Victoria, BC

Tillicum Medical Clinic

Abortion - Surgical Second Trimester

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Second trimester surgical abortion is performed for elective abortion, miscarriage management and for pregnancy termination due to fetal anomalies and maternal health conditions.

During the second trimester of pregnancy, 14 to 22 weeks since your last menstrual period, abortions are performed as two-day outpatient procedures, known as dilation and evacuation (D&E).

Second trimester surgical abortion is one of the safest medical procedures. Although rare, possible complications include:

  • A blood clot in the uterus that can cause pain or require a repeat aspiration
  • Infection, which is generally easily identified and treated
  • A tear in the cervix that can be easily repaired with suture
  • Perforation
  • Retained pregnancy tissue requiring repeat aspiration
  • Excessive bleeding requiring a transfusion

Complications from a surgical abortion are considerably less frequent and less serious than those associated with giving birth.

On the first day, you'll meet a health educator and doctor to prepare for the procedure. This visit will take about 2.5 hours. The next day, you'll meet the doctor at the hospital. This visit will take about four to five hours. In some cases, the procedure can be performed in one day for pregnancies 18 weeks or less, depending on the circumstance.

Cervical softening and dilating is performed with medication and small dilating sticks, called laminaria or Dilapan, that may be placed in the cervix, depending on the term of the pregnancy and your medical history. Laminaria are thin sticks made from a special seaweed material that widen as they absorb moisture from your body. Dilapan are synthetic sticks that work in the same way. The laminaria will stay in your cervix overnight and prepare your body for the next day's surgical procedure.

The day before the surgery, you will learn about your procedure, undergo an exam and ultrasound, and receive oral medications that may include a pain reliever and anti-anxiety medication for relaxation, if laminaria is required for overnight dilation. If you're given medications, it's important that you follow the instructions provided by your doctor.

During the laminaria insertion, you'll be awake. If someone accompanies you, he or she can remain in the exam room, if you wish. The doctor will:

  • Place a speculum to view inside your vagina.
  • Clean the cervix with gauze soaked in soap.
  • Apply numbing medication (local anesthesia) to the cervix.
  • Insert laminaria (or Dilapan) into your cervix, the opening to the uterus. The laminaria insertion takes about five to 10 minutes.

After the procedure, you will rest for a few minutes. You may experience cramping and spotting. You will receive detailed instructions on how to take care of your body overnight and how to prepare for the next day's procedure.

Someone must drive you home if you take anti-anxiety medications. Rest at home until the medications wear off. Don't eat or drink after midnight.

The next day, you'll check-in at the hospital, then go to the pre-operative area, where you'll meet your doctor.

Medication will be administered intravenously (IV) in your arm to induce anesthesia or loss of consciousness. Most women fall asleep and don't remember the procedure. After you're well relaxed, the doctor will remove the laminaria and use suction and gynecological instruments to empty your uterus, with ultrasound guidance. You'll be in the operating room for about an hour but the procedure may take from 15 to 45 minutes.

In the recovery room, nurses will monitor you for about two hours. You may have some cramping and spotting. Before you return home, you'll receive antibiotics to prevent infection and instructions for post-surgery care. The procedure and recovery period at the hospital takes about five hours in total.

Because of medications administered, you shouldn't drive until the medications wear off. Please make arrangements ahead of time for someone to take you home directly.

You can expect to return to normal activities, such as work and school, the next day.