Some clinicians have hesitated to perform dilatation and evacuation (D&E) procedures at 13 weeks' gestation or later because D&Es are more difficult to perform safely than suction-curettage procedures. Moreover, many clinicians still believe all second-trimester abortion procedures should be performed in a hospital. To evaluate these concerns, we analyzed 24,664 abortions performed between 1973 and 1978 by four physicians associated with a large outpatient abortion facility; 3,711 (15%) of the abortions were second-trimester procedures. Dilatation and evacuation was associated with a lower rate of serious complications per 100 procedures (0.23) than instillation of either dinoprost (prostaglandin F2α) (1.28) or hypertonic saline (2.26). In addition, D&E had lower rates for most other specific complications. We conclude that D&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.
Cates W, Schulz KF, Grimes DA, et al. Dilatation and Evacuation Procedures and Second-Trimester Abortions: The Role of Physician Skill and Hospital Setting. JAMA. 1982;248(5):559–563. doi:10.1001/jama.1982.03330050041028
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