Late Term Abortion
Late term abortion means an abortion performed from 14 weeks through 24 weeks. All late term abortions performed by Dr. Robinson will be the dilatation and evacuation technique exclusively. This is an excellent technique that avoids labor and delivery. Most of these late term abortion are painless and completed in 30 minutes or less. Induction of labor and delivery will not be done unless you specifically request this method of late term abortion.
At your visit for a late term abortion procedure, you will complete medical history forms and some lab testing will be conducted. An ultrasound examination will be done to confirm and date your pregnancy. This is very important for the safety of a late term abortion. You will view an educational video about surgical late term abortion and a staff person will answer your questions. Then the doctor will insert laminaria to safely dilate or open the cervix and or use Misoprostol tablets to soften and open the cervix. These measures increase the safety in late term abortions. After the surgical abortion, you will rest at least 30-60 minutes in our recovery area. You will receive instructions on how to care for yourself after the late term abortion. We ask that you return for a follow up examination 2- 3 weeks after the surgical abortion procedure.
Late term abortions are divided into the following:
- Early Second Trimester 14-15 week
- Mid Second Trimester 16-19 weeks
- Late Second Trimester 20-24 weeks
All patients will complete a patient registration form and a comprehensive medical history form. Basic laboratory tests will be performed. These include a urine pregnancy test, hemoglobin (anemia) test, and Rh blood typing. An abdominal ultrasound will be done to determine the length of your pregnancy. Next you will have a preoperative counseling session. We will discuss your situation and your reasons for considering abortion. We will review your medical history, lab and ultrasound results and discuss your particular abortion procedure in detail. We will answer your questions and have you sign consent forms for your procedure. All advanced and late term abortion procedures require the insertion of laminaria and or the use of Misoprostol tablets. Laminaria are small matchstick-sized pieces of sterile seaweed. When these are placed in the cervix they will swell and slowly and safely open the cervix. Misoprostol tablets inserted vaginally will soften and open the cervix to prepare it for surgery. These tablets may also be used by mouth, but must be dissolved in the mouth rather than swallowed. These measures increase the safety in advanced and late term abortions.
Laminaria insertion will be done as follows: You will be placed in the pelvic examination position and we can sedate you if you prefer. A pelvic examination will be performed and a small speculum will be placed in the vagina. The cervix and vagina will be cleansed with betadine or phisohex. The cervix will be anesthetized with a local anesthetic (lidocaine). The laminaria will then be carefully placed in the cervix. If Misoprostol tablets are to be used they will be inserted vaginally and a gauze pad will be placed in the vagina like a tampon. In some cases the tablets may be used without laminaria insertion.
Early Second Trimester (14-15 weeks)
Surgical abortion procedures at 14 to 15 weeks may be completed in one day and can be done in our Dallas office. Laminaria and or Misoprostol tablets are used as described above with the remainder of the procedure as follows: First we place you in a pelvic examination position. We will monitor your blood pressure, pulse and blood oxygen levels during the entire procedure. You will receive the IV sedation (Valium and Nubain). Ninety-five percent of our patients will sleep and have no memory of the procedure. A pelvic examination will be performed and a small speculum will be placed in the vagina. Gauze, laminaria and residual Misoprostol will be removed. The cervix and vagina will be cleansed with betadine or phisohex. The cervix will then be numbed with local anesthetic. A sterile plastic tube will be placed through the cervix into the uterus to vacuum amniotic fluid. Abdominal ultrasound will be used for guidance. A small pair of forceps will be placed inside the uterus and the fetus will be carefully removed. A uterine curette will be used to check the walls of the uterus for complete removal of the placenta. The vacuum will then be repeated. A final post-operative ultrasound will be done to make certain the uterus is empty and the procedure is complete. The procedure will take between 10 to 15 minutes. We will transfer you to our recovery area for observation before discharge.
Mid Second Trimester (16-19 weeks)
Surgical abortion procedures from 16 to 19 weeks usually are a two day process. These procedures must be done in our Ambulatory Surgery Center in San Antonio under general anesthesia. If your abortion procedure is being performed at our San Antonio location it is not necessary that you be seen in the Dallas office. We will review your ultrasound and lab work from your physician or clinic. All of your required forms may be faxed or emailed to our office. Dr. Robinson will visit with you in person or by telephone to answer your questions before your visit to the Ambulatory Surgery Center.
The Mid Second trimester abortion procedure begins the same as the early process. Laminaria insertion will be done on day 1 and your procedure will be completed the following day.
Following Insertion of Laminaria You May:
- Eat and drink normally
- Take a shower, not a tub bath
- Use sanitary pads, not tampons
- Do not place anything into the vagina
- Use Ibuprofen every 4 hours for cramping
Late Second Trimester 20-24 weeks
Procedures from 20 to 24 weeks are a 2-day process and must be done in our Ambulatory Surgery Center in San Antonio under general anesthesia. If your procedure is being performed at our San Antonio location it is not necessary that you be seen in the Dallas office. We will review your ultrasound and lab work from your physician or clinic. All of your required forms may be faxed or emailed to our office. Dr. Robinson will visit with you in person or by telephone to answer your questions before your visit to the Ambulatory Surgery Center. The Late Second Trimester abortion procedure begins with laminaria insertion. On the first day of the abortion, an injection of medication is made into the amniotic fluid surrounding the pregnancy to assure that it will be stillborn and will not experience any discomfort during the procedure. You will be sedated prior to this procedure.
Following the insertion of laminaria you may:
- Eat and drink normally
- Take a shower, not a tub bath
- Use sanitary pads, not tampons
- Do not place anything into the vagina
- Use Ibuprofen every 4 hours for cramping
On the second day, you will be taken to the operating room and put to sleep. The procedure is done by inserting a sterile plastic tube through the cervix into the uterus to vacuum amniotic fluid. Abdominal ultrasound will be used for guidance. A small pair of forceps will be placed inside the uterus and the fetus will be carefully removed. A uterine curette will be used to check the walls of the uterus for complete removal of the placenta. The vacuum will then be repeated. A final post-operative ultrasound will be done to make certain the uterus is empty and the procedure is complete. The procedure will take between 20 to 30 minutes. You will then be awakened and taken to the recovery room for observation.