Surgical Abortion (Second Trimester)

Surgical Abortion (second trimester)

Second-trimester dilation and evacuation (D&E) is performed to manage miscarriage and to end a pregnancy for personal reasons, fetal abnormalities or maternal health conditions.

Patients may also choose to have induction of labor instead of a procedure to remove a second-trimester pregnancy.

During the second trimester (14 to 26 weeks after the first day of your last menstrual period), procedures are typically performed over a two- or three-day period but don't require an overnight hospital stay. We usually recommend one night of cervical preparation for patients between 13 or 14 weeks and 23 weeks, and two nights of preparation for patients between 24 and 26 weeks.

In some cases, the procedure can be performed in one day for pregnancies under 18 weeks, depending on the circumstances.

Most second-trimester procedures are performed in the operating room. Low-risk patients who are fewer than 17 weeks pregnant may choose to have the procedure in the clinic if they wish. For more information, see our webpage on first-trimester procedures.

Preoperative appointment

At this appointment, you'll meet a health educator and doctor at the UCSF Center for Pregnancy Options. In a private exam room, you will learn about the procedure, undergo an ultrasound and start preparations. This visit takes about two and a half hours.

You may choose to take medication to help with anxiety and relaxation. If this would be helpful, please request it when you schedule the appointment. If you're given medications, it's important to follow the doctor's instructions.

Preparing the cervix

To prepare, we soften and dilate the cervix with medication, small dilating sticks or both. Our approach depends on the length of the pregnancy and your medical history. We usually recommend:

• 13-18 weeks: Medication only with mifepristone the day before and misoprostol on the day of the procedure
• 18-23 weeks: Cervical dilators for one night plus the medication mifepristone
• 24-26 weeks: Cervical dilators for two nights plus a medication and a fetal injection

We may use laminaria or Dilapan as dilating sticks. Laminaria are thin sticks made from a special seaweed material that expand as they absorb moisture from your body. Dilapan are synthetic sticks that work in the same way. These dilators stay in the cervix overnight to prepare your body for the procedure.

If dilating sticks are used, you'll be awake during the insertion. If you brought someone with you, they can remain in the exam room if you wish. During the insertion, the clinician will:

• Place a speculum to see inside your vagina
• Wipe the cervix with gauze soaked in a solution to help prevent infection
• Apply numbing medication to the cervix
• Insert laminaria or Dilapan into the cervix, the opening to the uterus

The insertion takes about five to 10 minutes.

Afterward, you will rest for a few minutes. You may have cramping and spotting. When you feel ready, you may get dressed. We will give you detailed instructions on how to care for your body overnight and how to prepare for the procedure. You will receive an antibiotic to take at home and pain medications to use if needed.

If you took relaxing medications, someone must drive you home. Rest at home until the medications wear off.

Surgical appointment

It's important that you don't eat for at least eight hours before your operating room procedure. You may drink clear liquids (such as water, broth or tea) up to three hours before your procedure. If you take a GLP-1 medication, there are additional instructions about avoiding eating. Please tell us if you take one of these medications so we can review the requirements with you.

On the day of your procedure, you'll check in at the hospital reception area. You will then go to the preoperative area to meet your doctor and anesthesia team.

You will receive medication through an IV in your arm to induce anesthesia, or loss of consciousness, though you are usually breathing on your own. Most patients fall asleep and don't remember the procedure.

Once you're fully relaxed, the doctor will remove the dilator sticks and use suction and gynecological instruments, with ultrasound guidance, to empty your uterus. You'll be in the operating room for about an hour. The procedure itself takes 15 to 45 minutes.

Recovery

After the procedure, nurses will monitor you in a recovery room for about two hours. You may have some cramping and spotting.

The preoperative preparation, procedure and recovery at the hospital take about five hours in total.

Do not drive until 24 hours after you received anesthesia.

You must arrange ahead of time for someone to take you home directly. If you don't have someone who can do this, contact Access, a women's health rights organization that may be able to arrange a pro-choice volunteer driver to help you. This must be coordinated with our clinic before your appointment, so please make arrangements as early as possible.

You should be able to return to normal activities, such as work and school, the next day. If you feel you need more time off, please discuss this with your team at your preoperative visit.

See our frequently asked questions about post-procedure care.

Follow-up visits

If you have concerns, please contact the Center for Pregnancy Options so we can arrange a timely visit. We do not typically schedule follow-up visits because we complete routine checks at the time of the procedure. We recommend seeing your primary care provider for regular evaluations.

Safety and effectiveness

Second-trimester surgical abortion is one of the safest medical procedures. Complications are rare but can include blood clots or retained tissue in the uterus, which may cause pain or require a repeat aspiration; infection, which is generally easy to identify and treat; a tear in the cervix that can be easily repaired with sutures; perforation; retained pregnancy tissue requiring repeat aspiration; and heavy bleeding requiring a transfusion. We will review the risks in detail at your preoperative visit.

In general, complications from surgical abortion are considerably less frequent and less serious than those associated with giving birth, though after 20 weeks of pregnancy the risks are more similar.