During the second trimester, 14 to 23 weeks after your last menstrual period, abortions are typically performed over a two to three day period but don't require an overnight stay in the hospital. These procedures are known as dilation and evacuation (D&E). On the first day, usually a Monday, you'll meet your medical team at the UCLA West Med Clinic to prepare for the procedure. This first visit will take about 3 hours.
Cervical softening and dilating is performed with medication and small dilating sticks, called laminaria or Dilapan, that may be placed in the cervix, depending on the gestational age of the pregnancy and your medical history. Laminaria are thin sticks made from a special seaweed material that widen as they absorb moisture from your body. Dilapan are synthetic sticks that work in the same way. The laminaria will stay in your cervix overnight and prepare your body for the surgical procedure. Depending on your gestational age, you may need one or two days of laminaria and an injection in the uterus that induces fetal demise.
On the day of the procedure, usually a Wednesday, you'll meet the medical team at UCLA Ronald Reagan Medical Center. This visit will take about four to six hours.
Pre-Operative Appointment
In a private exam room, you will learn about your procedure, undergo an exam and ultrasound, and receive oral medications. You will receive prescriptions for pain medications and antibiotics. It is important that you follow the instructions provided by your doctor. You will have the option to discuss and choose a birth control method. You will also have the option to make arrangements for private cremation services if you choose.
During the laminaria insertion, you'll be awake. If someone accompanies you, he or she can remain in the exam room, if you wish. The doctor will:
After the procedure, you will rest for a few minutes. You may experience cramping and spotting. You may get dressed when you feel able. Our nurse will give you detailed instructions on how to take care of your body overnight and how to prepare for the next day's procedure. She will also draw your blood as necessary.
Someone must drive you home if you take anti-anxiety or opiate medications. Rest at home until the medications wear off.
Surgical Appointment
Don't eat or drink after midnight on the day of your surgical procedure.
On the surgical day, usually Wednesday, you'll check-in at the hospital reception area at UCLA Ronald Reagan Medical Center then go to the pre-operative area, where you'll meet your medical team.
Once you are in the procedure room, medication will be administered intravenously (IV) in your arm to induce anesthesia or loss of consciousness. Most women fall asleep and don't remember the procedure. After you're well relaxed, the doctor will remove the laminaria and use suction and gynecological instruments to empty your uterus, with ultrasound guidance. If you desired a contraceptive implant or intrauterine device, it will be placed in the Operating Room after your procedure. You'll be in the operating room for about an hour but the procedure may take from 15 to 30 minutes.
Recovery
In the recovery room, nurses will monitor you for about two hours. You may have some cramping and spotting. The procedure and recovery period at the hospital takes about six hours in total. Because of medications administered, you shouldn't drive until the medications wear off. Please make arrangements ahead of time for someone to take you home directly.
If you don't have anyone to accompany you home, contact Access, a women's health rights organization that may have a pro-choice volunteer driver to assist you. This must be coordinated with our clinic before your appointment, so please make arrangements as soon as possible. You can expect to return to normal activities, such as work and school, the next day.
Follow-Up Visits
You will return to the clinic for a follow up appointment one to two weeks after your procedure to confirm that your procedure is completed and that you are healing well. It is important that you come to this appointment so your doctor can check for any problems. At this visit, you will be given a prescription for a birth control method if you did not get one after your procedure.
Safety and Effectiveness
Second trimester surgical abortion is one of the safest medical procedures. Although rare, possible complications include a blood clot in the uterus that can cause pain or require a repeat aspiration; infection, which is generally easily identified and treated; a tear in the cervix that can be easily repaired with suture; perforation; retained pregnancy tissue requiring repeat aspiration; and excessive bleeding requiring a transfusion. Complications from a surgical abortion are considerably less frequent and less serious than those associated with giving birth.
