Induction

Facts About Induction Procedure

(22 weeks and up)

An induction is used for 22 weeks gestation and up. The procedure is a 3-4 day procedure depending on gestation and medical history. First, ultrasound will be done. This is done by passing a microphone-like instrument over your abdomen which measures the size of your uterus. The final decision as to whether the Induction may be performed in the clinic will depend on your medical history, physical exam, laboratory tests, and the physician’s evaluation.

The first 2-3 days of the procedure you will have laminaria (seaweed sticks about the size of your pinky finger) inserted into your cervix that absorb bodily fluid to cause dilation. On the first day you will also receive an injection into the uterine cavity through the abdominal wall or the vagina which terminates the pregnancy. The last day of the procedure will be your induction. You are required to have someone drive you to the clinic and someone to stay with you overnight.

Some procedures take 3-4 days depending on medical history.

How an Induction Procedure is Done

Insertion of cervical dilators (laminaria): The cervix (the opening in the uterus) can be stretched open over a period of several hours using an osmotic cervical dilator that swells by soaking up fluid from the cervix. The vagina is first cleansed. Then the cervix is numbed with local anesthetic. Then the laminaria are inserted into the cervix where they will stay overnight, kept in place by a tampon, soaked in Betadine, inserted into the vagina. You will be sent home with medications to take around the clock. You will also be given written instructions for you care while the dilators are in place. Depending on your gestation this may be repeated the second day and even a third day.

Fetal, Amniotic or Placental Injection:

With the guidance of ultrasound, an injection into the uterine cavity through the abdominal wall or the vagina will be administered to terminate the pregnancy.

Induction:

On the final day of your induction, an IV will be inserted into your arm and connected to a bag of fluid. Once this is in place, we will give all your medications through the IV. You will be given a medication called Misoprostol (Cytotec) that helps soften the cervix and begin contractions. A local anesthetic is injected into or around the cervix. The tampons and laminaria which had been inserted the previous day will be removed. The bag of fluid that surrounds the pregnancy will be broken and drained to aide in the induction process. Oxytocin, a medication to start contractions, will be administered via the IV fluids. You will return to the recovery room to wait for this process to work. Once you begin having pain, you need to notify the person in the recovery room to get medications for your comfort. When you feel a lot of pressure like you need to have a bowel movement, notify the staff immediately so that you can be taken to the exam room to be completed.

A D&C (Dilation & Curettage) will be performed. A blunt tipped tube (cannula) is inserted into the uterus. This tube is attached to a suction machine which is then turned on. After the uterus has been emptied by gentle suction, a spoon shaped instrument (curette) may be used to determine that the uterus is completely empty.

After this, you will spend as much time as need in the observation room under care of a patient care technician. When your condition is stable and you are ready to leave, you will receive the necessary prescriptions and follow-up instructions, including what you should do in the event of a complication.

IMPORTANT: If you receive IV sedation you will not be able to drive. You must have someone with you to drive home.

You will be given an appointment for a check-up, usually about six (6) weeks after the abortion. If the induction process does not work, a D&E will be performed (See 2nd Trimester Multi-Day).

Pregnancy tests can read positive for up to six (6) weeks post abortions.

IMPORTANT

Birth control: You can become pregnant again right after your pregnancy ends. To avoid any unwanted or unplanned pregnancy start using birth control immediately.