Late term abortions ..................
Find a Conversation
|Sat, 06-28-2003 - 11:35am|
20 to 26 Weeks
Four day outpatient procedure
Late second trimester patients receive all of their preoperative evaluation and consultation on the first day of their appointment, and return on the second day for the initial steps of the abortion procedure.
At 20 menstrual weeks and later, the first step in the abortion procedure on the second day of her appointment is an injection of medication into the fetus that will stop the fetal heart instantly. The patient is awake during this procedure, which is done under local anesthesia and with the use of direct ultrasound vision. The woman does not observe the fetus on the ultrasound screen in this process. The injection, done with strict attention to sterile technique, usually takes about ten minutes, although the appointment may take longer because of preparations that must be made.
Following the injection into the fetus, the first laminaria is placed in the cervix. The patient may leave at that time and must stay in Boulder unless arrangements are made for the patient to stay in a neighboring town.
On the third day, the late second trimester patient returns for a brief appointment, at which time the first laminaria is removed and more are placed under local anesthesia. This process permits maximum gentle dilation of the cervix over a two-day period.
On the fourth day, the patient returns for her abortion. Following observation of vital signs (blood pressure, temperature, and pulse), the laminaria are removed and a long-acting local anesthesia is again placed in the cervix. Under direct ultrasound vision, the amniotic membrane is ruptured so as to permit free flow of the amniotic fluid from the uterus. The amniotic fluid is drained as completely as possible. Dr. Hern developed this technique for the following reasons:
Removal of the amniotic fluid reduces if not eliminates the risk of amniotic fluid embolism (AFE), probably the most dangerous possible complication of late abortion.
Release of the amniotic fluid allows the uterus to contract and become firm, reducing the risk of perforation of the uterus with instruments.
Contraction of the uterus reduces blood loss.
Release of the amniotic fluid and contraction of the uterus enhances movement of the fetus and placenta into the cervix, the opening of the uterus, thereby adding safety and reducing discomfort of the procedure.
This maneuver permits the accurate measurement of blood loss, which is usually minimal. However, heavy bleeding may occur in late abortion, and it is absolutely necessary to know accurately the volume of this bleeding in order to guide fluid or blood replacement if this should become necessary.*