Overview of second-trimester pregnancy termination
- Cassing Hammond, MD
Cassing Hammond, MD
- Associate Professor in Obstetrics & Gynecology
- Northwestern University
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 .
Second-trimester abortion is associated with more morbidity and mortality and, for some women, more social or emotional challenges than first-trimester abortion . 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 . The mortality risk increases by 38 percent for each successive gestational week after eight weeks .
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 .
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.
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- PROCEDURE PLANNING
- Indications and contraindications
- Preoperative evaluation
- Counseling and informed consent
- CHOOSING DILATION AND EVACUATION VERSUS INDUCTION TERMINATION
- Advantages and disadvantages
- - Dilation and evacuation
- - Induction abortion
- Procedure setting
- ABORTION TECHNIQUES AND PROTOCOLS
- Dilation and evacuation
- Induction abortion
- SPECIAL CIRCUMSTANCES
- Uterine anomaly
- Low-lying placenta
- Prior uterine scar
- Multifetal gestation
- Fetal anomaly or fetal demise
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS