients comfortable.
When the cervix is dilated enough, the uterine contents are evacuated. This is not a delivery and our patients do not need to push.