Medication abortion and procedural abortion in the second trimester: Comparison of complications at 16–23 6/7 Weeks’ gestation

Objective

To compare the frequency of complications for abortions performed by dilation and evacuation (D&E) and medication abortion between 16 and 23 6/7 weeks’ gestation.

Methods

The study was a retrospective cohort analysis of second-trimester abortion cases at an academic medical center between January 2012 and December 2022. The primary outcome was the frequency of complications during D&E versus medication abortion. The analyses were further stratified by gestational age: 16 0/7 to 19 6/7 weeks, and 20 0/7 to 23 6/7 weeks.

Results

We identified 1,261 patients who underwent abortion between 16 and 23 6/7 weeks’ gestation, with 1,049 D&E and 212 medication abortion procedures. A lower rate of complications occurred in the D&E group than in the medication abortion group (8.4 % versus 17 %, p < 0.001). The most common complication in the D&E group was cervical laceration, which increased with later gestational age. In the medication abortion group, the most common complication was hemorrhage. More complications occurred with medication abortion than with D&E in each of the gestational age strata.

Conclusion

Our study is one of the largest to directly compare second-trimester D&E and medication abortion complications and adds a large number of cases at 20 weeks and beyond. Complications occur less frequently with procedural compared to medication abortion, mostly related to hemorrhage. The overall frequency of complications was similar to that reported in previous literature.