title: Surgical and medical second trimester abortion in South Africa: a cross-sectional study.
abstract: BACKGROUND
  A high percentage of abortions performed in South Africa are in the second trimester. However, little research focuses on women's experiences seeking second trimester abortion or the efficacy and safety of these services.The objectives are to document clinical and acceptability outcomes of second trimester medical and surgical abortion as performed at public hospitals in the Western Cape Province.
  
  
  METHODS
  We performed a cross-sectional study of women undergoing abortion at 12.1-20.9 weeks at five hospitals in Western Cape Province, South Africa in 2008. Two hundred and twenty women underwent D&E with misoprostol cervical priming, and 84 underwent induction with misoprostol alone. Information was obtained about the procedure and immediate complications, and women were interviewed after recovery.
  
  
  RESULTS
  Median gestational age at abortion was earlier for D&E clients compared to induction (16.0 weeks vs. 18.1 weeks, p < 0.001). D&E clients reported shorter intervals between first clinic visit and abortion (median 17 vs. 30 days, p < 0.001). D&E was more effective than induction (99.5% vs. 50.0% of cases completed on-site without unplanned surgical procedure, p < 0.001). Although immediate complications were similar (43.8% D&E vs. 52.4% induction), all three major complications occurred with induction. Early fetal expulsion occurred in 43.3% of D&E cases. While D&E clients reported higher pain levels and emotional discomfort, most women were satisfied with their experience.
  
  
  CONCLUSIONS
  As currently performed in South Africa, second trimester abortions by D&E were more effective than induction procedures, required shorter hospital stay, had fewer major immediate complications and were associated with shorter delays accessing care. Both services can be improved by implementing evidence-based protocols.
authors.affiliation: Ibis Reproductive Health, Oakland, CA, 94612, USA. dgrossman@ibisreproductivehealth.org
authors.forename: Daniel
authors.initials: D
authors.lastname: Grossman
authors.forename: Deborah
authors.initials: D
authors.lastname: Constant
authors.forename: Naomi
authors.initials: N
authors.lastname: Lince
authors.forename: Marijke
authors.initials: M
authors.lastname: Alblas
authors.forename: Kelly
authors.initials: K
authors.lastname: Blanchard
authors.forename: Jane
authors.initials: J
authors.lastname: Harries
mesh_terms: D000019:Abortifacient Agents / Q000627:therapeutic use*; D000028:Abortion, Induced / Q000379:methods* / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004107:Dilatation and Curettage / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D015994:Incidence; D016595:Misoprostol / Q000627:therapeutic use; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D018570:Risk Assessment; D013019:South Africa; D055815:Young Adult
chemical_list: D000019:Abortifacient Agents; D016595:Misoprostol