Deaths from second trimester abortion by dilatation and evacuation: causes, prevention, facilities.

In 1978, dilatation and evacuation (D & E) became the leading method of abortion at 13 weeks' gestation or later in the United States. The increasing popularity of D & E reflects its relative advantages in safety, convenience, expense, and speed when compared with alternate methods. The authors reviewed all reported deaths from D & E in the United States between January 1, 1972, and December 31, 1978. The predominant causes of death were infection and hemorrhage. both race and gestational age significantly influence the death:case rate for D & E procedures. White women had a threefold lower risk of dying from D & E than women of other races. D & E procedures performed at 13 to 15 weeks' gestation were nearly 3 times safer than those performed at 16 weeks or later. D & E performed in nonhospital settings did not have higher death:case rates than those performed in hospitals. Comparative mortality data suggest abortion by D & E at 13 weeks' gestation or later is more dangerous than suction curettage performed earlier in gestation, but safer than instillation techniques performed later. The advantage of D & E occurs largely in the 13- to 15-week gestation interval, that is, at the beginning of the second trimester. Policy makers should reconsider laws requiring all second trimester abortions to be performed in hospitals. Based on these data, 16 weeks' gestation would be more appropriate threshold at present.