Dilatation and evacuation procedures and second-trimester abortions. The role of physician skill and hospital setting
W. Cates Jr, K. F. Schulz, D. A. Grimes, A. J. Horowitz, F. A. Lyon, F. H. Kravitz and M. J. Frisch
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 abortion 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
F2 alpha) (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.
