Late Term Abortions are those that occur after 20 to 24 weeks gestation or beyond. They are most often performed because a desired pregnancy has been found to develop serious complications or because continuing the pregnancy would endanger the health or the life of the mother.
There are three most commonly performed procedures for terminating late term abortion:
Dilation and Evacuation (D&E). Dilation of the cervix and evacuation of the contents of the uterus. This method is also used as a therapeutic procedure following miscarriage to ensure that pregnancy tissue in the uterus has been completely removed, and thereby prevent possible infection. The first step for performing a D&E is to dilate the cervix. This process is generally started the day before the actual surgical procedure and involves the placement of multiple Laminaria (sterile seaweed approximately the size of a match stick) into the cervix to initiate gradual dilation. Dilating or opening the cervix allows for safe insertion of surgical instruments such as a curette or forceps into the uterus. Depending on the length of the pregnancy, dilation may be accomplished in a few minutes, or may require several hours. Additional Laminaria may also be needed. A prostaglandin such as misoprostol which causes uterine contractions may also be administered.
Once the cervix has been adequately dilated, the second step is to remove the fetus and all of the surrounding pregnancy tissue. Local anesthetic, IV Sedation or General Anesthesia may first be administered to provide for the patient’s comfort. Ultrasound guidance may be used throughout the procedure. A plastic cannula, similar in size to a drinking straw is passed through the cervical opening and into the uterus. The cannula is attached to tubing connected to a bottle and vacuum aspirator for removing the pregnancy. If necessary, forceps may also be used to aid in the removal process. Repeated suction aspiration may be preformed to ensure removal of any remaining tissue.
Early Induction of Labor. A process for inducing labor and delivery with the use of medication. A combination of medicines may be administered to bring about early labor. Osmotic dilators are used to slowly dilate the cervix to avoid risk of injury. Substances such as saline, digoxin or potassium chloride may be injected into the amniotic sac to stop fetal heart activity. Prostaglandin medications such as misoprostol may be inserted into the vagina to initiate uterine contractions and soften the cervix, allowing for passage of the fetus. This process may take from four to 24 hours to complete.
Intact D&X Surgery. The D&X Procedure is usually performed in the late second and third trimester of pregnancy. This process is similar to a D&E procedure; however, the cervix is usually dilated a great deal more to allow for intact removal of the fetus from the uterus. The calvarium (skull) is often decompressed in order for safe removal through the cervix. The calvarium may be decompressed with the use of forceps or by piercing the skull to allow for suctioning of the intra-cranial contents. With adequate cervical dilation, the entire fetus may be extracted through the cervix. This process may take two to three days to complete. All late term abortions can be safely achieved when performed by a skilled practitioner; however, they all have specific risks and benefits. Therefore it is advisable for the patient to gain as much information as possible regarding the different types of late term terminations and the physicians who perform them to assure they will have the safest and most effective results from the abortion procedure. Due to recent advancements in medical technology, pregnancy terminations have become safer and more efficient; thereby reducing the risks associated with the later term abortion procedures.