What is a late-term abortion?

What is a Late-Term Abortion

A late-term abortion is generally defined as an abortion procedure performed after 20-24 weeks of gestation, during the periviable period when the fetus may potentially survive outside the uterus with intensive medical intervention but still faces high risks of death or severe morbidities. 1, 2

Definition and Clinical Context

• Late-term abortion typically refers to procedures performed in the second trimester, particularly after 20 weeks of gestation, which represents approximately 10% of all abortions performed in the United States 3
• The periviable period is defined by consensus as 20 0/7 to 25 6/7 weeks of gestation, which is when most late-term abortions occur 1
• These procedures are distinct from early abortions (before 13 weeks) and have different clinical considerations, techniques, and legal frameworks 2

Medical Indications

• Late-term abortions may be performed for various medical indications, including:
  • Preterm prelabor rupture of membranes (PPROM) at previable or periviable gestational ages 1
  • Severe fetal anomalies incompatible with life 2
  • Maternal health conditions where continuing pregnancy poses significant risks 1
• The Society for Maternal-Fetal Medicine recommends that pregnant patients with previable and periviable PPROM receive individualized counseling about maternal and fetal risks and benefits of both abortion care and expectant management 1

Procedural Methods

• Two primary methods are used for late-term abortions:
  • Surgical methods: Primarily dilation and evacuation (D&E), which is the most common technique, and intact dilation and extraction (D&X), which is a variant of D&E 2
  • Labor induction methods: Using medications such as mifepristone followed by misoprostol (most effective), or misoprostol alone when mifepristone is unavailable 4
• D&E is generally considered the safest method for abortions between 13-16 weeks, while for later gestational ages, D&E and induction abortion have similar safety profiles 3
• For labor induction abortion, the combination of mifepristone and misoprostol is most effective, with 95% of abortions complete within 24 hours of misoprostol administration 4

Maternal Outcomes and Risks

• Late-term abortions carry higher risks compared to earlier procedures but are still safer than continuing pregnancy in certain medical conditions 1
• In cases of previable PPROM (rupture of membranes before viability), expectant management is associated with higher maternal morbidity (60.2%) compared to abortion care (33.0%) 1
• The most common complication with expectant management of previable PPROM is intraamniotic infection (38.0% vs 13.0% with abortion care) 1
• Postpartum hemorrhage is also more common with expectant management compared to abortion care (23.1% vs 11.0%) 1

Future Pregnancy Considerations

• Late-term surgical abortion (≥20 weeks) does not appear to increase the risk of spontaneous preterm birth in subsequent pregnancies unless the abortion was performed due to cervical dilation and/or preterm premature rupture of membranes 5
• The technique used (intact dilation and extraction vs. dilation and evacuation using forceps) does not appear to affect future preterm birth rates 5

Legal and Ethical Considerations

• Late-term abortion remains a complex and controversial issue in healthcare and public policy 2
• Medical societies, including the American Medical Association, recommend that abortions not be performed in the third trimester except in cases of serious fetal anomalies incompatible with life 2
• Legal frameworks vary by jurisdiction, with different gestational age limits and requirements 1

Late-term abortion procedures require specialized training and expertise, and decisions should be made with careful consideration of maternal health, fetal prognosis, and available resources 1, 2.