Laura Jacques1, Megan Heinlein2, Jessika Ralph2, Amy Pan3, Melodee Nugent3, Kristina Kaljo2, Rahmouna Farez2. 1. Department of Obstetrics and Gynecology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA. Electronic address: Laura.Jacques@wisc.edu. 2. Department of Obstetrics and Gynecology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA. 3. Section of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
Abstract
OBJECTIVE: To compare complication rates of dilation and evacuation (D&E) to mifepristone and misoprostol labor induction for second trimester abortion for fetal indications. STUDY DESIGN: We performed a retrospective cohort study comparing complication rates with D&E and labor induction abortion for fetal indications at 14 weeks 0 days through 23 weeks and 6 days gestation between January 1, 2009, and August 31, 2017. We extracted demographic, procedural, and outcome data, focusing specifically on complications of maternal hemorrhage, infection, emergency department visit, hospital readmission, retained tissue requiring dilation and curettage (D&C), manual placental removal, or thromboembolism. We compared complication rates between the D&E and induction groups using univariate and multivariate analyses. RESULTS: We included outcomes from 75 (48%) D&E and 81 (52%) labor induction abortions. We identified any complication in 1 (1%) and 7 (7%) of patients, respectively (p = 0.12). The only complication in the D&E group was hemorrhage with an estimated blood loss of 1000 mL not requiring transfusion. Labor induction complications included retained tissue requiring manual removal (n = 2) or D&C (n = 1) and hemorrhage (n = 2). CONCLUSION: There was no difference in complication rates between the D&E group and the labor induction group. IMPLICATIONS: This study compared outcomes between D&E and labor induction using mifepristone and misoprostol for second trimester abortion. Our complication rate for labor induction using mifepristone and misoprostol, and particularly our rate of retained placenta requiring D&C, was lower than what has been previously reported for second trimester labor induction termination using other methods. This study suggests there is a benefit for the routine use of mifepristone with misoprostol for second trimester labor induction. Additionally, the low rate of major complications in this study for both D&E and labor induction further validates the safety of both procedures for second trimester abortion.
OBJECTIVE: To compare complication rates of dilation and evacuation (D&E) to mifepristone and misoprostol labor induction for second trimester abortion for fetal indications. STUDY DESIGN: We performed a retrospective cohort study comparing complication rates with D&E and labor induction abortion for fetal indications at 14 weeks 0 days through 23 weeks and 6 days gestation between January 1, 2009, and August 31, 2017. We extracted demographic, procedural, and outcome data, focusing specifically on complications of maternal hemorrhage, infection, emergency department visit, hospital readmission, retained tissue requiring dilation and curettage (D&C), manual placental removal, or thromboembolism. We compared complication rates between the D&E and induction groups using univariate and multivariate analyses. RESULTS: We included outcomes from 75 (48%) D&E and 81 (52%) labor induction abortions. We identified any complication in 1 (1%) and 7 (7%) of patients, respectively (p = 0.12). The only complication in the D&E group was hemorrhage with an estimated blood loss of 1000 mL not requiring transfusion. Labor induction complications included retained tissue requiring manual removal (n = 2) or D&C (n = 1) and hemorrhage (n = 2). CONCLUSION: There was no difference in complication rates between the D&E group and the labor induction group. IMPLICATIONS: This study compared outcomes between D&E and labor induction using mifepristone and misoprostol for second trimester abortion. Our complication rate for labor induction using mifepristone and misoprostol, and particularly our rate of retained placenta requiring D&C, was lower than what has been previously reported for second trimester labor induction termination using other methods. This study suggests there is a benefit for the routine use of mifepristone with misoprostol for second trimester labor induction. Additionally, the low rate of major complications in this study for both D&E and labor induction further validates the safety of both procedures for second trimester abortion.
Authors: Tal Margaliot Kalifa; Eyal Lang Ben Nun; Hen Y Sela; Fayez Khatib; Sorina Grisaru-Granovsky; Misgav Rottenstreich Journal: J Clin Med Date: 2022-05-13 Impact factor: 4.964
Authors: Bianca M Stifani; Susane Mei Hwang; Renata Rodrigues Catani; Helena Borges Martins da Silva Paro; Nerys Benfield Journal: Front Glob Womens Health Date: 2022-02-22