Is a medical termination or dilation and curettage (D&C) possible at 17 weeks of gestation?

From the Guidelines

Dilation and evacuation (D&E) is the recommended procedure for termination of pregnancy at 17 weeks of gestation, as it is considered the safest method in the second trimester. This procedure involves dilating the cervix and removing the pregnancy tissue using specialized instruments, and it should be performed in a healthcare facility with appropriate monitoring and anesthesia 1.

Key Considerations

• The method of termination should be individualized, taking into account the patient's medical history and risk factors 1.
• High-risk patients should be managed in an experienced center with on-site cardiac surgery 1.
• Antibiotic prophylaxis should be considered to prevent post-abortal endometritis, which occurs in 5-20% of women not given antibiotics 1.

Alternative Options

• Medical termination using prostaglandins E1 or E2, or misoprostol, can be considered if surgical evacuation is not feasible, but this approach may have a higher risk of complications 1.
• Saline abortion should be avoided due to the risk of expansion of the intravascular volume, heart failure, and clotting abnormalities 1.

Important Factors

• The patient's overall health and well-being should be carefully monitored during the procedure, with attention to potential complications such as hemorrhage and incomplete expulsion 1.
• Pain management, emotional support, and follow-up care are essential components of the termination procedure, regardless of the method chosen 1.

From the FDA Drug Label

In second trimester abortion, oxytocin infusion will often be successful in emptying the uterus. The answer is yes, a medical termination or dilation and curettage (D&C) is possible at 17 weeks of gestation, which falls within the second trimester.

• Oxytocin infusion may be used to empty the uterus in such cases, although other means of therapy may also be required. 2

From the Research

Medical Termination at 17 Weeks of Gestation

• The study 3 focused on medical versus surgical termination of pregnancy less than 14 weeks' gestation, and does not provide information on medical termination at 17 weeks of gestation.
• However, the study 4 mentions that surgical dilation and evacuation (D&E) appears to be a safe and cost-effective procedure for late termination of pregnancy, and medical termination appears equally safe when undertaken with the combined use of mifepristone and misoprostol.
• The study 5 evaluates cervical preparation methods for second-trimester surgical abortion, including D&E, and finds that osmotic dilators and/or misoprostol are safe and effective for cervical preparation before second-trimester D&E.

Dilation and Curettage (D&C) at 17 Weeks of Gestation

• The study 3 does not provide information on D&C at 17 weeks of gestation, as it focuses on termination of pregnancy less than 14 weeks' gestation.
• The study 5 mentions that cervical preparation is recommended for D&C after 12 weeks gestation and is standard practice for D&E beyond 14 weeks gestation, but does not specifically address D&C at 17 weeks of gestation.
• The study 4 suggests that D&E is a safe and cost-effective procedure for late termination of pregnancy, but does not provide information on D&C at 17 weeks of gestation.

Feasibility of Medical Termination or D&C at 17 Weeks of Gestation

• Based on the available studies 3, 4, 5, it appears that medical termination and D&E are feasible options for late termination of pregnancy, but the specific feasibility of medical termination or D&C at 17 weeks of gestation is not directly addressed.
• The study 5 suggests that osmotic dilators and/or misoprostol are safe and effective for cervical preparation before second-trimester D&E, which may be relevant to D&C at 17 weeks of gestation.