Julia McDonald DO, MPH, Montida Fleming MD, Suzan Goodman MD, MPH

June 2023

Adapted from the curriculum Incremental Expansion of Abortion Care from 13.6 weeks through 17 weeks

Authored by Dr. Julia McDonald and the Later Abortion Initiative, a project of Ibis Reproductive Health   

This chapter is designed to help providers develop their skills to expand access to abortion by independently and safely expanding their abortion practice to 18 weeks. It is intended for providers already comfortable providing abortion care to 12-14 weeks estimated gestational age (EGA). It considers challenges to patients’ ability to travel distances, the impact of waiting for care, and systemic contributors in a post-Dobb’s context.


Following completion of this chapter, you should be able to:

  • Identify common reasons and unique challenges for abortion delays
  • Explore and clarify values around abortion with advancing gestational ages
  • List key preparations for providing abortion care beyond ≥ 14 weeks EGA
  • List cervical preparation options for dilation and evacuation beyond ≥ 14 weeks EGA, and pros and cons of their use at different gestational ages
  • List key instruments, medications and procedural techniques for dilation and evacuation



  • Cervical Preparation for Second Trimester Surgical Abortion (SFP 2007)
  • Second Trimester Abortion (ACOG Practice Bulletin 135: 2013)
  • Second-trimester abortion care with complex medical conditions (Henkel 2022)
  • Abortion by Dilation and Evacuation (NAF Clinical Policy Guidelines 2022)
  • Paul et al (eds). Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care (Wiley-Blackwell, 2009)
    • Chapter 11: Dilation and Evacuation


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