Understanding Late-Term Abortions: Recovery, Duration, Cost, Complications, and Aftercare

Abortion taking place during the second trimester (week 13 to 27) or third trimester (week 28 onwards) of gestational age is referred to as “late-term abortion.”

Around 6% abortions were reported in 2019 that took place between the 14th and 20th weeks of pregnancy ⁽¹⁾.  Abortions taking place later in pregnancy is referred to as “late-term;” however, this phrase is medically incorrect.

Normal pregnancy lasts for 40 weeks ^{(2, 3)}. So, a “late-term” or “post term” pregnancy is one which has gone past 41 weeks of gestation ⁽⁴⁾, which means that childbirth has already taken place making the term “late-term abortion” incorrect.

Surgical abortion is done for women who want to end their pregnancy in their second or third trimester ⁽⁵⁾. This procedure is known as dilation and evacuation (D&E) and can be done on an outpatient basis ⁽⁵⁾.

In this procedure, the cervix needs to be softened and dilated first and this can be started a day before the actual D&E. After cleaning the cervix, the doctor will apply a local anesthetic and insert a dilating stick into the cervical canal to absorb the moisture and dilate the cervix. Misoprostol is a drug that can be given to the patient to prepare the cervix for this procedure.

Before starting D&E, the patient can be given general anesthesia or intravenous sedation to relax or sleep through the procedure. A first dose of antibiotic is also given to prevent infection.

The dilating stick is then removed and the uterus is scraped using a curette, which is a sharp-tip instrument. Vacuum suction along with other surgical instruments may be used to remove the fetus and placenta. This procedure is most likely done under ultrasound guidance for better visualization and complete removal. The average time taken to complete this procedure is about 30 minutes.

Dilation and evacuation done in second-trimester is thought to be safe and effective; however, there can be some potential complications ⁽⁵⁾, which are discussed below.

The average cost of dilation and evacuation done in first trimester is around $800 with the cost going up in second-trimester abortions ⁽⁶⁾. The cost is more if this procedure is done in a hospital when compared to a clinic. There are some health insurance policies, which can partially or completely cover abortion and some which do not.  In case if the insurance is not covering this procedure or if the patient is not having any insurance, there are other options for financial assistance in the form of organizations that help the patient fund this procedure. Please visit the National Network of Abortion Funds to know more.

The patient will have in-depth consultation with their doctor to discuss the following before undergoing dilation and evacuation ⁽⁵⁾:

• What the procedure entails is discussed in details so the patient completely understands it.
• The patient’s general health, including any preexisting medical issues.
• Whether the patient is taking any medications that need to be stopped before this procedure.
• Sometimes, the patient may need to visit their doctor a day before the procedure to start the process of dilating the cervix.
• The doctor will guide you as to pre and post abortion instructions.

It is also advised to do these things beforehand:

• Make sure you have someone to drive you home after the abortion.
• Always keep a sufficient supply of sanitary pads with you, as you won’t be able to use tampons after getting the abortion.
• Discuss with your doctor your birth control options.

The patient will be kept under observation for some hours to see if there is heavy bleeding or other complications. There may be some spotting and cramping.

After the patient is discharged, antibiotics are given to prevent infection and painkillers are given to relieve the pain. The patient is advised to not take aspirin or any medications with aspirin in them as it will increase the bleeding.

The recovery time post late term abortion can differ from patient to patient, so take adequate rest and follow your doctor’s instructions with regards to when to resume daily activities. Avoid heavy lifting or any heavy work, as it can increase the cramping and bleeding. Also, it is advised to take few days off work/ studies etc., to heal completely. 

Some of the common side effects of late term abortion are ⁽⁵⁾:

• Nausea can be felt in the initial couple of days.
• Cramping is likely to occur after third day after the procedure.
• There can be breast tenderness or tenderness in the chest region.
• There is light to heavy bleeding for 15 days to a month. Make sure to inform your doctor if you are soaking through more than two large sanitary pads in an hour for 2 or more hours consecutively.
• In case of low grade fever and if it is more than 100.4°F (38°C), then please consult your health care provider.
• If there are clots, which are bigger in size than the lemon then immediately seek medical attention.

After getting dilatation and evacuation, the body starts to prepare for ovulation and one can expect their first period post D&E about a month or two after the procedure (5). The patient can have commencement of their regular cycle in a month or so, or it can also take many months before the periods return to the way they were before. In case of some patients, periods can be lighter, irregular or heavier than previously before the late term abortion. Tampons are not advised to be used for a week after the procedure, as it carries the risk of infection.

No, the fertility is not affected after getting the procedure for late term abortion and the patient can get pregnant soon after getting D&E, even if there has been no period. So, it is advised to discuss birth control options at the time of getting the procedure with your health care provider.

Penetrative vaginal sex is to be avoided for some time till the bleeding stops, so the body can heal and to prevent infection.

Any type of surgical procedure carries potential complications and in case of D&E it is the same.  Some of the potential complications with late term abortion are:  excessive bleeding, allergic reaction to medications; severe pain and cramping; perforation or laceration of the uterus; larger blood clots; and cervical incompetence in pregnancies in future.

Infection in the uterus or fallopian tubes is another risk of D&E and the patient needs to seek medical attention if there is fever above 100.4°F (38°C), acute abdominal and pelvic pain; chills and strong-smelling discharge.

One should avoid the use of the following after getting D&E: douching, tampons, penetrative vaginal sex, swimming pools; baths and hot tubs. Shower instead of taking baths.

Every patient feels different kind of emotions after going through an abortion or terminating a pregnancy. Patient can experience a gamut of emotions, such as depression, sadness, even feelings of relief and a sense of loss. The hormonal fluctuations are also responsible for all these kind of emotions. If there are continuous feelings of depression or sadness, then it is advised to talk to your doctor or counselor about your feelings. People who are available for helping you navigate through different emotions are your gynecologist, clinic worker, general practitioner or hospital advocate who can refer you to appropriate support group or a mental health counselor.

References:

Also Read:

• How to Take Care of Yourself After Abortion?
• Risks of Home Remedies for Abortion
• 4 Different Types of Abortion
• What is Post-Abortion Syndrome?
• How to Care for Yourself Post Abortion?
• Signs of Womb Damage After an Abortion : Risks and Treatment