From the Guidelines
Third trimester abortions carry significant risks, including heavy bleeding, infection, and maternal mortality, and should only be performed when the mother's life is endangered or in cases of severe fetal anomalies, as supported by the most recent evidence 1.
Risks Associated with Third Trimester Abortion
The risks associated with third trimester abortion are numerous and can be life-threatening. These include:
- Heavy bleeding (hemorrhage)
- Infection
- Uterine perforation
- Cervical damage
- Adverse reactions to anesthesia
- Emotional and psychological impacts
- Increased risk of future pregnancy complications, including preterm birth, placenta issues, and uterine rupture
- Maternal mortality, although rare, is higher than for earlier abortions
Procedure and Recovery
The procedure for a third trimester abortion may require multiple days and can involve dilation and evacuation (D&E) or induction of labor using medications like mifepristone and misoprostol 1. Recovery typically requires several weeks of monitoring for bleeding, infection, and emotional health. The risks increase with gestational age because the uterus is larger and more vascular in later pregnancy, making the procedure technically more complex.
Considerations and Recommendations
When considering a third trimester abortion, it is essential to weigh the risks and benefits, taking into account the mother's health and well-being, as well as the fetal condition 1. The decision to undergo a third trimester abortion should be made after careful consultation with a healthcare provider and should only be performed in a medical setting with adequate resources and support. The most recent evidence suggests that termination of pregnancy in the third trimester should be approached with caution and only considered in exceptional circumstances 1.
From the FDA Drug Label
Cytotec may endanger pregnancy (may cause abortion) and thereby cause harm to the fetus when administered to a pregnant woman. A major adverse effect of the obstetrical use of Cytotec is the hyperstimulation of the uterus which may progress to uterine tetany with marked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism Pelvic pain, retained placenta, severe genital bleeding, shock, fetal bradycardia, and fetal and maternal death have been reported. The risk of uterine rupture increases with advancing gestational ages and with prior uterine surgery, including Cesarean delivery.
The risks associated with a third trimester abortion using misoprostol include:
- Uterine hyperstimulation
- Uterine rupture
- Amniotic fluid embolism
- Pelvic pain
- Retained placenta
- Severe genital bleeding
- Shock
- Fetal bradycardia
- Fetal and maternal death 2
From the Research
Risks Associated with Third Trimester Abortion
- The risks associated with third trimester abortion include bleeding, retained products of conception, retained cervical dilator, uterine perforation, amniotic fluid embolism, misoprostol toxicity, and endometritis 3
- Infectious complications are a significant source of morbidity and mortality associated with pregnancy termination worldwide, however, in areas where abortion practices are legal, the risk of infection is very low 4
- The use of mifepristone as an abortifacient has been associated with significant morbidity and mortality, including sepsis, drug toxicity/overdose, ruptured ectopic pregnancy, hemorrhage, and possible homicides 5
- Third trimester abortion may be justified on medical grounds in cases of severe fetal abnormalities, and the law should make provision for it 6
- Fetal abnormalities leading to third trimester abortion are often due to severe malformations with high probability of perinatal death or severe handicap, and routine prenatal care can help identify these abnormalities and prevent late terminations 7
Specific Risks
- Hemorrhage is a significant risk, especially when mifepristone and misoprostol are used together 5
- Retained products of conception and hemorrhage are common causes of morbidity 5
- Ectopic pregnancies, including ruptured ectopics, can occur after mifepristone use 5
- Sepsis is a significant risk, especially in cases of unsafe abortion 3