Mid-Trimester Abortion by Dilatation and Evacuation

Abstract

Abortions by dilatation and evacuation after the 12th menstrual week of pregnancy are said to be both hazardous and impractical. To evaluate this hypothesis, we compared the safety and feasibility of 6213 abortions by this means and 8662 induced by intra-amniotic instillation of saline during the 13th to the 20th week of pregnancy. Abortions by dilatation and evacuation had a lower rate for major complica-tions (0.69 vs. 1.78 per cent; P is less than 0.001) and lower rates for treatment of complications, including antibiotic administration (2.22 vs. 5.65 per cent; P is less than 0.001), blood transfusion (0.19 vs. 0.91 per cent; P is less than 0.001), and curettage or manual evacuation of the uterus (0.98 vs. 34.10 per cent; P is less than 0.001). Such abortions also had a lower rate for failure of the method to produced abortion (0.11 vs. 2.52 per cent; P is less than 0.001). Although large, randomized trials are required to determine the appropriate role of mid-trimester abortion by this means, this method appears safe and practical through the 20th week of pregnancy.

Study of efficacy of mifepristone as inducing agent for mid trimester medical termination of pregnancy in women with previous cesarean section

“…[12][13][14][15][16] For second trimester abortion (13-24 weeks of gestation), medical abortion with mifepristone followed by a prostaglandin analogue is an appropriate method and has been shown to be safe and effective, according to WHO and the RCOG. [17][18][19][20][21][22] It has been well proven that pretreatment with mifepristone 24-48 hours before prostaglandin administration increases the success rate, shortens the induction-to-abortion interval and reduces the amount of prostaglandins required in the second trimester in unscarred uteri. 23,24 In our series women with previous LSCS ,mifepristone 200 mg was given 36 hours prior to the misoprostol or oxytocin and found that none of the cases had incomplete abortion or rupture probably because we had ensured improvement in Bishop's score even by putting Foley's bulb before administration of prostaglandins.…”

Surgical Abortion in the Second Trimester

“…6,7 Induction of labour by intra-amniotic instillation of saline or urea-prostaglandin F2-alpha was shown to have higher relative risks of serious complications than D&E (RR 2.6, 95% CI 1.9-3.6 and RR 1.9, 95% CI 1.2-3.1, respectively). One randomised trial comparing D&E to intra-amniotic instillation of prostaglandin F2-alpha supported these findings.…”

“…A D&E refers to any instrumental evacuation of the pregnant uterus through the cervix at z13 weeks gestation. 7 This operational definition was proposed by the US Centers for Disease Control to differentiate second trimester curettage procedures from first trimester procedures (vacuum aspiration or suction curettage). Although vacuum aspiration can be performed to 16 weeks gestation using large-bore cannulae (14-16 mm in diameter), 37 by convention this would be referred to as a D&E.…”

Second Trimester Abortion Provision: Breaking the Silence and Changing the Discourse

“…Labour and delivery nurses caring for women throughout the process, not doctors, were the caregivers most burdened. 12 The shift to surgical second trimester abortion care did not begin until 1977, when David Grimes and colleagues published a pivotal study documenting the safety of D&E. 13 As D&E became increasingly accepted as a superior means of accomplishing second trimester abortion compared to labour induction, a small amount of research on provider perspectives on D&E resulted. Kaltreider et al found that some doctors who provided D&E had ''disquieting'' dreams and strong emotional reactions.…”

“…Kaltreider et al found that some doctors who provided D&E had ''disquieting'' dreams and strong emotional reactions. 13 Hern found that D&E was ''qualitatively a different procedure -both medically and emotionallythan early abortion''. 14 Many of his staff members reported:…”