Complications after Second Trimester Surgical and Medical Abortion

Posted: 27 Feb 2009

See all articles by Daniel Grossman

Daniel Grossman

affiliation not provided to SSRN

Kelly Blanchard

IBIS Reproductive Health

Paul Blumenthal

Professor, Division of Gynecologic Specialities, Stanford University

Date Written: May 2008

Abstract

Second trimester abortion is associated with higher rates of complications compared to first trimester abortion. Dilatation and evacuation (D&E) and medical induction using misoprostol alone or a combination of mifepristone and misoprostol are the methods most commonly used for later abortion in developed countries, yet little research has directly compared them. We reviewed the literature on PubMed and identified only one small randomised controlled trial and one retrospective cohort study with comparative data for these methods, although the cohort study did not include cases using the mifepristone regimen. We expanded our search to include case series and cohort studies for a single method. In the randomised trial, women undergoing medical induction reported significantly more pain and experienced more adverse events. In the cohort study, incomplete abortion was significantly more common among women undergoing medical induction. In the single method studies, serious complications such as uterine perforation, uterine rupture and haemorrhage were rare, although the latter may be more common with medical induction. Mild infection may also be more prevalent after medical induction. Current evidence suggests that, given trained providers and where otherwise feasible, D&E is preferable to medical induction. A larger randomised controlled trial is needed that directly compares outcomes between the two methods, examines acceptability to women and explores clinicians' perspectives on providing them.

Keywords: second trimester medical abortion, dilatation and evacuation, safety and efficacy, Canada, Scotland, United States, Viet Nam

Suggested Citation

Grossman, Daniel and Blanchard, Kelly and Blumenthal, Paul, Complications after Second Trimester Surgical and Medical Abortion (May 2008). Reproductive Health Matters Supplement, Vol. 16, No. 31, May 2008, Available at SSRN: https://ssrn.com/abstract=1350296

Daniel Grossman (Contact Author)

affiliation not provided to SSRN ( email )

Kelly Blanchard

IBIS Reproductive Health ( email )

Paul Blumenthal

Professor, Division of Gynecologic Specialities, Stanford University ( email )

Stanford, CA 94305
United States

Here is the Coronavirus
related research on SSRN

Paper statistics

Abstract Views
886
PlumX Metrics