Second-Trimester Surgical Abortion Is Safe: Audit of Complication Rates at an Australian Tertiary Hospital

An estimated 73.3 million abortions occur annually worldwide. Second-trimester abortion is known to carry a higher risk of complications than first-trimester abortion, though the absolute risk is thought to be low. There is limited Australian data about second-trimester surgical abortions and no studies have looked at surgical complications.

This study aimed to determine the complication rate of second-trimester surgical abortions at an Australian tertiary maternity hospital across a 5-year period.

A retrospective audit was conducted from 1 January 2019 to 31 December 2023. Inclusion criteria were women and pregnant people with a gestation of 14 + 0 to 23 + 6 weeks who underwent dilation and evacuation for termination of pregnancy. The primary outcome was the rate of complications.

Two thousand, one hundred and sixty-four D&Es were performed for termination of pregnancy across the study period. Forty-seven of these women experienced complications, equating to a complication rate of 2.17%. The major complication rate was 0.55% (n = 12). The overall complication rate was significantly lower in women under 20 weeks' gestation compared to women over 20 weeks (1.71% vs. 4.19%, p = 0.007). This difference was significant when comparing minor complication rates only (RR 0.32, 95% CI 0.16-0.61); major complication rates demonstrated no significant difference between gestation groups (RR 1.12, 95% CI 0.25-5.15).

This study demonstrates that surgical second-trimester abortions are safe. Increased complication risk with increased gestational age is evident, highlighting the importance of timely access to abortion care.