More often a pregnant woman who does not want to continue with the pregnancy would opt for an abortion in the first trimester when it is easy and safe. Doctors do not recommend second trimester abortion, except in some special cases where it is absolutely necessary due to serious medical issues.
Survey has shown that it is poverty and ignorance that generally leads to abortions after 13 weeks of gestation in a woman. The likelihood of serious threat to mother’s health due to pregnancy or severe abnormality or defect in the fetus is another reason why couples have to go for abortions in later stages of pregnancy.
Procedures for Second Trimester Abortion
Only 10% of abortions are carried out in the second trimester of pregnancy. As medication based abortions are possible only up to nine weeks into pregnancy, the procedure of second trimester abortion is more complicated and expensive process.
The different types of procedures performed for second trimester abortions are:
1. Dilation and Curettage: Commonly referred to as D &C, this is a surgical procedure which can be effective in termination of pregnancy up to 16 weeks of gestation period. The procedure as the name suggests involves dilation of the cervix and then scraping and scooping of the uterine contents with a sharp curettage. Suction by electric vacuum aspiration or manual suction is also commonly followed for removal of uterine tissues.
2. Dilation and Evacuation: D & E is the most preferred procedure for second trimester abortions. Typically it is a 2 day procedure. On the first day several laminaria sticks are inserted inside the cervix so that that will expand with natural body fluids and dilate the cervix in the process. The next day, a cannula is inserted into the uterus through the expanded cervix to dismember the fetus and evacuate all the uterine contents. A curette or forceps is further inserted to remove remains before using the vacuum to extract any remaining tissues.
3. Induction Abortion: In this procedure, salt water, urea or potassium chloride is injected into the amniotic sac surrounding the fetus, dinoprostone, prostaglandins or Misoprostol are inserted into the vagina and simultaneously Oxytocin is given intravenously to start uterine contractions after dilating the cervix with a cervical dilator.
The chances of complications and infections for abortions are directly proportional to the gestation period, however not all complications develop immediately as they may become obvious only after days, months or years to come. The immediate complications arising out of second trimester abortions are:
- Excessive bleeding
- Tearing, ripping or perforation of uterine walls or cervix
- Endo-toxic shock
- Blockage of arteries due to embolism
The complications that may show develop in later stages of life are:
- Increased risk of cervical, liver and ovarian cancer
- Undetected perforation of uterus
- Increased risk of placenta previa
- Chances of subsequent preterm miscarriages
- Abnormalities of fetus in following pregnancies
- Psychological problems
Even financially, it is more expensive than first trimester abortions.
Many countries have legislations that prohibit or restrict second trimester abortions other than in some special cases. Unfortunately this has led to women seeking abortions through unhealthy methods which could risk not just their health but also their lives.