Midtrimester abortion. Intra-amniotic instillation of hyperosmolar urea and prostaglandin F2 alpha v dilatation and evacuation.
Although dilatation and evacuation (D&E) is currently the most common method of midtrimester abortion in the United States, the intra-amniotic instillation of hyperosmolar urea and prostaglandin F2 alpha combined (U-P) has been proposed as a safer technique. To evaluate the comparative safety of U-P and D&E, we analyzed 2,805 U-P and 9,572 D&E abortions at 13 to 24 menstrual weeks' gestation. The U-P procedure resulted in significantly more serious complications than D&E (1.03 v 0.49 per 100 abortions). After adjusting for patient age, race, parity, follow-up information, and preexisting conditions, the relative risk of serious complications associated with U-P was 1.9 (95% confidence interval, 1.2 to 3.1). This advantage for D&E stems from its applicability to the 13- to 16-week interval. Although D&E appears to be safer overall in the midtrimester, for women obtaining abortion after 16 weeks, the rates of serious complications were comparable, with a relative risk of 1.0 (95% confidence interval, 0.4 to 2.5).
D000028:Abortion, Induced / Q000379:methods*; D000650:Amnion; D002584:Cervix Uteri / Q000293:injuries; D004107:Dilatation and Curettage / Q000009:adverse effects; D015237:Dinoprost; D004716:Endometritis / Q000139:chemically induced / Q000209:etiology; D005260:Female; D005334:Fever / Q000139:chemically induced / Q000209:etiology; D005865:Gestational Age; D006801:Humans; D006982:Hypertonic Solutions; D007795:Laminaria; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011460:Prostaglandins F / Q000009:adverse effects; D014508:Urea / Q000009:adverse effects; D014592:Uterine Hemorrhage / Q000139:chemically induced / Q000209:etiology
D006982:Hypertonic Solutions; D011460:Prostaglandins F; D014508:Urea; D015237:Dinoprost