Surgical versus medical methods for second-trimester induced abortion.

Area of Science:

• Obstetrics and Gynecology
• Reproductive Health

Background:

• Second-trimester abortions require understanding the benefits and harms of surgical versus medical methods.
• This review updates previous findings on outcomes and patient experiences to guide clinical practice.

Purpose of the Study:

• To compare the benefits and harms of surgical and medical methods for induced abortion in the second trimester (≥13 weeks' gestation).

Main Methods:

• A systematic review and meta-analysis of randomized trials comparing surgical abortion (vacuum aspiration or D&E) with medical abortion (mifepristone and misoprostol).
• Searched multiple databases up to November 2023 and contacted experts for additional studies.
• Assessed study validity using Cochrane methods and certainty of evidence with GRADE.

Main Results:

• Three trials (281 participants) were included, with pregnancy durations from 12 to 19 weeks and 6 days.
• Abortion completion rates were similar for both methods (very uncertain evidence).
• Surgical abortion may result in fewer incomplete abortions (very uncertain evidence), less bleeding (low certainty evidence), and potentially lower pain scores (very uncertain evidence).

Conclusions:

• Comparative evidence on second-trimester abortion methods is limited, with significant uncertainty due to study limitations.
• Both methods achieve high completion rates, but medical abortion may have a slightly higher risk of incomplete abortion and bleeding.
• Further research with consistent protocols and focus on patient experience is recommended.