OB Guideline 9: Pregnancy Termination After 14 Weeks

Patients interested in pregnancy termination should be offered the full range of management options, including referral if necessary, and a plan for care should be documented. Massachusetts Department of Public Health abortion consent, as well as any institution-specific consents should be obtained and documented. Patient preference for disposition of fetal remains should be documented.

Eligibility for abortion should be determined by medical providers in accordance with state law. Best estimate of gestational age should be used, and the calculation of gestational age should be consistently applied and transparently obtained by all available dating criteria. Ultrasound verification of gestational age including determination of biparietal diameter is preferred.

Prior to Pregnancy Termination After 14 Weeks

• Obtain medical and obstetrical history
• Confirm the gestational age
• Conduct a physical exam
• Counsel the patient regarding potential risks, agents, and methods for the chosen procedure

The plan of care should take into consideration:

• The patient’s wishes for an intact fetus
• The patient’s wishes to avoid labor and delivery
• Availability of care providers experienced in pregnancy termination procedures
• Medical or obstetrical co-morbidities

Plan of care may include, but not be limited to:

• Discussion of the appropriate location for the proposed procedure
• Anesthesia consultation as indicated
• Consultation with Social Work, Chaplaincy, or both as desired

Institutional Guidelines

Each facility shall develop guidelines for pregnancy termination after 14 weeks to include, at a minimum, details regarding:

• Standards for documenting gestational age
• Procedures
• Medications
• Use of cervical ripening agents
• Role of intra-operative ultrasound for procedures
• Potential role of feticidal agents
• Adherence to local and federal laws and regulations
• Strategy/plan in the event of a live birth

Methods of Pregnancy Termination After 14 Weeks

Methods of pregnancy termination after 14 weeks include dilation and evacuation, and induction of labor. Hysterectomy and hysterotomy are not considered primary methods for pregnancy termination.

Documentation

Documentation should include, but not be limited to:

• Discussion of procedures or methods, and their risks and benefits
• Consents for medical-surgical procedures and the Massachusetts Department of Public Health consents
• Plan for disposition of fetal remains
• Administration of medications: time, date, dose
• Placement of osmotic dilators (e.g., laminaria, dilapan), including date, time, and number placed, as needed for cervical preparation
• Patient’s clinical course
• Delivery or removal of fetal and placental tissues and completeness
• Complications and need for additional procedures^1,2

1. ACOG Practice Bulletin No. 135: Second-trimester abortion. Obstet Gynecol. 2013;121(6):1394-1406. Reaffirmed 2023. doi:10.1097/01.AOG.0000431056.79334.cc
2. American College of Obstetricians and Gynecologists. Abortion policy. ACOG. Updated July 2025. https://www.acog.org/clinical-information/policy-and-position-statements/ statements-of-policy/2025/abortionpolicy