Issues in second trimester induced abortion (medical/surgical methods).

Second trimester abortion remains a common procedure worldwide. Dilatation and evacuation (D&E) is the surgical method of choice, if the surgical expertise and facilities are available. Adequate cervical dilatation preoperatively is a prerequisite for a safe D&E. Medical abortion using misoprostol together with mifepristone is the medical method of choice. The recommended regimen is 200mg mifepristone followed by 800 microg of vaginal misoprostol 36-48 h later. Subsequent doses of 400 microg of misoprostol can be given orally every 3h up to a maximum of four more doses. Proper preoperative assessment would not only help to provide safe abortion treatment, but it also guides the choice of method. If the expertise and facilities of both methods are available, both methods should be discussed and offered to the patient so that the patient can make an informed choice. 2010 Elsevier Ltd. All rights reserved.