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, which allows uterine contents to pass through the cervix. Vaginal medicines include the prostaglandins dinoprostone and 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.
• Acetaminophen (such as Tylenol) or ibuprofen (such as Advil) can help relieve cramping pain.
• 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 immediately effective birth control, you can use a barrier method (such as a diaphragm, cervical cap, or condom). A copper intrauterine device (IUD) is effective immediately after it is placed in the uterus. If you start hormone birth control pills, patches, or injections right after the procedure, be sure to use a backup method until the hormone medicine becomes effective. 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, because 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.
• Decreased effectiveness in ending 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.

The hospital or surgery center may send you instructions on how to get ready for your surgery. Or a nurse may call you with instructions before your surgery.

Right after surgery, you will be taken to a recovery area where nurses will care for and observe you. You will probably stay in the recovery area for a period of time and then you will go home. In addition to any special instructions from your doctor, your nurse will explain information to help you in your recovery. You will go home with a page of care instructions including who to contact if a problem arises.

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