Objective: Our purpose was to compare the complication rate of first-trimester suction curettage with that of second-trimester dilation-and-evacuation abortions in the same clinical setting.
Study design: Retrospective analysis (chart review) of the 3772 induced abortions performed between 1986 and 1990 at the Family Planning Clinic of the Centre Hospitalier Universitaire de Sherbrooke, Quebec, Canada.
Results: Among the 3355 cases with known follow-up (89%), the complication rate was 5.1% for the 2908 suction curettages at < 15 weeks' gestation compared with 2.9% for the 447 dilation-and-evacuation procedures at 15 to 20 weeks' gestation. Serious complications were few and not increased among patients undergoing dilation and evacuation.
Conclusion: A careful approach to second-trimester dilation-and-evacuation procedures can make them comparatively as safe as suction curettages, contrary to common belief derived from large surveys done in the late 1970s.
PIP: Physicians reviewed 3355 charts of women who underwent an induced abortion between 1986 and 1990 at the family planning clinic of the Sherbrooke University Hospital in Quebec, Canada, to compare the complication rate of late second trimester abortions (15-20 weeks gestation) with that of first trimester abortions (15 weeks gestation). For all cases, physicians ordered preoperative cervical cultures for gonorrhea and chlamydia and used local anesthesia. They used laminaria tents for cases of at least 13 weeks gestation. They did an ultrasound for all cases of at least 15 weeks gestation. They disinfected the vagina, cervix, and perineum in all cases. They followed the no-touch sterile technique. Cases of at least 15 weeks gestation received iv oxytocin during the operation while the 10-14 week cases received injected oxytocin intracervically. The physicians applied Pratt cervical dilatation, ruptured the membranes, and let the amniotic fluid drain. They use Hern or Bierer forceps with adjunctive suction to empty the conceptus. They scraped the uterine cavity with sharp curettes in all cases to confirm that it was empty. 4.8% of all women had surgical complications which were more likely to occur in the 15-week group than in the or= 15-week group (5.1% vs. 2.9%; p = .056). Most common complications were infection (3.4% vs. 2%; p = .14) and incomplete abortions (0.9% vs. 0.4%, not significant, however). Just 11% of infection cases had to be hospitalized. 4 women experienced uterine perforations (3 in first trimester). Just 2 hospitalization cases were considered major surgical complications: postoperative moderate bleeding for 3 days in an incomplete abortion at 17 weeks, gestation, resulting in transfusion, and a first trimester postoperative infection case with a fever lasting more than 3 days. These findings showed that prudent second trimester dilatation and evacuation is essentially as safe as first trimester suction curettages.