MTP in Second Trimester: Symptoms & Type of Procedure Involved

Medical Termination of Pregnancy (MTP) is carried out differently depending on the stage of pregnancy, which may be the first, second, or third trimester. Each stage requires specific approaches. In the first trimester, both medication-based and surgical options may be considered, typically after an ultrasound confirms the pregnancy’s viability and provides accurate dating.

In the second trimester, termination is performed only through surgical procedures, which account for about 10% to 15% of all pregnancy terminations worldwide. These methods carry a somewhat higher risk of complications compared to first-trimester options and are responsible for nearly two-thirds of major termination-related complications. However, advancements in medical techniques over the past decade have made second-trimester procedures much safer and more widely accessible.

What Is Medical Termination of Pregnancy (MTP)?

MTP is the medical process of ending a pregnancy through safe and legally approved procedures. The approach used depends on the stage of pregnancy. During the second trimester, MTP refers specifically to surgical methods, as medication-based options are no longer considered effective or safe at this point.

The term MTP serves as an umbrella for various surgical techniques that may be chosen based on how far the pregnancy has progressed and the individual’s medical needs. These procedures are performed by qualified professionals in approved medical settings to ensure safety and reduce the risk of complications.

Types of MTP Procedures in the Second Trimester

The methods used for MTP in the second trimester are primarily surgical. The specific procedure depends on how far the pregnancy has progressed:

• Dilation and Curettage (D&C):

This surgical procedure, also called vacuum aspiration or suction curettage, is commonly performed up to 16 weeks of gestation. It involves dilating the cervix and removing the contents of the uterus using suction.

• Dilation and Evacuation (D&E):

This procedure is typically used after 16 weeks of pregnancy. It involves dilating the cervix and removing the pregnancy tissue with a combination of suction and surgical instruments.

• Induction Abortion:

This is a less common method in the second trimester. It involves inducing labour by injecting substances such as saline solution, urea, or potassium chloride into the amniotic sac. Prostaglandins may also be placed in the vagina, and Pitocin can be administered intravenously to stimulate uterine contractions.

It is important to note that termination with oral medication is generally limited to very early pregnancies, usually before seven weeks of gestation. For this reason, in the second trimester, surgical methods are the standard approach. In all cases, earlier termination tends to be safer and carries fewer risks than later procedures.

Reasons for Undergoing MTP

MTP in pregnancy may be needed for different reasons, such as:

• When the pregnancy puts the mother’s health or life at risk
• If the baby has serious genetic or structural problems
• To manage an incomplete or missed miscarriage
• In the case of an unwanted pregnancy

Each person’s circumstances are unique, and choosing MTP can have effects on both the body and mind. It is essential to consult a doctor and, when possible, seek support from trusted family or friends before making the decision.

Pre-Operative Procedure

Before the MTP procedure, the patient undergoes an ultrasound and a physical examination. Oral medications may be given as prescribed by the doctor. Pain relief and antibiotics are typically provided, and detailed instructions are given on what to do before, during, and after the procedure. Patients are also offered the option to choose a method of birth control if they wish.

During laminaria insertion, the following steps are generally performed:

• A speculum is placed inside the vagina.
• The cervix is cleaned with gauze soaked in a mild solution.
• Local anaesthesia or a numbing medication is applied to the cervix.
• Laminaria is gently inserted into the cervix, a process that usually takes five to ten minutes.

After the procedure, the patient is advised to rest for a few minutes. Mild cramping and spotting may occur. Nurses provide instructions on how to care for oneself and prepare for the next day’s schedule. Rest is an important part of MTP recovery.

Second Trimester Surgical Appointment

Patients undergoing a second-trimester surgical termination are usually advised not to eat or drink after midnight before the procedure. Upon arrival in the surgical room, medications are administered, and anaesthesia is given to induce unconsciousness.

Once the patient is unconscious, the procedure begins. The laminaria is removed, and the uterus is emptied using suction and gynaecological instruments, often guided by ultrasound. The procedure generally takes 15 to 30 minutes, followed by around an hour of observation in the operating room.

If the patient chooses, an intrauterine device (IUD) or contraceptive implant can be inserted immediately following the procedure.

What Does the Second Trimester Procedure Include? 

Several tests and scans are performed during a second-trimester MTP, which may include:

• Blood tests to check blood count, iron levels, and screen for chromosomal or genetic conditions
• Screening for gestational diabetes and other conditions as recommended by the doctor
• Urine tests to check for infection
• Ultrasound scans to evaluate fetal anatomy

Ultrasound helps assess fetal development by measuring the femur length, head size, and estimating fetal age. It also checks for fetal anomalies, placenta position, and amniotic fluid levels.

For procedures performed around 20 to 26 weeks of pregnancy, a surgical evaluation of the uterus is conducted. Instruments such as forceps may be used to remove the fetus and placenta. Surgeons prioritise patient safety throughout the procedure, considering factors such as medical induction, laminaria use, induced fetal demise if necessary, and post-procedure care.

Recovery and Symptoms After MTP

The patient is monitored for approximately two hours under the supervision of nurses. Mild cramping and spotting may occur during this time. On the day of the procedure, it usually takes about six hours for the patient to recover from the immediate effects of treatment. Patients are advised to avoid strenuous activity or heavy physical exertion due to medications. Most patients can resume normal activities within a day or so.

Benefits of MTP in Pregnancy

• Protects the mother’s health if the pregnancy poses serious risks.
• Reduces complications in high-risk pregnancies.
• Allows termination in cases of severe fetal abnormalities.
• Ensures safe completion of miscarriage or incomplete termination.
• Provides a safe option for unwanted pregnancies.
• Lowers the risk of complications compared to unsafe or unregulated methods.

Risks of Medical Termination

There are certain risks involved with a second-trimester MTP, which may include:

• Heavy bleeding, cervical laceration, or uterine perforation
• Infection
• Severe pain and blood loss due to uterine perforation, which may require major surgery, including hysterectomy
• Retained tissue, including placenta

Safety and Effectiveness in the Second Trimester

Considered one of the safest medical procedures, second-trimester MTP is associated with very rare complications.

In uncommon cases, possible complications of second-trimester MTP may include:

• Blood clots in the uterus, causing pain
• Infection
• Cervical tears
• Uterine perforation
• Retained pregnancy tissue requiring repeat aspiration
• Excessive bleeding that may require a blood transfusion

Overall, complications in the second trimester are less frequent and less severe compared to those associated with childbirth.

Patients are advised to schedule a follow-up appointment with their doctor to ensure the procedure was completed successfully and that healing is progressing well. During this visit, the doctor checks for any post-procedure issues and can also provide counselling on, or prescribe, a suitable method of birth control.

The Bottom Line

MTP in the second trimester is a safe and regulated procedure when carried out by qualified professionals. Surgical methods are required at this stage, and modern techniques have made the procedure more effective and considerably safer. It helps protect the mother’s health, manage high-risk pregnancies, address fetal abnormalities, and provide a safe option for unwanted or complicated pregnancies.

While some risks exist, serious complications are uncommon, and careful pre-operative preparation, skilled surgical care, and proper follow-up support a smooth recovery. Consulting a doctor and following post-procedure instructions are key to ensuring safety and well-being.

Apollo Cradle Jayanagar is a trusted healthcare centre for second-trimester MTP, offering safe and efficient care with experienced doctors, gynaecologist specialists, and advanced facilities. The hospital offers comprehensive support throughout the procedure, including pre-operative preparation, surgical care, and post-procedure follow-up. Patients can also benefit from services such as fetal ultrasounds, labour preparation classes, and maternity packages, along with special offers for pre-booking beds and diagnostics, ensuring both safety and convenience.

Frequently Asked Questions (FAQs)

Is the MTP Procedure Legal in India?

Yes, medical termination of pregnancy is legal in India under the Medical Termination of Pregnancy Act, 1971, when performed by qualified professionals within the legal gestation limits .

How to Naturally Terminate Early Pregnancy?

Early pregnancy should only be managed under medical guidance. Home remedies are unsafe. Consult a doctor for safe and approved options.

What to Expect After the MTP Procedure?

Mild cramping, spotting, and fatigue are common. Rest, follow-up care, and prescribed medications help ensure a smooth recovery.

How to Terminate Pregnancy in the First Month?

Consult a doctor immediately. Early pregnancy termination may involve approved medication under medical supervision to ensure safety.

What Is the MTP Procedure Cost?

Cost varies by facility, gestation stage, and services. Consult the hospital or clinic for an exact estimate, including pre- and post-procedure care.