Second Trimester Abortions

A second-trimester abortion can be performed with a surgical procedure or with medication. 

In Oklahoma, an abortion cannot be performed on you if you are 20 weeks from conception or more, unless, you have a condition “which so complicates your medical condition as to necessitate abortion of your pregnancy to avert your death or to avert serious risk of substantial and irreversible physical impairment of a major bodily function.  When an abortion is to be performed on a woman twenty (20) weeks or more pregnant, the physician shall terminate the pregnancy in the manner which, provides the best opportunity for the unborn child to survive, unless termination of the pregnancy in that manner would pose a greater risk either of the death of the pregnant woman or of the substantial and irreversible physical impairment of a major bodily function of the woman, which does not include psychological or emotional conditions.” (Title 63 O.S § 1-745.5)

Common Surgical Procedures

Dilation and Evacuation (D&E)

This procedure is a common method used after 13 weeks from the last menstrual period.   Dilation and evacuation (D&E) is a procedure to open (dilate) the cervix and surgically remove the contents of the uterus. In many cases, this is a two day procedure. For this procedure, the physician will:

Day One:

• Perform laboratory tests to confirm the pregnancy, test for Rh status, and test for anemia and red blood cell count.
• Take a medical and obstetrical history, including a history of allergies and all current medications.
• Examine the uterus and perform an ultrasound to confirm how far along the pregnancy is.
• Educate the patient about the abortion process, side effects, and clear instructions for assessing emergency services.  Prescribe antibiotics to prevent infection.
• Insert a speculum into the vagina, to hold it open.  The physician cleans the vagina and cervix with an antiseptic solution.  At this time, a numbing agent (local anesthetic) may be injected in the cervix. 
• Insert osmotic dilators (small tubes that absorb moisture from the tissues surrounding the cervix and swell) approximately 12-24 hours before the surgical procedure to open the cervix, allowing access to the uterus.  Misoprostol may also be given several hours before surgery. This medicine can help soften the cervix.
• In some cases, medicines are injected through the abdomen or vagina into the amniotic fluid or the heart of the fetus.  This causes the death of the fetus and makes fetal tissue more pliable.

Day Two:

• Insert a speculum into the vagina, to hold it open.  The physician cleans the vagina and cervix with an antiseptic solution.  At this time, the osmotic dilators are removed from the cervix and a pelvic exam is performed. 
• Inject pain medication in the cervix along with a sedative or general anesthesia and medication that slows uterine bleeding and reduces blood loss. 
• Dilate (open) the cervix with a series of dilators inserted into and withdrawn from the cervix to gradually increase the size of the opening. 
• Perform an ultrasound to confirm the absence of a fetal heartbeat and guide the physician in locating fetal tissue.
• Insert a tube (cannula) through the cervix into the uterus and a suction machine removes tissue from the uterus. 
• Insert forceps (a grasping instrument) into the uterus to grasp and remove larger pieces of fetal parts and placenta.
• Insert a curette to scrap the walls of the uterus to dislodge any remaining placental tissue. Followed by suctioning the uterus to confirm all fetal tissue has been removed. 
• Examine the tissue removed to confirm the procedure is complete.

Common side effects include:

• Bleeding
• Cramping

Less frequent complications can include:

• Heavy or prolonged bleeding
• Blood clots
• Damage to the cervix or uterine lining
• Nausea
• Sweating
• Lightheadedness
• Tingling or numbness in the arms and legs
• Blurry vision
• Headaches
• Dilators dislodging from cervix
• Infection due to remaining tissue or infection caused by an STD or bacteria being introduced to the uterus can cause fever, pain, abdominal tenderness and possibly scar tissue

Rare complications can include:

• Spontaneous rupture of membranes
• Onset of labor and fetal expulsion before surgery
• Dilators migrate into uterine cavity
• Allergic reaction
• Toxic Shock Syndrome
• Uterine hemorrhage
• Perforation of the uterus
• Tissue remaining in the uterus (incomplete abortion)
• Injury to the bowl or bladder
• Scar tissue in uterus or cervix
• Placenta Previa in future pregnancies
• Infertility due to the consequences of infection or damage to cervix
• Pulmonary Embolism
• Amniotic Fluid Embolism
• Death