The procedure of Medical Termination of Pregnancy and its type are determined by how far a woman is into pregnancy. There are various stages of MTP that includes first trimester, second trimester, and third trimester. During the first trimester, there is an option of having a surgical abortion or a medical abortion procedure. It is always advised to obtain a sonogram in order to determine if the pregnancy is viable and used for accurate pregnancy dating. Second Trimester does not involve medication-based abortion.
The Second trimester procedure constitutes about 10 to 15 percent of abortions worldwide and are responsible for two-thirds of major complication in abortions. The second trimester methods are considerably improved during the last decade, thus becoming safe and more accessible.
Type of procedure involved in the Second Trimester
Below are the types of the procedure involved in the Second Trimester treatment –
- Dilation and Curettage (D & C) which is a surgical abortion procedure is used to terminate a pregnancy up to or within 16 weeks gestation. D & C procedure is also termed as vacuum aspiration or suction curettage procedure.
- Dilation and Evacuation (D & E) is a surgical abortion procedure which is used to terminate the pregnancy after 16 weeks gestation.
- Induction Abortion is a rare surgical procedure performed for abortion during the second trimester. This procedure includes urea, salt water, or potassium chloride which is injected into the amniotic sac. Also, prostaglandins are inserted into the vagina while Pitocin is injected intravenously.
Termination of the pregnancy can be done with oral medication if the pregnancy is earlier than seven weeks. It is safer for the woman to undergo termination the sooner it is done. Usually, the age of the pregnancy is calculated from the last period of the woman.
Symptoms during the second trimester
Symptoms which are visible during the first trimester begin to improve during the second trimester of pregnancy. Some of the symptoms and changes reflected in the women’s body include –
- Expansion of the uterus
- Larger abdomen
- Due to lower blood pressure chances of light-headedness and dizziness
- Body aches
- A Sensation of baby moves
- Increase in the appetite
- Stretch marks on the body parts such as breasts, thighs, stomach, and buttocks
- Itching
- Swelling of hands and ankles
- Skin colour changes like there is darkening of the skin around the nipples
Other symptoms also include vomiting, nausea, extreme swelling, and rigid weight gain. Patients are advised to consult doctors if they experience these issues.
Pre-Operative Procedure
The patient undergoes with ultrasound and examination while receiving oral medication before the procedure. Doctors prescribe the patient with pain medications and antibiotics and instructions are given to follow before, during, and after the procedure. Patient will be given with an option to choose for a birth control method if they want to.
During the laminaria insertion, doctors will perform the below procedure –
- A speculum is placed inside the vagina
- Cleaning of the cervix with the help of gauze soaked in soap
- Local anesthesia or numbing medication is applied to the cervix
- Insertion of laminaria into the cervix which takes about five to ten minutes
The patient is advised to rest for a couple of minutes after the procedure. Cramping and spotting can be experienced by the patient after the procedure is done. Detailed instructions are given to the patient by the nurse on how to take care of and prepare for the next day’s schedule. Rest is the best medication that doctors will advise after the procedure.
Second Trimester Surgical Appointment
The patient undergoing second trimester surgical abortion are advised not to eat or drink on the day after midnight of the surgical procedure. Medications are administered once the patient is in the surgery room and will be induced with anesthesia for loss of consciousness. Once the patient is unconscious, doctors start with the procedure by removing the laminaria by using suction and gynaecological instruments to empty the uterus and with the help of ultrasound guidance.
The procedure usually takes about 15 to 30 minutes while the patient is kept in the operating room for about an hour. If the patient has opted for an intrauterine device or contraceptive implant, it will be performed and operated in the Operating room after the procedure.
What does the Second Trimester procedure include?
The patient needs to take various scans and tests during the second trimester procedure. This may include a blood test, screen for blood count and the iron level, chromosomal and genetic conditions, gestational diabetes, and other conditions recommended by the surgeon or the doctor. For infection, doctors can recommend for urine tests. Ultrasound scan during the second trimester is conducted to evaluate the fetal anatomy. Additional diagnostic tests can also be asked to conduct if the result of the blood test and an ultrasound scan is of concern.
The patient receives ultrasound screening exam. During this time, the diagnosis of the fetus is done that includes measuring various parts of the fetus, such as femur length, head size, and fetal age. Presence of fetal anomalies, the position of the placenta, absence, and presence of an unusual quantity of amniotic fluid is done. During the second trimester, procedure which is done in around 20 to 26 week of the pregnancy requires the surgeon to perform a surgical evaluation of the uterus. This is done using instruments such as forceps, which is used to remove placenta and fetus. The safety of the patient is taken care of by the surgeons by considering various points such as medical induction, usage of laminaria, induced fetal demise, and utmost safety after the procedure for the patient.
Second Trimester recovery
The patient is monitored for about two hours under the observation of nurses. There are chances of the patient experiencing cramping and spotting. It takes about six hours for the patient to recover from the entire procedure on the day of the treatment. The patient is advised not to exert or involve in any physical activities after the treatment due to medications. The patient can return to normal activities after a day or so.
What are the risks involved in Second Trimester?
There are certain risks involved while going for Second Trimester abortion that may include –
- Heavy bleeding, cervical laceration, and perforation
- Infection
- Severe pain and blood loss due to uterine perforation. This may result in major surgery and treatment that can include hysterectomy.
- Retained tissues that include placenta
Safety and Effectiveness for the Second Trimester
Consider as one of the safest medical procedure, second trimester surgical abortion consist of very rare complications. Although there can be rare cases where possible complications can occur that includes a blood clot in the uterus causing pain, an infection, a tear in the cervix, perforation, retained pregnancy issues that require repeat aspiration, and excessive bleeding that can require transfusion. The complications from the second trimester are less frequent and less serious compared to complications associated with giving birth.
The patient is asked to have a follow-up appointment with the doctor to confirm that the procedure is completed successfully and that the patient is healing up well. Doctors check for any problems that can occur post the procedure. The Doctor can prescribe with a birth control method after the procedure is completed.
How to stay healthy during the Second Trimester?
Patients are advised with do’s and don’ts to avoid any complications. In order to stay healthy during this phase, women are advised to follow below instructions –
- Drink a lot of water every day
- Eat enough food which is high on calories
- Exercise regularly
- Keep gums and teeth healthy which affects as dental hygiene is linked to premature labor
- Eat healthy diet food such as vegetables, fruits, fiber and low-fat forms of proteins
Women in the second trimester should avoid indulging into below activities –
- Alcohol
- Smoking
- Should not eat raw food like fish, seafood, sprouts
- Should not do strength and excessive exercise and workout
- Limit consumption of unpasteurized milk or other dairy products
Patients can seek for a medical emergency if suffering from symptoms such as –
- Excessive vaginal bleeding in order to soak the menstrual pad
- Severe pain in the pelvic region and abdomen
- Clumps or clots of tissue passed through the vagina
The Patient can suffer from miscarriage if there is excessive bleeding. The pain can worsen causing rapid weak pulse, fainting, and clamminess.
Apollo Cradle Jayanagar is capable of handling the MTP cases very efficiently. The doctors and surgeons at Apollo Cradle offer the safest and efficient medical services with the best healthcare facilities. With the help of the best gynecologists, Apollo Cradle provides the best medical services to its patients. It is always advisable to perform the second trimester procedure in a health care centre like Apollo Cradle as there are heavy vaginal bleeding and surgical complications associated with the procedure. With highly effective methods such as mifepristone and misoprostol available for second trimester procedure, Apollo Cradle gives the best care to its patients.
The hospital also provides discounts and offers to its patients that include early bird offer for pre-booking of bed. Admissions are granted as per the availability of the bed, hence one can pre-book the room of their own choice and can avail a benefit of Rs. 20,000. Some of the offers include –
- A Discount of 10% on all-in-house diagnostics
- 2 labor preparation and yoga classes free for pregnant women
- Sessions on childbirth education and labor preparation
- 2 Fetal scans by expert gynaecologists offered free for the patient
- Free photograph by a professional photographer of the new-born baby
The doctors and gynaecologist at Apollo Cradle always help the patients to make the right decision in terms of pregnancy and guides by doing the right things for both the mother and the baby. Apollo Cradle ensures that the life of the mother and the baby is in the safe hands.
The doctors and faculties offer the highest quality care to their patients. With a wide range of maternity packages, Surgical ICU, highly trained nurses and gynaecologists, specialized labor and delivery rooms, state-of-art ultrasound imaging facilities, and Apollo experts make Apollo Cradle one of the best and trusted maternity hospitals in the country.
