Name of the Procedure:

Induced Abortion, 17 to 24 Weeks
Common name(s): Second-trimester abortion
Technical/Medical term: Surgical Termination of Pregnancy between 17 and 24 Weeks

Summary

Induced abortion between 17 and 24 weeks is a medical procedure to terminate a pregnancy during the second trimester. This process involves the removal of the fetus and placenta from the uterus using surgical methods.

Purpose

This procedure addresses the medical, psychological, or social needs of a woman who chooses to terminate a pregnancy during the second trimester.
Goals/expected outcomes: Safe termination of pregnancy; prevention of complications associated with carrying an unwanted pregnancy to term.

Indications

• Severe fetal abnormalities or malformations diagnosed in the second trimester
• Life-threatening or significant health risks to the pregnant woman
• Pregnancy resulting from rape or incest
• Personal or socio-economic reasons
• Complications in the first-trimester treatment

Preparation

• Fasting: Patients usually must fast for 6-8 hours before the procedure.
• Medication adjustments: Patients may need to stop or adjust certain medications.
• Diagnostic tests: Ultrasound to confirm gestational age, blood tests to check hemoglobin levels and screen for infections.

Procedure Description

1. Arrival and Consent: Patient arrives at the healthcare facility, signs informed consent forms.
2. Anesthesia: Administration of local anesthesia, general anesthesia, or intravenous sedation.
3. Dilation: Gradual dilation of the cervix using medications or mechanical dilators, which may take several hours or be done a day prior.
4. Evacuation: Surgical removal of the fetus and placenta using methods like dilation and evacuation (D&E), which involves the use of suction and surgical instruments.
5. Post-Procedure Care: Monitoring vital signs and ensuring stable condition before discharge.

Tools/Equipment: Suction device, forceps, curette, speculum, ultrasound. Anesthesia: Local anesthesia, general anesthesia, or intravenous sedation as needed.

Duration

Typically, the procedure takes 15-30 minutes, but pre-procedure dilation can take several hours to a day.

Setting

Performed in a hospital, specialized outpatient clinic, or surgical center.

Personnel

• Obstetrician/Gynecologist or specialized surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurse
• Support staff for pre- and post-operative care

Risks and Complications

• Common risks: Bleeding, cramping, infection
• Rare risks: Uterine perforation, damage to other internal organs, adverse reaction to anesthesia
• Management: Prompt medical or surgical intervention, antibiotics for infections, blood transfusion if necessary

Benefits

• Safe termination of an unwanted pregnancy
• Relief from psychological or physiological stress
• Prevention of complications associated with carrying the pregnancy to term Expected to be realized immediately after the procedure, with emotional and physical recovery varying by individual.

Recovery

• Post-procedure: Observation for a few hours, pain management, and comprehensive post-procedure instructions
• Estimated recovery time: 1-2 weeks
• Restrictions: Avoidance of heavy lifting, sexual intercourse, and certain physical activities for a specified period
• Follow-up: Scheduled appointment within 1-2 weeks for check-up

Alternatives

• Medical abortion: Use of medications to terminate the pregnancy; typically more suited for earlier gestations.
• Expectant management: In rare cases, the decision to continue monitoring the pregnancy. Pros and cons: Medical abortion may have a longer process and more bleeding; surgical abortion is quicker but involves anesthesia and surgical risks.

Patient Experience

During the procedure: Sedation or anesthesia will minimize pain; some discomfort and cramping expected. After the procedure: Cramping and bleeding similar to a menstrual period; pain management provided with medications. Comfort measures: Emotional support, hot packs, prescribed pain relief, rest, and addressing any concerns with healthcare providers.