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Second-Trimester Abortion for Fetal Anomalies or Fetal Death: Labor Induction Compared With Dilation and Evacuation

Bryant, Amy G. MD; Grimes, David A. MD; Garrett, Joanne M. PhD; Stuart, Gretchen S. MD, MPHTM

doi: 10.1097/AOG.0b013e31820c3d26
Original Research

OBJECTIVE: To compare the safety and effectiveness of dilation and evacuation (D&E) and labor-induction abortion performed for fetal anomalies or fetal death in the second trimester.

METHODS: We performed a retrospective cohort study of second-trimester abortions performed for fetal indications. We compared the frequency of complications and effectiveness of abortions performed at 13–24 weeks for these indications. We calculated proportions of patients with complications for these two methods and controlled for confounding using a log binomial model.

RESULTS: Labor-induction abortions had higher complication rates and lower effectiveness than did D&E. Thirty-two of 136 women undergoing labor induction (24%) experienced one or more complications, in contrast to 9 of 263 women (3%) undergoing D&E (unadjusted relative risk 6.9 [95% confidence interval 3.4–14.0]). When controlled for confounding, the adjusted risk ratio for labor induction was 8.5 (95% confidence interval 3.7–19.8) compared with D&E.

CONCLUSION: Dilation and evacuation is significantly safer and more effective than labor induction for second-trimester abortion for fetal indications. Bias and chance are unlikely explanations for these large discrepancies. Women facing this difficult decision should be offered a choice of methods and be provided information about their comparative safety and effectiveness.

LEVEL OF EVIDENCE: II

Dilation and evacuation is safer and more effective than labor induction for secondtrimester abortion performed for fetal anomalies or fetal death.

From the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

See related editorial on page 775.

Dr. Stuart is supported by National Institutes of Health 5K12 HD050113 (Women's Reproductive Health Research Faculty Scholar Award).

Presented at the Association of Reproductive Health Professionals Annual Meeting, September 22–25, 2010, Atlanta, Georgia.

Corresponding author: Amy G. Bryant, MD, 3031 Old Clinic Building, Campus Box 7570, Chapel Hill, NC 27599-7570; e-mail: amy_bryant@med.unc.edu.

Financial Disclosure Dr. Stuart is a consultant for Schering-Plough. The other authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.