Abortion at 13 Weeks Gestation
Dilation and evacuation (D&E) is the recommended method for abortion at 13 weeks gestation, as it is the safest procedure with significantly lower complication rates compared to medical methods. 1, 2, 3
Surgical Method: Dilation and Evacuation (Preferred)
D&E should be performed in a hospital setting by experienced providers, as it is the safest procedure for second-trimester termination with lower rates of complications compared to medical methods 1
D&E has a hemorrhage rate of 9.1% versus 28.3% with medical methods 1
D&E has an infection rate of 1.3% versus 23.9% with medical methods 1
D&E has a retained tissue rate requiring additional procedures of 1.3% versus 17.4% with medical methods 1
The procedure is typically performed with sedation or general anesthesia 1
D&E requires more operator skill than first-trimester suction curettage but can be safely learned by gynecologists familiar with suction-curettage techniques 3
At 13 weeks gestation specifically, D&E demonstrates its greatest safety advantage over alternative methods 2
Medical Method (Alternative Option)
Medical abortion at 10-13 weeks gestation using mifepristone 200 mg followed by misoprostol (up to 3 doses) is safe and effective for women who wish to avoid surgery and anesthesia 4
Medical abortion at this gestational age requires a second procedure in approximately 5.4% of cases 4
Prostaglandin regimens can be administered, with prostaglandin E1 (misoprostol) and prostaglandin E2 as options 1
Prostaglandin F compounds should be avoided as they can significantly increase pulmonary arterial pressure and may decrease coronary perfusion 1
Systemic arterial oxygen saturation should be monitored with transcutaneous pulse oximetry during prostaglandin administration 1
Women experience higher rates of side effects with medical abortion compared to surgical methods at this gestational age 4
Essential Post-Procedure Care
All Rh-negative women must receive anti-D immunoglobulin to prevent alloimmunization, as fetomaternal hemorrhage occurs in 32% of spontaneous abortions 5
The recommended dose is 50 μg of anti-D immunoglobulin for procedures at this gestational age 5
Antibiotic prophylaxis is recommended to prevent post-abortal endometritis, which occurs in 5-20% of women not given antibiotics 1
Contraceptive Counseling
Contraceptive counseling should be provided immediately, as ovulation can resume within 2-4 weeks post-abortion 5
Combined hormonal contraceptives or implants can be initiated immediately after abortion without waiting for next menses 5
If starting contraception within 7 days of abortion, no backup contraception is needed 5
Critical Considerations
Fetal analgesia is not recommended during pregnancy termination procedures, as there is no evidence of fetal pain awareness before 24-25 weeks gestation 1
The method chosen should be based on gestational age, provider expertise, and facility capabilities 1
Approximately 10% of all abortions in the United States are performed at 13 or more weeks' gestation 2
Patient preference is an important factor in method selection, though surgical D&E offers superior safety outcomes at this gestational age 4, 6