Second-trimester abortion for fetal anomalies or fetal death: labor induction compared with dilation and evacuation.

OBJECTIVE: To compare the safety and effectiveness of dilation and evacuation (D&E) and labor-induction abortion performed for fetal anomalies or fetal death in the second trimester.

METHODS: We performed a retrospective cohort study of second-trimester abortions performed for fetal indications. We compared the frequency of complications and effectiveness of abortions performed at 13-24 weeks for these indications. We calculated proportions of patients with complications for these two methods and controlled for confounding using a log binomial model.

RESULTS: Labor-induction abortions had higher complication rates and lower effectiveness than did D&E. Thirty-two of 136 women undergoing labor induction (24%) experienced one or more complications, in contrast to 9 of 263 women (3%) undergoing D&E (unadjusted relative risk 6.9 [95% confidence interval 3.4-14.0]). When controlled for confounding, the adjusted risk ratio for labor induction was 8.5 (95% confidence interval 3.7-19.8) compared with D&E.

CONCLUSION: Dilation and evacuation is significantly safer and more effective than labor induction for second-trimester abortion for fetal indications. Bias and chance are unlikely explanations for these large discrepancies. Women facing this difficult decision should be offered a choice of methods and be provided information about their comparative safety and effectiveness.

LEVEL OF EVIDENCE: II.