The difficult issue of second-trimester abortion.

Abstract

In the US, 10.2% of legal abortions are performed at 13-20 weeks and an additional 1% occur at 21 weeks gestation or beyond. These second-trimester abortions account for about 140,000 procedures per year. Dilatation and evacuation; instillation of saline, urea, or medication into the amniotic cavity; and intravenous prostaglandin administration are the approaches available for these procedures. At present, intravaginal prostaglandin E is the most commonly used mid-trimester abortion method; new research suggests that intravaginal misoprostol may confer advantages. Since teenagers are the population group most likely to delay abortion until the second trimester, priority should be given to making abortion services more accessible and removing requirements such as parental consent. Most beneficial would be a preventive approach that decreases the number of unintended pregnancies among adolescents through school-based sex education programs and access to free, effective contraceptive methods. Problematic is the reluctance on the part of many obstetricians and gynecologists to perform abortions due to a lack of technical training or moral objections. These practitioners should be mandated to fulfill their obligation to meet the needs of their patients, regardless of their personal views on the abortion issues.