The Choice of Second Trimester Abortion Method: Evolution, Evidence and Ethics

Posted: 27 Feb 2009

See all articles by David A. Grimes

David A. Grimes

University of North Carolina School of Medicine

Date Written: May 2008

Abstract

Decades after its introduction, dilatation and evacuation (D&E) is still not universally offered by gynaecologists who provide second trimester abortion. Three lines of evidence point to D&E as the preferred method for most women. First, the uterus has evolved to expel its contents early and late in pregnancy, not in the middle. Hence, induction of labour with medical abortion forces the uterus to perform a task it is not designed to do. Second, cohort studies and randomised, controlled trials over the past 30 years have consistently shown that D&E is safer and more effective than labour induction abortion, regardless of the abortifacient used. Third, the ethical principles of beneficence, autonomy and justice require that D&E be routinely offered by gynaecologists who perform second trimester abortions. The uneven geographical availability of D&E may stem from lack of information, lack of requisite equipment and training, or lack of motivation. According to the principles of evidence-based medicine and bioethics, these barriers to better care for women can and should be overcome.

Keywords: second trimester abortion, medical abortion, dilatation and evacuation

Suggested Citation

Grimes, David A., The Choice of Second Trimester Abortion Method: Evolution, Evidence and Ethics (May 2008). Reproductive Health Matters Supplement, Vol. 16, No. 31, May 2008, Available at SSRN: https://ssrn.com/abstract=1350297

David A. Grimes (Contact Author)

University of North Carolina School of Medicine ( email )

102 Ridge Road
Chapel Hill, NC NC 27514
United States

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