Medical Termination of Pregnancy at 4 Months

Surgical Method (Preferred)

Dilation and evacuation (D&E) is the safest procedure for second-trimester termination of pregnancy, with lower rates of complications compared to medical methods, and should be performed in a hospital setting by experienced providers 1
The American College of Cardiology is not mentioned, however, the European Heart Journal recommends D&E, which has benefits including lower risk of hemorrhage (9.1% vs 28.3% with medical methods) and lower risk of infection (1.3% vs 23.9% with medical methods) 2

Prostaglandin regimen can be administered to evacuate the uterus, with options including prostaglandin E1 (misoprostol) and prostaglandin E2 1

Systemic arterial oxygen saturation should be monitored with transcutaneous pulse oximetry during prostaglandin administration 1
Prostaglandin F compounds should be avoided as they can significantly increase pulmonary arterial pressure and may decrease coronary perfusion 1

Most D&E procedures are performed with sedation or general anesthesia, and fetal analgesia is not recommended during pregnancy termination procedures as there is no evidence of fetal pain awareness before 24-25 weeks gestation 3

Antibiotic prophylaxis is recommended to prevent post-abortal endometritis, which occurs in 5-20% of women not given antibiotics 1
Rh-negative women should receive anti-D immunoglobulin to prevent alloimmunization 2

The method chosen should be based on gestational age, provider expertise, and facility capabilities 1, 2
High-risk patients should be managed in experienced centers with on-site cardiac surgery capabilities 1