Treatment Overview
Starting (inducing) labor and delivery in the
second or third
trimester of a pregnancy is done using medicines. To
prevent complications, the cervix may be slowly opened (dilated) with a device
called a
cervical (osmotic) dilator before the induction is
started. Medicines to start early labor can be:
- Injected into the
amniotic sac surrounding the fetus (instillation) or injected into the fetus. Substances injected
include salt water (saline), digoxin, or potassium chloride.
- Inserted into the vagina to start uterine contractions
and soften the cervix. This allows uterine contents to pass through the
cervix. Vaginal medicines include prostaglandins, such as
misoprostol.
- Injected into a vein (intravenously,
or IV) to start uterine contractions. Oxytocin (Pitocin) is commonly used for
this purpose.
The different medicines available for an
induction abortion may be combined for effectiveness and to decrease the amount
of bleeding.
An induction abortion does cause you to go through
the stages of labor and delivery. Pain medicines can be used during the
procedure.
What To Expect After Treatment
As your body returns to its nonpregnant
condition, there are changes you can expect during the days and weeks after the
procedure. Normal recovery includes:
- Irregular bleeding or spotting for the first 2
weeks. During the first week, avoid tampon use and use only pads.
- Cramps similar to menstrual cramps, which may be present for
several hours and possibly for a few days as the uterus shrinks back to its
nonpregnant size.
- Emotional reactions for 2 to 3
weeks.
After the procedure:
- Antibiotics may be given to prevent
infection.
- Rest quietly for the next several days. You can return
to your normal activities based on how you feel.
- Ask your doctor if you can take acetaminophen
(such as Tylenol) or ibuprofen (such as Advil). They may help relieve cramping
pain. Be safe with medicines. Read and follow all instructions on the label.
- Do not have sexual intercourse for at least 1 week, or
longer, as advised by your doctor.
- When you start having
intercourse again, use birth control. And use condoms to prevent infection. For more information, see
the topic
Birth Control.
Why It Is Done
Abortions in the second or third
trimester are usually done because of a medical problem or illness present in
the fetus or the pregnant woman.
How Well It Works
Induction abortion is effective in
the second and third trimesters.
Dilation and evacuation (D&E)
is more commonly used in second-trimester abortions. It is safer,
quicker, and more effective than induction abortion.
Risks
Risks of induction abortion by injecting
medicines into the amniotic sac include:
- An accidental injection of saline or other
medicines into the mother's bloodstream.
- Possible damage to the
uterus during the injection
procedure.
- Infection.
- Excessive bleeding
(hemorrhage).
Risks of induction abortion by inserting medicines into the
vagina include:
- Excessive bleeding.
- Excessive
uterine contractions and pain.
- Uterine rupture if a uterine scar is
present from a previous surgery (rare).
Risks of injecting medicine into a vein
(IV) include:
- Excessive bleeding.
- Excessive
uterine contractions and pain.
- Failure to end the pregnancy.
What To Think About
Induction abortions must be done
in a hospital so that you can be monitored during the entire procedure. Less
than 1% of therapeutic abortions in the United States use an induction method.
Induction abortions may be used more in other countries around the world where
skilled health professionals are not available or trained to perform D&E
procedures.
An induction abortion that is done because of fetal
abnormalities might include time after the procedure for the parents to be with
their child. With an induction abortion, genetic testing and an
autopsy can also be done.
An abortion is
unlikely to affect your fertility. So it is possible to become pregnant in the
weeks right after the procedure. Avoid sexual intercourse until your body has
fully recovered, for at least 1 week or as advised by your doctor. When you do
start having intercourse again, use birth control. And use condoms to prevent
infection.
Counseling for a second-trimester abortion may be more
involved than for an early abortion because of the length of the pregnancy and
the reason for the abortion. If you have continuing
emotional reactions after an abortion, seek counseling
from a grief counselor or other licensed mental health professional.
Depression can be triggered when pregnancy hormones
change after an abortion. If you have more than 2 weeks of symptoms of
depression, such as fatigue, sleep or appetite change, or feelings of sadness,
emptiness, anxiety, or irritability, see your doctor about treatment.
Complete the special treatment information form (PDF)(What is a PDF document?) to help you understand this treatment.
Credits
ByHealthwise Staff
Primary Medical ReviewerSarah Marshall, MD - Family Medicine
Kathleen Romito, MD - Family Medicine
Adam Husney, MD - Family Medicine
E. Gregory Thompson, MD - Internal Medicine
Specialist Medical ReviewerRebecca H. Allen, MD, MPH - Obstetrics and Gynecology
Kirtly Jones, MD - Obstetrics and Gynecology
Current as ofMarch 16, 2017