Early midtrimester pregnancy termination. A comparison of dilatation and evacuation and intravaginal prostaglandin E2

Pregnancy termination by dilatation and evacuation (D&E) during the early midtrimester has been recommended as being more safe and acceptable than delaying for later induction with an intraamniotic instillation procedure. The availability of prostaglandin E2 (PGE2) for vaginal administration provides an alternative that is noninvasive and applicable in the early midtrimester without delay. This study compared the results of 400 consecutive abortions by D&E at 13 through 15 weeks' gestation to those previously obtained in 112 patients at the same period of gestation treated with PGE2 by serial vaginal administration. The PGE2 group experienced a complete abortion rate of 75%, a failure of 7.1% and a mean initiation-to-abortion time of 14.1 hours. Prostaglandin reactions, consisting of vomiting, diarrhea and transient temperature elevation, each occurred in about one-third of these patients. There were no failures in the D&E group and no increased risk of major complications. It is concluded that termination of pregnancy by D&E is preferable to the use of intravaginal PGE2, at least through the 15th week of gestation.