ABORTION 20-24 WEEKS GESTATION - Second Trimester

3 Day Procedure with General Anesthesia

Pregnancies in the later part of the second trimester require more dilation for a safe procedure. 

Between 20 and 24 weeks, the entire process takes 3 consecutive days to safely and slowly dilate the cervix.  In this situation, the first day consists of ultrasound, counseling and lab work.  There is an exam with the doctor, during which cervical dilators called laminaria are inserted into the cervical opening.  How many depends on gestation. 

There are no medications for this process.  It usually takes about 2-5 minutes and may cause mild menstrual-style cramping during insertion. 

Each patient is then sent home with a prescription for narcotic pain medication and information regarding her appointment the following day, when the first set of laminaria are removed and a second set are inserted for further dilation. 

This appointment is late morning and generally takes 60-90 minutes. Again, the patient is sent home, this time given information regarding her surgery appointment, the next day, where both the laminaria and pregnancy are removed under general anesthesia.  The surgery appointment is usually early in the morning and may take 2-3 hours.

Manual Aspiration/Menstrual Extraction

This procedure is performed from 5-10 weeks gestation and is done at the discretion of the physician.

Each procedure can be done in one visit, with either local or general anesthesia. 

A follow-up visit 2 weeks later is recommended.

• Rest
• Use a heating pad
• Try a uterine massage: pressing from your belly-button down to your pelvic bone for 10 to 15 minute intervals will often help.
• Use pain relievers given and/or prescribed by your physician.  Take as directed.

Clotting
It is common to pass small clots (up to the size of an silver dollar) after an abortion; and for increased cramping when passing clots.

Bleeding and Discharge

• Normal bleeding can range from none to moderate menstrual-style bleeding, and can be off and on until you have your next period.  This bleeding is not your period.  This is post-abortion bleeding and it is normal.
• Your first period can be expected 4-6 weeks after your abortion.  It may be heavier or lighter than your usual period.
• Heavier bleeding 3-7 days after your procedure can be normal, as can no bleeding at all.
• Vaginal discharge may be anything from clear, brown-tinged, dark brown or black in color.
• Always worry about too much, never worry about too little.

Symptoms you should watch out for:

Should you experience any of the following symptoms, CALL LOVEJOY IMMEDIATELY

• bleeding through two full size pads, front to back, each hour for 2 hours straight.
• passing two (2) or more blood clots larger than a 50 cent piece accompanied by strong cramping and bleeding.
• extreme cramping that is not relieved by Ibuprofen or Vicodin.
• a temperature of 100.4 or greater.
• you have not had a period for 4 weeks or more after your procedure.

During office hours
Monday-Friday | 8:00 AM to 5:00 PM
Saturday | 8:00 AM to 12:00 NOON
(503) 221-1870 or (800) 752-6189

After hours medical emergencies only: (503) 294-3088

If possible, call Lovejoy first before seeking care elsewhere.  We will evaluate the problem and provide you with care at our health center if necessary at no additional cost, or help you get medical care elsewhere (at your own expense).

Nausea usually goes away in 24 hours

Breast tenderness usually goes away in 2-7 days.  If you are lactating, leaking fluid from the breast, or they are hard & engorged:

• Wear a supportive bra
• Avoid breast stimulation
• Avoid hot pads and warm water
• Use a cold pack

The pregnancy hormones can take 3-6 weeks to leave your body so do not take a pregnancy test; it could still show positive.  The best way to know you are no longer pregnant is to return for a 2 week check up.

How to prevent infection:

Take all your antibiotics as directed.

You may want to check you temperature for a few days following your procedure.  Call us immediately if your have a fever at or above 100.4.

Do not:

• put anything in your vagina for 1 week;
• except Nuva Ring or prescribed medications
• have sex for 1 week
• use tampons for 3 days
• swim, tub bathe, or douche for 3 days

Activity restrictions:

Do not lifting over 20 pounds the 3 days following your abortion.

Avoid strenuous exercise in the weeks following your abortion; including aerobics, jogging, hiking and other regular exercise, may cause heavier bleeding and cramping.

General Anesthesia Patients
It is a good idea to rest the first 24 hours after your procedure.
Start eating slowly with clear fluids before eating solid foods.
You should not drive until the day after your procedure.

Local Anesthesia Patients
You should not drive for 12 hours after your procedure.
You may return to work, school & normal activities the day after your procedure.

Birth Control:

An abortion does not affect your fertility or ability to get pregnant.  You can become pregnancy as soon as the evening of your abortion if you are not using birth control.  If you choose to start birth control, you should begin it the first Sunday after your procedure, or as directed by your physician.  Your after care packet will include 1 or 2 samples (should we have them on hand), a prescription for more and a birth control info sheet noting the day birth control should be started.  You can fill your prescription at any pharmacy, and see you primary care physician or gynecologist for more.  Be sure to use a back-up method the first month you are on birth control.

Your follow-up visit:

We recommend a check-up 2 weeks after your procedure to ensure that you are no longer pregnant.  There is no charge in our office for this appointment, and it usually takes 30-60 minutes if you are on time.  The appointment includes an exam to confirm your uterus is back to non-pregnant size and, in some cases, may include a vaginal ultrasound.   You should call our office to schedule.  Appointments are available most Tuesdays, Thursdays and Saturdays