NEW YORK (Reuters Health) – For removal of uterine contents during the second trimester, dilation and evacuation (D&E) appears to prompt fewer complications and may be more cost-effective than prostaglandin labor induction, Pennsylvania-based researchers report in a July 25th on-line paper in the American Journal of Obstetrics and Gynecology.

Such abortions are in the minority (about 90% take place in the first trimester) and Dr. Kari A. Whitley and colleagues at the Lehigh Valley Health Network, Allentown note that D&E is generally considered to be the safest method of pregnancy termination. But many factors which may affect outcome have changed over the years. Among these is the growing number of abortions for fetal anomalies.

To provide more recent information, the team retrospectively examined data from their institution on 94 women who had undergone D&E under continuous ultrasound guidance and 126 who had had prostaglandin induction between 2005 and 2010. Misoprostol was the agent most commonly used.

The D&E group were significantly less likely to reach a composite complication endpoint (15% versus 28%). This comprised infection, need for additional surgery, unexpected admission or readmission, serious maternal morbidity or death. For example, additional unplanned surgery was required by 9% of the D&E patients compared to 22% of the other group.

However, Dr. Whitley told Reuters Health by email “The primary reason for this risk reduction was an increased incidence of D&C’s for retained placenta in the induction group.”

D&E was generally an outpatient procedure and the median length of stay was 5.4 hours, much less than the 28.1 hours in the induction group. This, say the researchers, is among factors which lead to the cost of D&E being about two-thirds of that of an induction.

Nevertheless, concluded Dr. Whitley, “Overall, when considering serious complications such as the need for blood transfusion or major additional surgery post-procedure, maternal morbidity and/or maternal death, there was no difference between the two procedures, making either a reasonable choice for midtrimester uterine evacuation.”

Am J Obstet Gynecol 2011.