title: Second-trimester abortion for fetal anomalies or fetal death: labor induction compared with dilation and evacuation.
abstract: 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.
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  II.
authors.affiliation: From the Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Amy G
authors.initials: AG
authors.lastname: Bryant
authors.forename: David A
authors.initials: DA
authors.lastname: Grimes
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Garrett
authors.forename: Gretchen S
authors.initials: GS
authors.lastname: Stuart
mesh_terms: D000028:Abortion, Induced / Q000009:adverse effects / Q000379:methods; D000328:Adult; D015331:Cohort Studies; D016001:Confidence Intervals; D000013:Congenital Abnormalities / Q000601:surgery*; D004107:Dilatation and Curettage / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005313:Fetal Death / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007751:Labor, Induced / Q000009:adverse effects / Q000379:methods*; D008429:Maternal Welfare; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D017751:Safety Management; D018709:Statistics, Nonparametric; D014619:Vacuum Curettage / Q000009:adverse effects / Q000379:methods; D055815:Young Adult