Dilatation and evacuation procedures and second-trimester abortions. The role of physician skill and hospital setting

Publisher Website
Google Scholar
Abstract
Some clinicians have hesitated to perform dilatation and evacuation (D and E) procedures at 13 wk gestation or later because D and E are more difficult to perform safely than suction-curettage procedures. Many clinicians still believe that all 2nd trimester abortion procedures should be performed in a hospital. To evaluate these concerns, 24,664 abortions performed between 1973 and 1978 by 4 physicians associated with a large outpatient abortion facility were analyzed: 3711 (15%) of the abortions were 2nd trimester procedures. D and E was associated with a lower rate of serious complications per 100 procedures (0.23) than instillation of either dinoprost (prostaglandin F2.alpha.) (1.28) or hypertonic saline (2.26). In addition, D and E had lower rates for most other specific complications. D and E, while requiring more operator skill than earlier suction-curettage procedures, can be learned by gynecologists familiar with suction-curettage, can be performed more safely than the alternative instillation procedures, and can be safely practiced in selected ambulatory settings.