You will see that there is overlap in the different methods that can be used at the different stages of later term abortions. Each woman will discuss her options with her doctor, who will take her medical circumstances into account.
Medical induction (induced miscarriage)*
When: 13-24 weeks
Where: Clinic / Hospital. Up to two nights’ stay, depending on gestation.
What happens: The patient is under local anaesthetic to reduce pain. The heart of the fetus is stopped. A combination of hormones is used to soften the cervix, cause contractions and bring on labour. Contractions can last 6-12 hours. The next day the doctor checks the abortion is complete. If not, the patient will be given a local anaesthetic and any remaining tissue will be removed with a small suction pump.
*Mifepristone and prostaglandin, the drugs used for early medical abortion, can also be used for abortion in later pregnancy.
Surgical dilatation & evacuation (D&E)
When: 15-19 weeks
Where: Clinic / Hospital. Usually carried out as a day-care procedure but may require an overnight stay.
What happens: The patient is given general anaesthetic. Before the procedure a pessary may be put in the vagina to relax the cervix. The cervix is eased open (dilated) so that forceps can be used to remove the fetus and the uterus lining (evacuation). After the fetus has been removed the doctor may have to use suction to remove any remaining tissue.
Surgical two-stage abortion
When: 20-24 weeks
Where: Clinic / Hospital. At least one night’s stay.
What happens: The patient is given a general anaesthetic. The heart of the fetus is stopped. A hormone softens the cervix and the tissues of the pregnancy. The next day a dilation and evacuation is performed. The patient can usually leave 4-6 hours after this second procedure.
Abortions after 24 weeks are only performed by the NHS. They are extremely rare, less than 0.1 per cent of the total, and can only be performed if there is:
• risk to the life of the woman,
• evidence of severe fetal abnormality, or
• risk of grave physical and mental injury to the woman.
Methods used are similar to those used between 20 and 24 weeks.
After abortion, at any stage, many women experience some cramping, pain or discomfort which can be eased by painkillers. There will also be some bleeding. The clinic will prescribe antibiotics to prevent infection and the patient will be advised on possible side effects.