Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Overview of second-trimester pregnancy termination

Cassing Hammond, MD
Section Editor
Jody Steinauer, MD, MAS
Deputy Editor
Sandy J Falk, MD, FACOG


Second-trimester pregnancy termination comprises 10 to 15 percent of the approximately 42 million abortions performed annually worldwide [1,2]. The United States Centers for Disease Control and Prevention (CDC) reported that 7.1 percent of abortions were performed between 14 to 20 weeks and 1.3 percent at or after 21 weeks [3].

Second-trimester abortion is associated with more morbidity and mortality and, for some women, more social or emotional challenges than first-trimester abortion [4]. Legal induced abortion is rarely associated with death; from 2008 to 2012, the CDC reported 36 deaths associated with abortions in the United States, the case-fatality-ratio was 0.80 [3]. The mortality risk increases by 38 percent for each successive gestational week after eight weeks [5].

Similar to first-trimester abortion, second-trimester procedures can be performed either with dilation and evacuation (D&E) or medication. An overview of second-trimester pregnancy termination and the procedure for surgical termination are reviewed here. Second-trimester induction termination and second-trimester D&E, as well as first-trimester pregnancy termination and other topics regarding induced abortion, are discussed separately. (See "Second-trimester pregnancy termination: Induction (medication) termination" and "Second-trimester pregnancy termination: Dilation and evacuation" and "Surgical termination of pregnancy: First trimester" and "First-trimester medication abortion (termination of pregnancy)" and "Overview of pregnancy termination".)


Indications and contraindications — Women terminate pregnancies in the second-trimester for many reasons. Procedures are often performed in the second trimester because of a delay in diagnosis of the pregnancy or delay in obtaining an abortion. As an example, at one large United States public hospital, 58 percent of patients having second-trimester procedures were already beyond the first trimester by the time they obtained a pregnancy test [6].

For some women, a fetal anomaly or maternal illness (eg, early onset severe preeclampsia) is not recognized or does not present until the second-trimester. Midtrimester preterm premature rupture of membranes may also be an indication for pregnancy termination.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: May 24, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. ACOG Practice Bulletin No. 135: Second-trimester abortion. Obstet Gynecol 2013; 121:1394. Reaffirmed 2017.
  2. Sedgh G, Henshaw S, Singh S, et al. Induced abortion: estimated rates and trends worldwide. Lancet 2007; 370:1338.
  3. Jatlaoui TC, Ewing A, Mandel MG, et al. Abortion Surveillance - United States, 2013. MMWR Surveill Summ 2016; 65:1.
  4. Henshaw SK, Finer LB. The accessibility of abortion services in the United States, 2001. Perspect Sex Reprod Health 2003; 35:16.
  5. Bartlett LA, Berg CJ, Shulman HB, et al. Risk factors for legal induced abortion-related mortality in the United States. Obstet Gynecol 2004; 103:729.
  6. Drey EA, Foster DG, Jackson RA, et al. Risk factors associated with presenting for abortion in the second trimester. Obstet Gynecol 2006; 107:128.
  7. http://www.guttmacher.org/sections/abortion.php (Accessed on November 17, 2015).
  8. Stubblefield PG, Carr-Ellis S, Borgatta L. Methods for induced abortion. Obstet Gynecol 2004; 104:174.
  9. Grimes DA, Schulz KF, Cates WJ Jr. Prevention of uterine perforation during curettage abortion. JAMA 1984; 251:2108.
  10. Pazol K, Creanga AA, Burley KD, et al. Abortion surveillance - United States, 2010. MMWR Surveill Summ 2013; 62:1.
  11. Kafrissen ME, Schulz KF, Grimes DA, Cates W Jr. Midtrimester abortion. Intra-amniotic instillation of hyperosmolar urea and prostaglandin F2 alpha v dilatation and evacuation. JAMA 1984; 251:916.
  12. Grimes DA, Schulz KF, Cates W Jr, Tyler CW Jr. Mid-trimester abortion by dilatation and evacuation: a safe and practical alternative. N Engl J Med 1977; 296:1141.
  13. Hern WM. Serial multiple laminaria and adjunctive urea in late outpatient dilatation and evacuation abortion. Obstet Gynecol 1984; 63:543.
  14. Peterson WF, Berry FN, Grace MR, Gulbranson CL. Second-trimester abortion by dilatation and evacuation: an analysis of 11,747 cases. Obstet Gynecol 1983; 62:185.
  15. Strauss LT, Gamble SB, Parker WY, et al. Abortion surveillance--United States, 2004. MMWR Surveill Summ 2007; 56:1.
  16. Tietze C, Henshaw SK. Induced abortion: a world review, 3rd ed, Alan Guttmacher Institute, New York 1986.
  17. Grimes DA, Smith MS, Witham AD. Mifepristone and misoprostol versus dilation and evacuation for midtrimester abortion: a pilot randomised controlled trial. BJOG 2004; 111:148.
  18. Kelly T, Suddes J, Howel D, et al. Comparing medical versus surgical termination of pregnancy at 13-20 weeks of gestation: a randomised controlled trial. BJOG 2010; 117:1512.
  19. Cowett AA, Golub RM, Grobman WA. Cost-effectiveness of dilation and evacuation versus the induction of labor for second-trimester pregnancy termination. Am J Obstet Gynecol 2006; 194:768.
  20. Freeman EW. Abortion: subjective attitudes and feelings. Fam Plann Perspect 1978; 10:150.
  21. Rooks JB, Cates W Jr. Abortion methods: morbidity, costs and emotional impact. 3. Emotional impact of D&E vs. instillation. Fam Plann Perspect 1977; 9:276.
  22. Kaltreider NB, Goldsmith S, Margolis AJ. The impact of midtrimester abortion techniques on patients and staff. Am J Obstet Gynecol 1979; 135:235.
  23. Kerns J, Steinauer J. Management of postabortion hemorrhage: release date November 2012 SFP Guideline #20131. Contraception 2013; 87:331.
  24. Niinimäki M, Suhonen S, Mentula M, et al. Comparison of rates of adverse events in adolescent and adult women undergoing medical abortion: population register based study. BMJ 2011; 342:d2111.
  25. Thonneau P, Poirel H, Fougeyrollas B, et al. A comparative analysis of fall in haemoglobin following abortions conducted by mifepristone (600 mg) and vacuum aspiration. Hum Reprod 1995; 10:1512.
  26. Edlow AG, Hou MY, Maurer R, et al. Uterine evacuation for second-trimester fetal death and maternal morbidity. Obstet Gynecol 2011; 117:307.
  27. Clinical Policy Guidelines of the National Abortion Federation, 2013. https://www.prochoice.org/wp-content/uploads/2013NAFCPGsforweb.pdf (Accessed on June 03, 2013).
  28. Espey E, MacIsaac L. Management of unintended and abnormal pregnancy: Comprehensive abortion care, Paul M, Lichtenberg S, Borgatta L, et al (Eds), Wiley-Blackwell, Oxford, London 2003. p.211.
  29. Jurkovic D, Gruboeck K, Tailor A, Nicolaides KH. Ultrasound screening for congenital uterine anomalies. Br J Obstet Gynaecol 1997; 104:1320.
  30. Pennes DR, Bowerman RA, Silver TM, Smith SJ. Failed first trimester pregnancy termination: uterine anomaly as etiologic factor. J Clin Ultrasound 1987; 15:165.
  31. Gürkan Zorlu C, Aral K, Ekici E, et al. Causative factors in first trimester abortion failure. Adv Contracept 1996; 12:63.
  32. Valle RF, Sabbagha RE. Management of first trimester pregnancy termination failures. Obstet Gynecol 1980; 55:625.
  33. Thomas AG, Alvarez M, Friedman F Jr, et al. The effect of placenta previa on blood loss in second-trimester pregnancy termination. Obstet Gynecol 1994; 84:58.
  34. Goyal V. Uterine rupture in second-trimester misoprostol-induced abortion after cesarean delivery: a systematic review. Obstet Gynecol 2009; 113:1117.
  35. Borgatta L, Chen AY, Vragovic O, et al. A randomized clinical trial of the addition of laminaria to misoprostol and hypertonic saline for second-trimester induction abortion. Contraception 2005; 72:358.
  36. Jain JK, Mishell DR Jr. A comparison of misoprostol with and without laminaria tents for induction of second-trimester abortion. Am J Obstet Gynecol 1996; 175:173.
  37. Thong KJ, Baird DT. A study of gemeprost alone, dilapan or mifepristone in combination with gemeprost for the termination of second trimester pregnancy. Contraception 1992; 46:11.