Second-Trimester Abortions

To the Editor.— The report of Cates and associates in The Journal (1982; 248:559) was the latest one of a series of publications in which they extolled the merits of second-trimester abortion by dilatation and evacuation (D&E). In their recent article, the authors continued to emphasize the safety of the method as compared with other midtrimester procedures and present reassuring data about the rate of "serious" postoperative complications. Regretfully, there is much evidence to indicate that neither the statistics they quoted nor the scope of complications they referred to present a realistic picture.

A rapidly increasing number of publications indicate that the main risk of artificially induced abortion is not postoperative hemorrhage, sepsis, and uterine perforation (which only occasionally occur), but permanent cervical incompetence that follows induced abortion in a considerable proportion of the cases. The fact that second-trimester spontaneous abortion and premature birth frequently follow instrumental interruption of gestation