Midtrimester abortion. Intra-amniotic instillation of hyperosmolar urea and prostaglandin F2 alpha v dilatation and evacuation
M. E. Kafrissen, K. F. Schulz, D. A. Grimes and W. Cates Jr
Although dilatation and evacuation (D&E) is currently the most common
method of midtrimester abortion in the United States, the intra-amniotic
instillation of hyperosmolar urea and prostaglandin F2 alpha combined (U-P)
has been proposed as a safer technique. To evaluate the comparative safety
of U-P and D&E, we analyzed 2,805 U-P and 9,572 D&E abortions at 13
to 24 menstrual weeks' gestation. The U-P procedure resulted in
significantly more serious complications than D&E (1.03 v 0.49 per 100
abortions). After adjusting for patient age, race, parity, follow-up
information, and preexisting conditions, the relative risk of serious
complications associated with U-P was 1.9 (95% confidence interval, 1.2 to
3.1). This advantage for D&E stems from its applicability to the 13- to
16-week interval. Although D&E appears to be safer overall in the
midtrimester, for women obtaining abortion after 16 weeks, the rates of
serious complications were comparable, with a relative risk of 1.0 (95%
confidence interval, 0.4 to 2.5).
