Dilation and evacuation at ≥20 weeks: comparison of operative techniques

Objective The objective of this study is to compare the relative safety of 2 techniques for surgical abortion late in the second trimester. Study design Retrospective review of patients who underwent surgical abortion at ≥20 weeksʹ gestation at our hospital from June 1996 through June 2003. Records were reviewed to determine whether the technique used was dilation and evacuation or intact dilation and extraction. Subsequent pregnancies at our hospital were identified, and obstetric outcomes were recorded. Categorical data were compared with Fisher exact test and χ2 analysis. Continuous data were compared with Mann-Whitney U test. Results Three hundred eighty-three patients met inclusion criteria. Intact dilation and extraction was performed in 120 cases, and dilation and evacuation was used in 263. Intact dilation and extraction was associated with higher parity, later gestational age, and more preoperative cervical dilation. There was no difference in procedure time or estimated blood loss in the 2 groups. Complications occurred in 19 cases (5.0%), and occurred with similar frequency in the 2 groups. We identified 62 subsequent pregnancies. There were no second-trimester miscarriages. Spontaneous preterm birth occurred in 2 of 17 (11.8%) pregnancies in the intact dilation and extraction group, compared with 2 of 45 (4.4%) in the dilation and evacuation group (P = .30). Conclusion Outcomes appear similar between patients undergoing dilation and evacuation and intact dilation and extraction after 20 weeksʹ gestation. Subsequent obstetric outcomes are similar between the 2 groups. The technique for surgical abortion should be determined by the physician on the basis of intraoperative factors.