Abortion in the Third Trimester - Why It is a Rare Decision?

Medically Reviewed by Dr. Arti Sharma
Written by Charu Shrivastava, last updated on 9 February 2024
Abortion in the Third Trimester - Why It is a Rare Decision?

Abortion in the later stage of the pregnancy, i.e., the third trimester, is usually complex and challenging to achieve. The public support for abortion after 24 weeks is low. Moreover, the law of abortion in India does not permit women to abort their babies after 24 weeks unless there are complications. Thus, abortion in the third trimester is a rare decision. Less than 1% of abortions take place in the third trimester.

Abortion in Third Trimester

The third trimester is the last stage of pregnancy. It occurs between weeks 27 to 40 (the 7th, 8th, and 9th months) of pregnancy. During the third trimester, the baby grows and changes position to prepare for delivery. The baby can hear, smile, cry, see, and suck on its thumb. The lungs and kidneys of the baby mature, and the brain continue to develop. Furthermore, the third trimester can be challenging for the woman.

It can be complicated and challenging to carry out an abortion in the third trimester of pregnancy. Additionally, women are not allowed to get abortions in India after 24 weeks unless there are complications. Abortion during the third trimester is, therefore, a rare choice.

Read the blog below to learn more about the process, side effects, and possible complications of abortion in the third trimester.

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Reasons for Abortion in the Third Trimester

There are two main reasons for which women seek abortion in the third trimester, which include:

  1. New information about the health of the foetus (foetal anomalies) and the mother. For instance, a woman may need an abortion if the brain of the foetus has not developed. It could be also due to other serious genetic or structural conditions. The couple may also decide to end the pregnancy if it has life-threatening complications for the mother.
  2. Barriers to abortion before the third trimester. It includes social stigma, lack of information, inability to pay, or policy restrictions.

Why Do Women Terminate a Pregnancy on the Grounds of Foetal Anomalies?

The opponents of abortion often argue against the termination of pregnancy due to foetal anomalies. According to these people, even children born with a disability can lead a good life. But, the couple may still choose abortion as an ideal choice because of the emotional and financial cost of raising a disabled child. Furthermore, raising a child who might need constant medical attention and suffer from pain may seem unfair.

Preparing for an Abortion in the Third Trimester

Women who end their pregnancy in the third trimester need a surgical abortion procedure called Dilation and Evacuation (D&E). It is an outpatient procedure performed in a hospital or clinic. Before the procedure, you will have an in-depth consultation visit with your healthcare professional to discuss the following:

  1. Your pre-existing medical conditions
  2. Your health
  3. The medications you take and whether you need to stop taking them before the procedure
  4. The details and steps of the abortion procedure

Your healthcare team will also provide instructions to follow before and after the procedure. Additionally, you will have to stop eating or drinking anything 8 hours before the procedure. In some cases, you will have your cervix dilated a day before the procedure.

Abortion Procedure in the Third Trimester

The D&E procedure involves the following steps:

  1. Step 1: Dilation
    1. Your doctor will soften and dilate your cervix the day before the procedure. 
    2. You will have to place your feet in the table’s stirrups, like in a pelvic exam. 
    3. The doctor will use a duck-bill-shaped speculum device to widen your vaginal opening. 
    4. Next, they will clean your cervix, and the anaesthesiologist will apply a local anaesthetic. 
    5. The doctor will insert a laminaria (dilating stick) into the cervical canal to open the cervix by absorbing moisture. 
    6. They may also decide to administer a drug called Misoprostol for preparing the cervix. 
  2. Step 2: Evacuation
    1. On the day of the procedure, the anaesthesiologist will administer general anaesthesia to make you sleep through the procedure. 
    2. They will remove the dilating stick and use a curette (a sharp-tip instrument) to scrape your uterus. 
    3. They will use other instruments like vacuum suction and forceps to evacuate the foetus and placenta, emptying the uterus. 
    4. Some doctors may even inject a medication to ensure foetal death before evacuation. 

Side Effects and Complications After the Procedure

Some potential side effects after the abortion include:

  1. Breast tenderness
  2. Nausea during the first two days after the procedure
  3. Cramping between the third and fifth days
  4. Light to heavy bleeding for two to four weeks 
  5. Lemon-sized clots
  6. Low-grade fever

There are some possible complications from D&E in the third trimester that may need additional treatment. These complications include:

  1. Reaction to medication
  2. Severe cramping
  3. Clots larger than lemon
  4. Excessive bleeding
  5. Perforation of the uterus
  6. Incompetent cervix (the cervix opens in the second or early-third trimester of pregnancy) in future pregnancies

Call your healthcare professional if you experience the following:

  1. Heavy bleeding that soaks more than two maxi-pads an hour for more than two hours in a row
  2. Clots larger than a lemon
  3. Signs of infection in the uterus, including:
    1. Fever above 100.4 ℉
    2. Chills
    3. Foul-smelling vaginal discharge
    4. Severe pain in the pelvic or abdominal region that does not improve with medications

Preventing Infections After the Procedure

To reduce the risk of infection, you must avoid the following for the first week after the procedure:

  1. Tampons
  2. Bath
  3. Swimming pools and hot tubs
  4. Penetrative vaginal sex
  5. Douching

Consulting Your Healthcare Professional

It is essential to consult your healthcare professional while taking your final decision about abortion in the third trimester. Since abortion in the later stage can pose more risk to the mother’s life, consulting with an expert before making a decision is highly critical. You can contact the team of doctors at HexaHealth anytime to discuss all your options and decide the best line of action. Moreover, we will help you understand the procedure and what you should expect before and after the abortion. Make sure to write down the questions you may have for the doctor so that you don’t forget anything during the appointment. 

Emotional Support After a Third Trimester Pregnancy

Abortion at any stage during the pregnancy can bring about a range of different emotions. However, pregnancy in the third trimester can be particularly challenging. Why? Because of the social stigma and lack of support attached to it. Apart from social factors, you may experience negative emotions like depression, sadness, or a sense of loss due to hormonal fluctuations. You may want to consult a mental health professional if you experience constant grief or sorrow. Your gynaecologist can refer you to a therapist, counsellor, or support group to help you process your emotions. 

Wrapping It Up

As the weeks of pregnancy increase, your risk of complications may also increase. The doctor may recommend an abortion at this stage only when it is necessary to preserve your health or to prevent death. The increasing complications, legal restrictions, and social stigma are reasons for abortions in the third trimester being a rare decision. While third-trimester abortions are relatively uncommon compared to first-trimester abortions, sometimes, abortions in the later stage may be the ideal choice. Talk to your healthcare professional to make a safe and legal decision.

Frequently Asked Questions

What is the last trimester of pregnancy?

The final stage of your pregnancy is the third trimester or last trimester. The duration is weeks 29 through 40, or months 7, 8, and 9. Your baby develops, grows, and begins to move into a birthing position during this trimester.

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What are the reasons for abortion in the last trimester?

In the third trimester, women commonly seek abortions for the following two reasons:

  1. A woman might need an abortion if the brain of the foetus is not developed or has some major genetic issue.
  2. If the pregnancy develops difficulties that could endanger the mother's or baby's life, the couple may also decide to terminate the pregnancy.
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What are the side effects of abortion in the last trimester?

The side effects of surgical abortions are rare. Following an abortion, the following potential side effects which could occur might be:

  1. Breast sensitivity
  2. Nausea for the first two days following the operation
  3. Over two to four weeks, there is light to moderate bleeding.
  4. Lemon-sized clots
  5. Low-grade fever
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What is the procedure of abortion in the last trimester?

An ultrasound is performed before a D&E and after the procedure to check for any remaining foetal tissues. The surgeon will insert a speculum into the vagina. Dilators, which are thin rods, dilate the cervix. Gentle suction is done with instruments to remove the pregnancy.

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Can abortion in the last trimester lead to infertility?

No, abortion in the last trimester will not affect fertility. Only Asherman syndrome and infection, which are comparatively rare, can impact your fertility. 

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Can I become pregnant after D&E Procedure?

Yes, you can become pregnant after an abortion. It makes no difference if you've had an abortion or not to become pregnant in future. Additionally, it doesn't put you at a higher risk of difficulties in future pregnancies.

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What pain relief options are available after the D&E procedure?

Different degrees of pain management are there during and following an abortion. A few of them are as follows:

  1. Numbing agent and local anaesthetic around your cervix
  2. Medications that you take orally to reduce stress and manage discomfort
  3. Moderate sedation induced by IV drugs
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When can I resume normal activities after abortion in the last trimester?

You should return home and rest after an abortion. Return to your routine the following day only if you are ready. Avoid any action that makes your pain worse. Don't drive for eight hours after the procedure if you are given oral sedatives or narcotic painkillers.

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Will I bleed or have cramps after an abortion in the last trimester?

Depending on the type of abortion (medical or surgical) and your gestational age, you may bleed irregularly for up to four weeks after the surgery. From extremely mild to somewhat heavy, the flow might change. Blood clots of small size are common. Clots can be crimson or dark purple. After the operation, only use sanitary pads and not tampons if you have bleeding. For a few days, cramping can be an issue. Four to six days following the surgery, some individuals endure an episode of intense bleeding and discomfort.

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After the D&E procedure, when will my period start?

Four to seven weeks following the operation, your next period should start. The fourth week of your contraceptive cycle will be when you get your next period

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When can I have sex after an abortion in the last trimester?

It's advisable to refrain from penetrative vaginal sex for at least a week after having a D&E, including using fingers, a fist, or sex toys.  Your body will be able to recover and help avoid infection as a result.

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Will abortion in the last trimester affect my health?

Abortion is risk-free. There is no risk to your general health or ability to have children in the future. In fact, after an abortion, it is possible to become pregnant fast. Therefore, discussing a birth control strategy with your doctor after having an abortion is wise.

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Can I use tampons after an abortion in the last trimester to prevent bleeding?

Tampons shouldn't be used for two weeks following your abortion. Use sanitary napkins to lessen the risk of infection and track how much you're bleeding.

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How effective is the D&E procedure?

In the second and third trimesters of pregnancy, D&E is a successful abortion technique. This method can also remove the tissue left over from a miscarriage.

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Is the D&E procedure safe?

Abortions performed surgically are highly safe. Rare complications do occur. However, there is some risk associated with every surgery. Infection is one potential issue with surgical abortions. Other rare complications include cervical tear, perforation of the uterus, bleeding, medicine allergies or side effects. 

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Updated on : 9 February 2024


Dr. Arti Sharma

Dr. Arti Sharma

MBBS, DNB Obstetrics and Gynaecology, Diploma In Cosmetic Gynaecology

8 Years Experience

Dr Arti Sharma is a well-known Obstetrician and Cosmetic Gynaecologist currently associated with Aesthetica Veda in Bengaluru. She has 8 years of experience in Obstetrics and Cosmetic Gynaecology and worked as an expert Obstetrician...View More


Charu Shrivastava

Charu Shrivastava

BSc. Biotechnology I MDU and MSc in Medical Biochemistry (HIMSR, Jamia Hamdard)

2 Years Experience

Skilled in SEO and passionate about creating informative and engaging medical content. Her proofreading and content writing for medical websites is impressive. She creates informative and engaging content that educ...View More

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