You will be given the time and the place of your scheduled appointment. Most patients arrive by air, train, bus or private automobile. If you arrive the day before or the day of your appointment, you will be given the name and address of the hotel where you will be staying overnight for the one day (24 hours or less) second trimester, third trimester or late term abortion procedure.
Upon arrival to the medical facility, you will first be greeted by warm, friendly, and compassionate staff that will make you comfortable and give you a medical history form to complete and sign.
Most patients would have had certain initial labs done before coming to our facility. The necessary labs will be done that are needed to perform the abortion procedure. Patients are asked to provide a urine sample and a small amount of blood will be taken from your finger to determine whether or not your pregnancy test is positive, if you have a low red blood cell count (anemia) and your Rh factor. Your pre-operative vital signs (blood pressure, pulse and temperature) will also be taken.
A sonogram (ultrasound) will be performed to determine the length of your pregnancy along with assuring other factors that would prevent the abortion procedure from taking place.
Abortion can be one of the most difficult decisions a woman may ever have to make. In the United States alone there are approximately 1.3 million unwanted pregnancies that result in abortion. It is one of the most commonly performed medical procedures. The decision to have an abortion is very complex. The reasons women want to terminate their pregnancies vary. The most common are 1) they cannot afford to have a child; 2) they need to take care of the children and family they already have; and 3) having a child would interfere significantly with their current life path and could potentially lead to a hindrance of planning for future goals such as completing their education.
There are many other reasons which can include difficulty with significant other, recent death of a partner, severe medical problems, and possibly rape or incest. These are only a few. No woman wants to have an abortion. She alone has her reasons. During your counseling session the alternatives to abortion will be discussed, along with describing the fetal intra-cardiac injection procedure.
The benefits and risks of the procedure are discussed and the steps involved in carrying out the procedure are communicated. It includes the following:
Cervical Maturation (softening and opening of the cervix):
This consists of using osmotic dilators (Laminaria, Delavan, Lamaze), uterotonic medications Misoprostol (Cytotec) and other medications that were used to assure cervical ripening to occur. This reduces the chance of the most frequent and rare side effects, risks and complications associated with the second trimester, third trimester and late term abortion procedures. Our offices have less than 0.5% or less chance of any complications or side effects. The maternal death rate is approximately 10 times higher for women who deliver their pregnancy at term (40 plus or minus 2 weeks).
Stopping the Fetal Heart Beat In-Utero:
It is recommended the fetal heart be stopped in patients who are 21.5 weeks gestation or further to prevent any question of viability upon delivery. There are several medications and methods used to do so.
Intra-Fetal injections can be placed intra-cardiac, buttocks, extremity, intra-thoracic or intra-cranial. Medications can also be injected directed into the amnionic fluid. Though highly effective this latter method may take a few hours for the fetal heart to become asystole (absent fetal heart beat).
Fetal Intra-cardiac Injection:
The patient is taken to the procedure room where she is placed on an exam table. If patient elects to have a mild IV sedative it is given at this point. The patient's abdomen is cleansed with an anti-septic solution. A sonogram sector scan is placed on the patient's abdomen and the fetal abdominal cavity is isolated. A spinal needle is guided slowly into the fetal heart where a feticide agent (digoxin, potassium chloride, hypertonic saline) or 50cc's of air is injected via a syringe to stop the fetal heart beat. The procedure usually takes 2 to 4 minutes to perform. The patient is then observed for several minutes in the procedure room.
Complications associated with fetal intra-cardiac or other forms of fetal or intra-amnionic injection:
With or without IV Sedation patients are able to go home in 10 to 15 minutes after the procedure is performed. The majority of patients experience no pain or discomfort following the procedure. Some patients experience very mild cramping and contractions for 2 to 5 minutes after the procedure. There are some women who experience vaginal spotting or bleeding. It is extremely rare but complete or partial separation of the placenta (abruption) can occur along with heavy vaginal bleeding. There have been rare occasions where infection of the amniotic fluid (amnionitis), the intrauterine cavity (Endometritis), or the muscle of the uterus (myometritis) occurs. It is extremely rare but maternal death has occurred due to sepsis (infection getting into the mother's blood) or severe vaginal bleeding. The incidence of any of these complications occurring is very rare and has never been seen by our offices but must be discussed in order for patients to be fully informed.
Medications are started the following morning that induce (begin) the labor process. Other medications are given to reduce discomfort and anxiety. The process is complete within a few hours. The process is associated with minimal to no complications.
Women are able to call or email preferable (Drpendergraft@gmail.com) 24 hours a day, 7 days a week.