Second-trimester abortion (14 to 27 weeks): what happens

How common it is

The CDC's most recent report, for 2022, counts abortions in the states that report to it (not a full national count). In those states:

About 93% of abortions happened at or before 13 weeks.
About 6% happened between 14 and 20 weeks.
About 1% happened at 21 weeks or later.

The two methods compared

	Dilation and evacuation (D&E)	Induction abortion
How often it's used	Most second-trimester abortions	Less common
What happens	The cervix is opened, then the fetus and placenta are removed with suction and instruments	Medicines make the uterus contract and pass the pregnancy, like labor
Where	In a clinic or hospital, usually with sedation or anesthesia	Usually somewhere you can be monitored for many hours
How long	Cervical preparation can start hours or a day before; the procedure itself is shorter	Usually 12 to 24 hours

Dilation and evacuation (D&E)

ACOG calls D&E the usual approach after about 12 to 15 weeks. Because the fetus is larger, the cervix has to open wider than in the first trimester. That often begins hours or a day before, using small dilators that slowly absorb fluid and swell, medicine to soften the cervix, or both. During the procedure, usually with sedation or anesthesia, the doctor uses suction and forceps to remove the fetus and placenta. ACOG's language guide notes this can mean the fetus is removed in parts. No cut is made in the skin. Read what happens during a surgical abortion for the step-by-step.

Induction abortion

In an induction, medicines given by mouth, in the vagina, by IV or by injection into the uterus make the uterus contract and pass the pregnancy, much like labor and delivery. ACOG says it usually starts within 12 hours and takes 12 to 24 hours in all, and pain medicine is usually given. Nausea, vomiting, diarrhea and fever are common side effects.

Stopping the fetal heart first

Before some later procedures, the doctor injects a medicine (digoxin, potassium chloride or lidocaine) into the fetus or the fluid around it to stop the fetal heart. The Society of Family Planning recommends this near and after viability, to avoid a live birth, but not routinely before viability.

How developed the baby is at 14 to 27 weeks

By the start of the second trimester, all of the essential organs have begun to form. During these weeks they keep growing and maturing. Based on MedlinePlus and ACOG:

Weeks 11 to 14: the face is well formed, nails appear on the fingers and toes, and the baby can make a fist.
Weeks 13 to 16: the structures for hearing begin to develop.
Weeks 15 to 18: bones grow harder, the baby begins to move and stretch, and makes sucking motions.
Weeks 19 to 21: the baby can hear and is more active. Many mothers first feel fluttering movements around now.
Week 22: eyebrows and lashes appear, and the heartbeat can be heard with a stethoscope.
Weeks 23 to 26: the lungs keep developing, the baby begins to store fat, and may startle at loud noises.

When a baby can survive outside the womb

ACOG calls about 20 through 25 weeks the periviable period, when survival outside the womb becomes possible but isn't likely, and says there's no single cutoff. Survival to hospital discharge rises quickly:

Before 23 weeks: about 5 to 6%
23 weeks: about 23 to 27%
24 weeks: about 42 to 59%
25 weeks: about 67 to 76%

See fetal development week by week for the full picture.

Where experts disagree

Can a fetus feel pain in the second trimester?

The major medical groups' view: ACOG says a fetus doesn't have the capacity to feel pain until at least 24 to 25 weeks. The UK's Royal College of Obstetricians and Gynaecologists reviewed the evidence in 2022 and concluded pain perception before 28 weeks is unlikely. Both say reflex reactions earlier in pregnancy aren't the same as feeling pain.

The other view: in a 2020 paper in the Journal of Medical Ethics, two researchers who hold opposing views on abortion argued the brain area those groups point to may not be required for pain. They said the evidence points toward a basic, unreflective pain experience possibly from as early as 12 weeks, and that pain relief during later abortions is reasonable to consider.

Pain can't be measured directly in a fetus, and this question is still debated.

Why some people have an abortion later

People reach the second trimester for many reasons. A 2013 U.S. study interviewed women who had abortions at or after 20 weeks. Many had found out they were pregnant later, and many described delays from finding a provider and raising money for the procedure and travel. Common circumstances included raising children alone, conflict with a partner or abuse, depression or substance use, being young and pregnant for the first time, and having a hard time deciding.

For others, the reason is news about the baby or their own health. Ultrasounds in the second trimester can find problems with how the baby is developing that weren't known before.

If you're facing a hard diagnosis, you have time to ask questions. A specialist in high-risk pregnancy can explain what the diagnosis means and what care is possible, and some families choose to continue the pregnancy with support. If money, a partner or fear of doing this alone is part of what you're weighing, that kind of help exists too. See financial help and all your options.

Risks compared with earlier abortion

Serious complications are uncommon at any stage, but the risk rises the further along the pregnancy is:

An NIH clinical review reports that major complications (needing a hospital stay, surgery or a transfusion) rise from about 2 in 1,000 procedures at 8 weeks to about 15 in 1,000 at 20 weeks.
A CDC-led study of U.S. abortion deaths from 1998 to 2010 found deaths are rare overall, under 1 in 100,000, but the rate rose with each stage of pregnancy, from 0.3 per 100,000 at 8 weeks or earlier to 6.7 per 100,000 at 18 weeks or later.
For induction, ACOG says a tear (rupture) of the uterus or cervix is rare, under 1 in 1,000, and the risk rises the longer the pregnancy has gone on.

Other risks are the same as for any procedure: heavy bleeding, infection, tissue left behind, and injury to the cervix or uterus.

Call your doctor or get medical care right away (call 911 or go to an emergency room if you can't reach them) if you have:

Heavy bleeding: soaking through two maxi pads an hour for two hours in a row
Severe pain in your belly or back
A fever above 100.4°F (38°C)
Foul-smelling discharge from the vagina

For what to expect physically and emotionally afterward, see after an abortion.

Sources

ACOG. Induced abortion (patient FAQ) and Abortion language guide.
CDC. Abortion Surveillance, United States, 2022.
StatPearls (NIH Bookshelf). Abortion (updated 2025).
Society of Family Planning. Induction of fetal asystole before abortion (2024).
MedlinePlus. Fetal development and Pregnancy ultrasound.
ACOG. How your fetus grows during pregnancy and Understanding and navigating viability.
ACOG. Gestational development and capacity for pain.
Royal College of Obstetricians and Gynaecologists. Fetal awareness: evidence review (2022).
Derbyshire SW, Bockmann JC. Reconsidering fetal pain. Journal of Medical Ethics 2020;46(1):3–6.
Foster DG, Kimport K. Who seeks abortions at or after 20 weeks? Perspectives on Sexual and Reproductive Health 2013;45(4):210–218.
Zane S, et al. Abortion-related mortality in the United States, 1998–2010. Obstetrics & Gynecology 2015;126(2):258–265.

Common questions

What happens in an abortion at 16 weeks?

At 16 weeks, the most common method is dilation and evacuation (D&E). The cervix is opened, often starting the day before, and the doctor removes the fetus and placenta with suction and instruments, usually with sedation. Less often, medicines are used to start labor instead (induction).

What happens in an abortion at 20 weeks?

The methods are the same as earlier in the second trimester, D&E or induction, but the cervix needs more preparation and the risk of complications is higher than earlier in pregnancy. By about 20 weeks the baby can hear and the mother often feels movement.

How common are second-trimester abortions?

Uncommon. In CDC data for 2022 from reporting states, about 6% of abortions happened between 14 and 20 weeks and about 1% at 21 weeks or later. About 93% happened at or before 13 weeks.

Can a baby survive if born in the second trimester?

Survival becomes possible in the periviable period, about 22 to 25 weeks, and the odds rise each week. ACOG reports survival to hospital discharge of about 23 to 27% at 23 weeks and 67 to 76% at 25 weeks. See fetal development week by week.

Last updated 2026-11-02. Medical facts on this page are drawn from the sources listed at the end and on our sources page. This is general information, not medical advice.