Medical Termination of Pregnancy Procedures

Second Trimester MTP (14+ weeks)

Dilation and evacuation (D&E) is the safest and preferred method for second-trimester MTP, with significantly lower complication rates than medical methods, including hemorrhage in 9.1% versus 28.3% and infection in 1.3% versus 23.9% with medical approaches, according to the American College of Obstetricians and Gynecologists 1, 2, 3
D&E should be performed in a hospital setting by experienced providers, with most procedures performed under sedation or general anesthesia, as recommended by the American College of Obstetricians and Gynecologists 1, 2, 3
At 6 months gestation (24 weeks), specialized expertise is required due to increased risks, as stated by the American College of Obstetricians and Gynecologists 1
Prostaglandin regimens (misoprostol or prostaglandin E2) can be used to evacuate the uterus if D&E is unavailable, but prostaglandin F compounds should be avoided as they increase pulmonary arterial pressure and may decrease coronary perfusion, according to the American Heart Association 2

Antibiotic prophylaxis is mandatory to prevent post-abortal endometritis, which occurs in 5-20% of women without antibiotics, as recommended by the Centers for Disease Control and Prevention 1, 2, 3
All Rh-negative women must receive anti-D immunoglobulin, as stated by the American College of Obstetricians and Gynecologists 1, 2, 3

Pregnancy termination is advised if chemotherapy or radiotherapy is required during the first trimester, as these treatments carry up to 20% risk of fetal malformations, according to the National Comprehensive Cancer Network 4, 5
Chemotherapy can be administered during second and third trimesters with reasonable safety, though risks of stillbirth, growth retardation, and premature delivery increase, as stated by the National Comprehensive Cancer Network 6, 4
Allow 3 weeks between last chemotherapy dose and delivery to avoid the nadir period, as recommended by the National Comprehensive Cancer Network 4, 5
Do not administer chemotherapy beyond week 33 of gestation, as stated by the National Comprehensive Cancer Network 4, 5

Fetal analgesia is not recommended during pregnancy termination as there is no evidence of fetal pain awareness before 24-25 weeks gestation, according to the American Academy of Pediatrics 7, 2, 3