Why late abortion? The ordeal of mid trimester pregnancy termination
Most women chose to abort their unplanned pregnancy early in the pregnancy. Generally, an early abortion between seven to eight weeks of gestation is technically easier, less traumatic and more psychologically acceptable. Nevertheless, some women sought abortion in the mid trimester. 10-12% of abortions are performed between twelve and twenty-four weeks. In Singapore, a pregnancy may be legally terminated before the end of the twenty-fourth week of gestation.
Reasons for late abortion
Late abortion involves pregnancies that are still mostly unplanned. Some women struggled with the initial shock of the unplanned pregnancy. The partner and the woman may have difficulty in making the appropriate decision. In many instances, the woman may be left to handle the dilemma alone, shouldering an immense burden, and unable to gather advice and support from loved ones, who are often kept in the dark. There was this woman who saw me and wanted to continue with the pregnancy. She was determined to be a single mother. She overcame many mental hurdles and suffered through the phase of morning sickness. As the pregnancy progressed, she became fearful; being the sole breadwinner, she was uncertain if she could care for the baby and her ailing parents at the same time. She eventually aborted the pregnancy at twenty weeks.
There are those women who have not got a grip on what they want; and vacillated for weeks. The uncertainty may come from the anxiety over issues that may not be substantial, such as the fear of pain from needle injection! Younger women may not be psychologically prepared, and do not appreciate the intricacy in deciding, and they sometimes delay the decision into the second trimester.
Occasionally, a pregnant woman may be in denial and refused to accept the possibility of being pregnant even after months of delayed periods. When she saw the fetus moving inside her womb, she had no choice but to accept that her growing abdomen was not because she was “fat” but that she was pregnant.
Nevertheless, there are some late abortions that began as a planned pregnancy; a pregnancy that is desired, and the difficult decision to terminate the pregnancy was made reluctantly when the fetus is diagnosed to have a major anomaly that is not compatible with normal survival or development.
Performing Mid Trimester Pregnancy Termination
Mid trimester abortion is performed in two stages. The first stage uses medication to induce uterine contractions in order to expel the fetus, which by the second trimester will be more than six centimetres long. It usually takes several hours for this process to occur, and the duration will depend on the dosage and regimen used, as well as the woman’s response to the treatment. The contraction pain that accompanies the expulsion can be reduced by strong pain killers. The second stage is to remove the remaining pregnancy tissue from the womb, which is done under deep sedation or anaesthesia.
After Effect of Mid Trimester Abortion
In late abortion, the expulsion of a larger fetus and larger volume of pregnancy products, naturally suggests the possibility of more long term complication. The fear of subsequent infertility, and the risk of miscarriage and premature labor in future pregnancies have been extensively debated. To date, the jury is still out. When the abortion is inadequately performed and infection occurs, the woman may end up infertile. When the womb is inadvertently scarred by untrained personnel, future pregnancy may be difficult to maintain it to full-term delivery. Also, a woman who has a scarred uterus from preceding surgery to the womb has increased risk of womb rupture when she goes through the late abortion (just as she would be if she were to deliver a term baby).
In conclusion, late abortion should be avoided if possible. It should be regarded as a major procedure and the far reaching consequences have to be comprehended.