The comparative safety of second-trimester abortion methods

The comparative safety of methods used to perform second-trimester abortion is an important public health concern. Morbidity and mortality studies indicate that dilatation and evacuation (D & E) is safer than instillation abortion, which is safer than hysterotomy or hysterectomy. In the third phase of the Joint Program for the Study of Abortion, the adjusted relative risk of serious complications associated with intra-amniotic instillation of urea and prostaglandin F2 alpha (the safest abortifacient regimen) was 1.9 times that associated with D & E (95% confidence interval 1.2-3.1). Surveillance of abortion mortality in the United States from 1972 to 1981 revealed a death-to-case rate of 4.9 per 100 000 abortions associated with D & E, 9.6 with instillation methods, and over 60 with hysterotomy or hysterectomy. Little information exists on potential late sequelae of second-trimester abortion. D & E appears to be the safest method of second-trimester abortion available in the United States.