Second-trimester pregnancy termination: Induction (medication) termination
- Cassing Hammond, MD
Cassing Hammond, MD
- Associate Professor in Obstetrics & Gynecology
- Northwestern University
Second-trimester (14 to <28 weeks of gestation) pregnancy terminations comprise 10 to 15 percent of the approximately 42 million abortions performed annually worldwide . 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 .
Induction abortion (also referred to as medication or medical abortion) is performed by inducing labor with medications. Women have historically relied upon a variety of herbal and other substances to stimulate labor to abort an undesired pregnancy. Women may choose medication abortion if they prefer more awareness of the termination process, if they prefer an intact fetus, or they want to avoid surgery. An intact fetus may be desirable if the patient desires to hold the fetus or, in cases of fetal anomalies, if an intact fetus is beneficial for a morphologic evaluation. In some healthcare settings, there is more access to second-trimester induction abortion than surgical abortion.
Second-trimester induction termination is reviewed here. An overview of second-trimester pregnancy termination and the technique for surgical abortion are discussed separately. First trimester medication abortion is also discussed separately. (See "Overview of second-trimester pregnancy termination" and "First-trimester medication abortion (termination of pregnancy)".)
Women desiring second-trimester induction termination require preoperative evaluation to establish gestational age, assess general medical status, and identify any medical factors that may impact the choice of induction versus surgical termination. Many of the medical factors favoring medical abortion are "provider-dependent" in that they derive from a specific provider’s skill in a particular situation.
Choice of procedure is discussed in detail separately. (See "Overview of second-trimester pregnancy termination", section on 'Choosing dilation and evacuation versus induction termination'.)
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- PREPROCEDURE PREPARATION
- Prophylactic antibiotics
- Cervical preparation
- Induced fetal demise
- Type of prostaglandin
- Route and regimen
- - Use of mifepristone
- Medical society protocols
- Use of other medications
- OUTCOME AND COMPLICATIONS
- Incomplete abortion
- Retained placenta
- Uterine rupture
- Cervical laceration
- Other complications
- SPECIAL CIRCUMSTANCES
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS