Mid-Trimester Abortion by Dilatation and Evacuation

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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 complications (0.69 vs. 1.78 per cent; P<0.001) and lower rates for treatment of complications, including antibiotic administration (2.22 vs. 5.65 per cent; P<0.001), blood transfusion (0.19 vs. 0.91 per cent; P<0.001), and curettage or manual evacuation of the uterus (0.98 vs. 34.10 per cent; P<0.001). Such abortions also had a lower rate for failure of the method to produce abortion (0.11 vs. 2.52 per cent; P<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. (N Engl J Med 296:1141–1145, 1977)

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