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Overview of second-trimester pregnancy termination

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

INTRODUCTION

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 7.0 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 terminations [4]. Legal induced abortion is rarely associated with death; in 2008, there were only 12 deaths associated with the over 800,000 abortions reported to the CDC [3,5], but the mortality risk increases by 38 percent for each successive gestational week after eight weeks [6].

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".)

PROCEDURE PLANNING

Indications and contraindications — Women terminate pregnancies in the second-trimester for many reasons. Elective 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 [7].

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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Literature review current through: Nov 2016. | This topic last updated: Tue Nov 17 00:00:00 GMT+00:00 2015.
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