Second trimester termination of pregnancy: a review by site and procedure type.
BACKGROUND
We hypothesized that complications for second trimester terminations are higher in a low-volume residency training program than in a high-volume private practice.


METHODS
Complications and cost were compared between three groups undergoing second trimester terminations: patients undergoing dilation and evacuation (D&E) at a university hospital (Hospital D&E, n=83) or medical pregnancy termination at a university hospital (Hospital Induction, n=89) and D&E at a private outpatient facility (Clinic D&E, n=253).


RESULTS
Major complications occurred in 11% of the Hospital D&E, 10% of the Hospital Induction, and 1% of the Clinic D&E patients (p=.0019). Complication rates remained statistically significant when a logistic regression model was applied to the data. The mean total charge for the three respective groups was US$4625, US$5029 and US$1105 (p<.001).


CONCLUSIONS
Second trimester terminations of pregnancy by D&E in well-selected patients in a dedicated outpatient facility can be safer and less expensive than hospital-based D&E or induction of labor.
Turok
David K
DK
Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT 84132-2209, USA. david.turok@hsc.utah.edu
Gurtcheff
Shawn E
SE
Esplin
Michael S
MS
Shah
Madhuri
M
Simonsen
Sara E
SE
Trauscht-Van Horn
Jennifer
J
Silver
Robert M
RM
D000019:Abortifacient Agents / Q000627:therapeutic use; D000028:Abortion, Induced / Q000009:adverse effects* / Q000191:economics / Q000379:methods; D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000191:economics / Q000706:statistics & numerical data*; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D004107:Dilatation and Curettage / Q000009:adverse effects; D015232:Dinoprostone / Q000627:therapeutic use; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D016595:Misoprostol / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies
D000019:Abortifacient Agents; D016595:Misoprostol; D015232:Dinoprostone