Impact of midtrimester dilation and evacuation on subsequent pregnancy outcome.
OBJECTIVE
This study was undertaken to evaluate the impact of second-trimester dilation and evacuation (D&E) on subsequent pregnancy outcome.


METHODS
Medical record review of 600 patients undergoing midtrimester (14-24 weeks) D&E from 1996 to 2000 and evaluation of subsequent pregnancy outcome. Mann Whitney U, Spearman rho, and chi(2) tests were used in statistical analysis with a P value <.05 considered significant.


RESULTS
Ninety-six subsequent pregnancies were identified, including 12 first-trimester spontaneous abortions, 1 second-trimester fetal death, 1 ectopic pregnancy, and 5 elective terminations. Seventy-seven pregnancies resulted in the delivery of a live-born infant at a median gestational age of 39.0 weeks. Five pregnancies (6.5%) were complicated by spontaneous preterm birth. Patients delivered preterm had an earlier gestational age at D&E (18.0 vs 20.0 weeks, P =.02) and a trend toward less preoperative cervical dilation (2.0 vs 3.0 cm, P =.09) than patients delivered at term.


CONCLUSIONS
Second-trimester D&E is not a risk factor for midtrimester pregnancy loss or spontaneous preterm birth. Preterm delivery in future gestations appears less likely when greater preoperative cervical dilation is achieved with laminaria, possibly because of a decrease in cervical trauma.
Kalish
Robin B
RB
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, New York Weill Cornell Medical Center, 525 E. 68th Street, Room J-130, New York, NY 10021, USA. ROBINKAL@aol.com
Chasen
Stephen T
ST
Rosenzweig
Laura B
LB
Rashbaum
William K
WK
Chervenak
Frank A
FA
D000028:Abortion, Induced / Q000379:methods*; D000328:Adult; D004107:Dilatation and Curettage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007747:Labor Stage, First; D008499:Medical Records; D007752:Obstetric Labor, Premature / Q000209:etiology; D009772:Obstetrical Forceps; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D012307:Risk Factors