Abortion Service in Botswana

Second Trimester Abortion

It is common for women to have an abortion performed in the first trimester of pregnancy. There are numerous reasons that second trimester abortion procedures occur. Some of them include the following:

1. Unaware that she was pregnant
2. Can’t afford a child
3. In school or have a job that prevents the patient from having a child
4. Threat to the mother’s life or health

A woman choosing to have a second trimester abortion has greater challenges when it comes to her health during and after the abortion is performed. There is approximately 1:100,000 chance of maternal death when undergoing an abortion in the first trimester of pregnancy. Second trimester abortions have a higher chance of complications and risks than when an abortion is performed in the first trimester. There are fewer abortion clinics that provide second trimester abortions. Second trimester abortions are more expensive than first trimester abortions. Second trimester abortions have significantly decreased since the mid-seventies due to earlier diagnosis of pregnancy.

What is second trimester abortion?

The second trimester pregnancy starts from the 13th to the 26th week of pregnancy. Fetal abnormalities and the mother’s life being affected to the pregnancy do not commonly present themselves until the second trimester of pregnancy.

The most common abortion procedure performed in the second trimester of pregnancy is the surgical Dilation and Evacuation (D&E). This is normally a two day procedure which begins with cervical softening and opening with the use of medications or placement of Laminaria into the cervix. The Laminaria is sterile seaweed which acts like a sponge by absorbing water from the cervix. They normally remain in place over night. The surgery involves Dilation of the cervix with serial Dilators and removal of the pregnancy using special surgical instruments.

How is a D&E performed?

An ultrasound scan is performed to determine the gestational age of the fetus after the cervical preparation is performed as described above. It can take from a few hours to several days to get adequate dilation of the cervix. The cervix is anesthetized with lidocaine. IV Sedation or General anesthesia may be given to reduce discomfort. Surgical instruments like forceps are used successfully to remove the intra-uterine contents.

The complication rate is greater when performing a second trimester abortion procedure. Thus it is very important in having a Physician with many years of experience perform the procedure which reduces the chance of harm to the patients health.

Some of the complications and risks associated with second trimester abortions and D&E procedures are the following:

1. There is a greater chance of uterine perforation even if the procedure is not done with great care.

2. There is higher chance of uterine infection, particularly if the patient has an STD and has not been treated for it.

3. Bleeding or hemorrhage can occur due to cervical tears, uterine rupture or perforation, or damage to the bladder, bowel or other internal organs.

4. There is also the possibility of retained pregnancy tissue that may lead to bleeding, lower abdominal pain, back pain and uterine cramps. Endometritis and uterine infections may lead to maternal sepsis (bacteria in blood stream) which on rare occasions has lead to maternal death.

5. The cervical os (opening of the cervix) may become blocked by some of the pregnancy tissue at times which may lead to build up of blood within the uterus causing severe lower abdominal pain and discomfort along with nausea, vomiting and uterine infection. A surgical D&C is commonly performed to alleviate the patients symptoms and treat the problem.

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