Second-trimester surgical abortion is performed for elective abortion, miscarriage management and for pregnancy termination due to fetal anomalies and maternal health conditions.
Surgical Abortion (Second Trimester)
During the second trimester, 15 to 23 weeks after your last menstrual period, abortions are typically performed over a two-day period but don't require an overnight stay in the hospital. These procedures are known as dilation and evacuation (D&E).
On the first day, usually a Tuesday, you'll meet a health educator and doctor at the UCSF Women's Options Center to prepare for the procedure. This visit will take about two and a half hours.
The next day, you'll meet the doctor at UCSF Medical Center hospital at Mount Zion. This visit will take about four to five hours. In some cases, the procedure can be performed in one day for pregnancies 18 weeks or less, depending on the circumstances.
Cervical softening and dilating is performed with medication and small dilating sticks, called laminaria or Dilapan, that may be placed in the cervix, depending on the term of the pregnancy and your medical history. Laminaria are thin sticks made from a special seaweed material that widen as they absorb moisture from your body. Dilapan are synthetic sticks that work in the same way. The laminaria will stay in your cervix overnight and prepare your body for the next day's surgical procedure.
Preoperative appointment
In a private exam room, you will learn about your procedure, undergo an exam and ultrasound, and receive oral medications that may include a pain reliever and anti-anxiety medication for relaxation, if laminaria is required for overnight dilation. If you're given medications, it's important that you follow the instructions provided by your doctor.
During the laminaria insertion, you'll be awake. If someone accompanies you, he or she can remain in the exam room, if you wish. The doctor will:
- Place a speculum to view inside your vagina.
- Clean the cervix with gauze soaked in soap.
- Apply numbing medication (local anesthesia) to the cervix.
- Insert laminaria (or Dilapan) into your cervix, the opening to the uterus. The laminaria insertion takes about five to 10 minutes.
After the procedure, you will rest for a few minutes. You may experience cramping and spotting. You may get dressed when you feel able. We will give you detailed instructions on how to take care of your body overnight and how to prepare for the next day's procedure.
Someone must drive you home if you take anti-anxiety medications. Rest at home until the medications wear off.
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Surgical appointment
Don't eat for at least eight hours before your operating room procedure. You may drink clear liquids (such as water, broth or tea) up to three hours before your procedure.
The next day, you'll check in at the hospital reception area of UCSF Medical Center at Mount Zion, then go to the preoperative area, where you'll meet your doctor.
Medication will be administered intravenously (IV) in your arm to induce anesthesia or loss of consciousness. Most women fall asleep and don't remember the procedure. After you're well relaxed, the doctor will remove the laminaria and use suction and gynecological instruments to empty your uterus, with ultrasound guidance. You'll be in the operating room for about an hour, but the procedure may take from 15 to 45 minutes.
Recovery
In the recovery room, nurses will monitor you for about two hours. You may have some cramping and spotting. Before you return home, you'll receive antibiotics to prevent infection and instructions for postsurgical care.
The procedure and recovery period at the hospital takes about five hours in total.
Because of medications administered, you shouldn't drive until the medications wear off. Please make arrangements ahead of time for someone to take you home directly.
If you don't have anyone to accompany you home, contact Access, a women's health rights organization that may have a pro-choice volunteer driver to assist you. This must be coordinated with our clinic before your appointment, so please make arrangements as soon as possible.
You can expect to return to normal activities, such as work and school, the next day.
See our frequently asked questions about post-procedure care.
Follow-up visits
Unless you experience complications or have concerns, there's no need to return to the Women's Options Center. We recommend that you see your primary care doctor for regular evaluations.
Safety and effectiveness
Second-trimester surgical abortion is one of the safest medical procedures. Although rare, possible complications include a blood clot in the uterus that can cause pain or require a repeat aspiration; infection, which is generally easily identified and treated; a tear in the cervix that can be easily repaired with suture; perforation; retained pregnancy tissue requiring repeat aspiration; and excessive bleeding requiring a transfusion.
Complications from a surgical abortion are considerably less frequent and less serious than those associated with giving birth.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
