Second-Trimester Abortion

Publication Date: June 1, 2013

Recommendations and Conclusions

The following recommendations and conclusions are based on good and consistent scientific evidence.

  • Cervical preparation is recommended before D&E to decrease risk of cervical trauma.
  • Mifepristone followed in 24–48 hours by misoprostol is the most effective regimen for second-trimester medical abortion.
  • Misoprostol as a single agent is effective for medical abortion.
  • Administration of prophylactic antibiotics decreases the risk of infection after surgical abortion and, therefore, should be provided to all patients undergoing D&E.
  • Except for hysteroscopic sterilization, diaphragm, or cervical cap, all forms of contraception can be considered after second-trimester abortion and initiated on the day of the procedure.
( A )

The following recommendations and conclusions are based on limited or inconsistent scientific evidence.

  • Dilation and evacuation is associated with fewer complications than medical abortion involving misoprostol regimens.
  • When there is a suspicion of abnormal placentation, D&E is the preferred abortion method, and preparations should be made for possible hemorrhage by ensuring the procedure is performed at an appropriate facility with accessibility to blood products, interventional radiology, and the capability to perform a hysterectomy if necessary.
  • The use of vasopressin in the paracervical block may decrease blood loss from D&E.
  • Methylergonovine maleate is an appropriate first-line uterotonic agent unless contraindicated, as in patients with hypertension. Misoprostol is an effective agent in the setting of postabortion hemorrhage, and doses of 800–1,000 micrograms are recommended.
  • If refractory bleeding is thought to be due to atony or lower uterine segment bleeding, a Foley catheter or intrauterine balloon should be inserted to tamponade the endometrial cavity.
  • Because the risk of uterine rupture associated with prior cesarean delivery is similar to the risk among women without a prior cesarean delivery, guidelines support the safety of misoprostol specifically and medical abortion generally in women with one prior cesarean delivery.
( B )


Recommendation Grading




Second-Trimester Abortion

Authoring Organization

Publication Month/Year

June 1, 2013

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Adolescent, Adult

Health Care Settings

Operating and recovery room, Outpatient

Intended Users

Physician, nurse, nurse practitioner, physician assistant



Diseases/Conditions (MeSH)

D000028 - Abortion, Induced, D011262 - Pregnancy Trimester, Second


abortion, 2nd trimester, second trimester