Laminaria Insertion Procedure for Second/Third Trimester Abortion
Abortion and D&C procedures performed in the second/third trimester must be completed in either two, three, or four days depending on the length of the pregnancy. The Approximate breakdown is as follows:
15+ weeks through 16+ weeks: 1-2 day procedure
17+ weeks through 19+ weeks: 2 day procedure
20+ weeks through 23+ weeks: 2-3 day procedure
24+ weeks: 3-4 day procedure
The size of the pregnancy in the second & third trimester necessitates that the cervix be slowly and gradually dilated, or widened, over the course of one or two days. On the final day of a second trimester procedure, the contents of the uterus are removed using a combination of aspiration (suction) and evacuation. The dilation and evacuation method is the safest manner in which to perform a second trimester abortion/ D&C, and ensures the least amount of discomfort for the patient. The final day of the procedure for pregnancies that are 24+ (third trimester) is an induction of labor and delivery.
To dilate the cervix, the provider will insert a substance called laminaria, which is sterile compressed seaweed, into the cervical canal. The laminaria rods slowly expand as they absorb the natural moisture from the body, thus gradually enlarging the opening of the cervix. The laminaria dilators are removed on the day of the procedure. In the case of a 3 or 4 day procedure, the 2nd day the doctor will remove the laminaria from the day before, and insert new, sterile laminaria for the 2nd night.
While dilation of the cervix is not the actual abortion, it does begin the procedure and is a crucial part. Therefore, it is very important that you return at your appointed time to have the surgery completed. In addition, if you live outside the Albuquerque area, you need to plan to stay in the area after dilation has begun. An additional medication called misoprostol typically is given a few hours before the evacuation of the uterus on the final day of the procedure. Misoprostol serves to further soften the cervix and encourage uterine contractions.