Second-trimester surgical abortion practices in the United States

Area of Science:

• Medical Practice
• Reproductive Health
• Surgical Procedures

Background:

• Second-trimester surgical abortions are a critical component of reproductive healthcare.
• Evidence-based guidelines exist to standardize and optimize these procedures.
• Understanding current provider practices is essential for assessing adherence to these guidelines.

Purpose of the Study:

• To evaluate the alignment of current U.S. second-trimester surgical abortion practices with established evidence-based policy guidelines.
• To identify areas of consensus and variability in provider practices.

Main Methods:

• A cross-sectional survey was conducted among U.S. abortion facilities from June to December 2013.
• Data were collected from 172 clinicians performing second-trimester surgical abortions (dilation and evacuations [D&Es]).
• The survey assessed various practice aspects, including medication use, patient selection, and procedural techniques.

Main Results:

• Most clinicians use misoprostol for cervical preparation and employ routine intraoperative ultrasound.
• Variability exists in practices such as routine fetal demise induction and referral criteria for specific patient conditions (e.g., placenta previa).
• Many clinicians have BMI restrictions for sedation and routinely use prophylactic uterotonics and perioperative antibiotics.

Conclusions:

• Second-trimester surgical abortion practices largely align with professional evidence-based guidelines.
• Practices lacking a strong evidence base exhibit greater variability among providers.
• The provider workforce is younger, but access to outpatient abortion may be limited by facility and hospital restrictions.