Second trimester dilation and evacuation: a risk factor for preterm birth?

Area of Science:

• Obstetrics and Gynecology
• Reproductive Health
• Maternal-Fetal Medicine

Background:

• Second trimester pregnancy termination is performed for various medical reasons.
• Understanding the long-term reproductive outcomes, specifically preterm birth risk, following different termination methods is crucial for patient counseling.

Purpose of the Study:

• To compare the subsequent risk of preterm birth in women who underwent second trimester pregnancy termination via dilation and evacuation (D&E) versus induction of labor (IOL).

Main Methods:

• Retrospective cohort study of 173 women undergoing second trimester termination for fetal anomalies, fetal death, or previable premature rupture of membranes.
• Analysis of spontaneous delivery rates before 37 weeks in the first pregnancy post-termination.
• Comparison of cohort preterm birth rates with national averages and analysis by the number of prior procedures.

Main Results:

• Women undergoing D&E (n=130) had a significantly lower rate of subsequent preterm birth (6.9%) compared to those undergoing IOL (30.2%; P<0.01).
• This association persisted in a subset of women without obstetric risk factors.
• No statistical difference in preterm birth rates was observed between D&E and national averages, or across varying numbers of prior first or second trimester procedures.

Conclusions:

• Dilation and evacuation (D&E) for second trimester pregnancy termination was not found to be a risk factor for subsequent preterm delivery when compared to induction of labor (IOL) or national rates.
• The findings suggest D&E is a safe procedure regarding future pregnancy outcomes related to preterm birth.