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Impact of midtrimester dilation and evacuation on subsequent pregnancy outcome
Robin B Kalish1, Stephen T Chasen, Laura B Rosenzweig
1Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, New York Weill Cornell Medical Center, 525 E. 68th Street, Room J-130, New York, NY 10021, USA. ROBINKAL@aol.com
Objective:
This study was undertaken to evaluate the impact of second-trimester dilation and evacuation (D&E) on subsequent pregnancy outcome.
Study Design:
Medical record review of 600 patients undergoing midtrimester (14-24 weeks) D&E from 1996 to 2000 and evaluation of subsequent pregnancy outcome. Mann Whitney U, Spearman rho, and chi(2) tests were used in statistical analysis with a P value <.05 considered significant.
Results:
Ninety-six subsequent pregnancies were identified, including 12 first-trimester spontaneous abortions, 1 second-trimester fetal death, 1 ectopic pregnancy, and 5 elective terminations. Seventy-seven pregnancies resulted in the delivery of a live-born infant at a median gestational age of 39.0 weeks. Five pregnancies (6.5%) were complicated by spontaneous preterm birth. Patients delivered preterm had an earlier gestational age at D&E (18.0 vs 20.0 weeks, P =.02) and a trend toward less preoperative cervical dilation (2.0 vs 3.0 cm, P =.09) than patients delivered at term.
Conclusion:
Second-trimester D&E is not a risk factor for midtrimester pregnancy loss or spontaneous preterm birth. Preterm delivery in future gestations appears less likely when greater preoperative cervical dilation is achieved with laminaria, possibly because of a decrease in cervical trauma.