Complications after second trimester surgical and medical abortion

Second trimester abortion is associated with higher rates of complications compared to first trimester abortion. Dilatation and evacuation (D&E) and medical induction using misoprostol alone or a combination of mifepristone and misoprostol are the methods most commonly used for later abortion in developed countries, yet little research has directly compared them. We reviewed the literature on PubMed and identified only one small randomised controlled trial and one retrospective cohort study with comparative data for these methods, although the cohort study did not include cases using the mifepristone regimen. We expanded our search to include case series and cohort studies for a single method. In the randomised trial, women undergoing medical induction reported significantly more pain and experienced more adverse events. In the cohort study, incomplete abortion was significantly more common among women undergoing medical induction. In the single method studies, serious complications such as uterine perforation, uterine rupture and haemorrhage were rare, although the latter may be more common with medical induction. Mild infection may also be more prevalent after medical induction. Current evidence suggests that, given trained providers and where otherwise feasible, D&E is preferable to medical induction. A larger randomised controlled trial is needed that directly compares outcomes between the two methods, examines acceptability to women and explores clinicians' perspectives on providing them.