Obstetrics & Gynecology

Skip Navigation LinksHome > April 2011 - Volume 117 - Issue 4 > Second-Trimester Abortion for Fetal Anomalies or Fetal Death...
Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e31820c3d26
Original Research

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

Collapse Box


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.


© 2011 by The American College of Obstetricians and Gynecologists.



Looking for ABOG articles? Visit our ABOG MOC II collection. The selected Green Journal articles are free through the end of the calendar year.


If you are an ACOG Fellow and have not logged in or registered to Obstetrics & Gynecology, please follow these step-by-step instructions to access journal content with your member subscription.

Article Tools


Article Level Metrics