What Are Late Term Abortions?
There is no medical term that defines what a late term abortion is. Only 1.3% of abortions are performed at 21.3 weeks or further. This happens to be just below the lower edge of fetal viability.
Fetal Viability (fetus able to live outside the womb) is not defined by a specific number of weeks. Viability must be evaluated on an individual basis. The range may be 22 to 28 weeks. It must be understood that infants at 30 to 40 weeks may not be viable.
Abortions being performed from 22 weeks or further should ensure fetal demise prior to beginning the abortion procedure whether the surgical or a medical abortion pill procedure.
For our definition of late term abortion, we are using the arbitrary number of 21.3 weeks pregnant because of the lower edge of fetal viability.
Late Term Abortion Methods
There are two methods of how Late Term Abortions can be performed:
- Medical Abortion using the Late Term Abortion Pill
- Surgical Dilation and Evacuation (D&E)
Late Term Abortion Pills:
The Late Term Medication Abortion Method uses the combination of two pills.
The first pill is Mifepristone (RU 486, Mifegyne, Mifeprex, Early Options, French Pill). The second pill is Misoprostol (Cytotec).
The Late Term Medications have been used to perform second trimester and late term abortions since the late 80’s in several European Countries (Sweden and other Norwegian Countries, France). It quickly spread to China, India and other Asian Countries.
The procedure was found to be highly efficient, safe with minimal complications and side effects.
How Far Can Abortions Be Performed Utilizing The Medical Abortion Pill Process?
The Late Term Medication can be used throughout the second trimester (14.1 to 28 weeks) and the third trimester of pregnancy 28.1 weeks or further.
There are several Late Term Abortion Pill Clinics that perform abortions up to 24, 26, 28, 30 weeks or further if there are maternal or fetal medical indications.
How Does Late Term Abortion Work?
Mifepristone works by blocking the hormone Progesterone from binding to its receptors on the Uterus. This causes the following to occur:
- Increase of pressure inside the Uterine (womb) cavity
- Breakdown of the lining of the Uterus which leads to increased production of Prostaglandins
- Softening and opening of the Cervix (opening at the lower portion of the Uterus
The combination of above leads to Uterine contractions, internal production of prostaglandins and Vaginal bleeding.
Approximately 0.5 to 1% of women may go in active labor and delivery of the fetus with within 24 hours taking Mifepristone alone.
Misoprostol is a Prostaglandin E1 tablet. It binds to the Prostaglandin receptors on the Uterus and leads to Uterine contractions and vaginal bleeding. This leads to the pregnancy tissue being expelled.
Performing Late Term Abortions Utilizing Surgical Dilation and Evacuation Procedure:
Second Trimester Surgical abortions are responsible for ⅔ of the maternal morbidity and mortality around the World.
Late Term Abortion Clinics use the most advanced abortion surgical instruments, medications and techniques have reduced the maternal morbidity and death rate to less than 0.05%.
Cervical Preparation (Ripening, Priming) For In-Clinic Second Trimester And Late Term Abortion:
The most important step to be performed when undergoing the in-clinic second trimester and late term abortion surgical procedure is assuring the Cervix is adequately primed. If not, there is the increased risk of a Incompetent Cervix.
An incompetent cervix is due to using abortion instruments to force open the firm and closed cervix.
A incompetent cervix is where the cervical tissue becomes weak and may lead to problems with future pregnancies. This may include:
- Spontaneous abortions between 15 to 22 weeks
- Premature births
- Low birth weight
Priming of the Cervix is the use of medications that adequately soften and dilate (open) the cervix in order to safely remove the fetus and placenta (after birth) with minimal complications or side effects. The side effects associated with the surgical abortion procedure are the following:
- Cervical tears and lacerations
- Damage to the bowel or bladder
- Uterine perforation (puncture of the wall)
- Heavy vaginal bleeding
- Retained pregnancy tissue
- Uterine Infection
- Endometritis
- Pelvic Inflammatory Disease
- Severe Sepsis (Bacteria in the blood)
- Maternal Death
The medications used for Cervical Priming are 1) Laminaria and 2) Misoprostol.
Laminaria is sterile seaweed that is shaped in the form and length of a matchstick. When inserted inside the cervix, it absorbs water similar to a sponge. The Laminaria slowly enlarges symmetrically. This slowly softens and opens the Cervix.
Cervical priming with Laminaria may take 2 to 4 days to accomplish adequate opening of the cervix in order for the surgical procedure to be carried out in a safe manner.
The patients will need to return to the office every day and at times twice daily in order to remove and reinsert new Laminaria until sufficient dilation of the Cervix is accomplished.
Misoprostol tablets can be inserted vaginally or placed between the cheek and gum (buccally) or underneath the tongue (sublingually).
Misoprostol causes Uterine contractions with softening and opening of the Cervix.
In Summary;
Abortion Clinic Late Term facilities in the US are able to perform in-clinic and outpatient Second Trimester and Late Term Abortions using the Abortion Pill or Surgical Methods. At this point, those seeking late term abortions can receive the customized attention and support they need from Orlando Women’s Center.
