Comparing medical versus surgical termination of pregnancy at 13–20 weeks of gestation: a randomised controlled trial

Abstract

Objective To compare the psychological impact, acceptability and clinical effectiveness of medical versus surgical termination of pregnancy (TOP) at 13-20 weeks of gestation.Design Randomised trial.Setting Large UK tertiary centre.Sample Women accepted for TOP at 13-20 weeks of gestation.Methods Medical TOP (MTOP) using mifepristone and misoprostol or surgical TOP (STOP) by vacuum aspiration at <15 weeks of gestation, and by dilatation and evacuation at 15 or more weeks of gestation.Main outcome measures Distress 2 weeks after TOP, measured by the impact of events scale (IES), and acceptability, measured by the proportion of women who would opt for the same procedure again.Results One hundred and twenty two women were randomised: 60 to the MTOP group and 62 to the STOP group. Twelve women opted to continue their pregnancy. Follow-up rates were low (n = 66/110; 60%). At 2 weeks post-procedure there was no difference in total IES score between groups. However, compared with women undergoing STOP, women undergoing MTOP had a higher score on the IES intrusion subscale (mean difference 6.6; 95% CI 1.4-11.8), and a higher score on the general health questionnaire (GHQ) (P = 0.033). Women found STOP more acceptable: compared with MTOP, more women would opt for the same procedure again (100% versus 53%, P £ 0.001), and fewer women found the experience to be worse than expected (0% versus 53%, P = 0.001). Women who had MTOP experienced more bleeding (P = 0.003), more pain on the day of the procedure (P = 0.008), and more days of pain (P = 0.020). Of the 107 women who declined to participate, 58 (67%) preferred a STOP.Conclusions Randomised trials of women requesting midtrimester TOP are challenging. Women found STOP less painful and more acceptable than MTOP.

Barriers to dilation & evacuation practice among Maternal-Fetal Medicine subspecialists: quantitative and qualitative results from a national survey

“…Dilation and evacuation (D&E) and induction termination are both safe and effective methods of second-trimester abortion [2]. D&E is faster, more predictable, more cost-effective, has a lower complication rate, and is associated with higher patient acceptability as compared to induction termination [3][4][5][6][7]. However, because of the inadequate number of D&E providers in the U.S., many women do not have timely access to D&E [8].…”

Confronting the challenge of unsafe second‐trimester abortion

“…Dilation and evacuation is the only second-trimester surgical method recommended by the WHO [20]. Limited randomized controlled trial data and a Cochrane review indicate that it is superior to induction, with fewer adverse effects, faster completion time, less pain, and overall higher patient acceptability [21][22][23]. Conclusive data are lacking on provider acceptability of dilation and evacuation versus induction termination.…”

Mort fœtale in utero au-delà de 14SA : induction du travail et obtention de la vacuité utérine

“…La dilatation mé canique du col suivie de l'é vacuation chirurgicale du contenu uté rin (dilatation and evacuation) est susceptible de provoquer des complications opé ratoires traumatiques ou hé morragiques. Plusieurs é tudes comparatives randomisé es ou non d'origine anglo-saxonne ont montré que la chirurgie é tait plus efficace (obtention de la vacuité uté rine) et n'augmentait pas les risques de complications opé ratoires et hé morragiques par rapport aux mé thodes d'induction mé dicale du travail par le misoprostol [12,13]. Les complications à long terme sur les grossesses ulté rieures (pré maturité , perte de la grossesse) ne semblent pas augmenté es aprè s une interruption chirurgicale de la grossesse au deuxiè me trimestre [14,15].…”