title: Midtrimester dilation and evacuation versus prostaglandin induction: a comparison of composite outcomes.
abstract: OBJECTIVE
  The objective of the study was to determine the optimal procedure for midtrimester uterine evacuation.
  
  
  METHODS
  This was a retrospective cohort study of women undergoing midtrimester uterine evacuation by prostaglandin induction or dilation and evacuation (D&E). Primary outcome was composite complication, defined as any of the following: infection, need for additional surgery, unexpected admission or readmission, serious maternal morbidity, and/or maternal death.
  
  
  RESULTS
  Two hundred twenty patients met inclusion criteria: 94 D&E and 126 induction. D&E was associated with less composite complications (15% vs 28%, P = .02), which persisted in adjusted analysis (adjusted odds ratio, 0.38; 95% confidence interval, 0.15-0.99; P = .05). Women in the induction group had higher rates of retained placenta requiring curettage (22% vs 2%, P = .01), whereas cervical injury was more common in the D&E group (5% vs 0%, P = .01). Median length of stay was significantly shorter in the D&E group (5.7 hours vs 28.4 hours, P < .001).
  
  
  CONCLUSIONS
  Midtrimester D&E is associated with fewer complications than prostaglandin induction.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Lehigh Valley Health Network, Allentown, PA, USA. kari_a.whitley@lvhn.org
authors.forename: Kari A
authors.initials: KA
authors.lastname: Whitley
authors.forename: Kevin
authors.initials: K
authors.lastname: Trinchere
authors.forename: Wendy
authors.initials: W
authors.lastname: Prutsman
authors.forename: Joanne N
authors.initials: JN
authors.lastname: Quiñones
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Rochon
mesh_terms: D000028:Abortion, Induced / Q000379:methods*; D000328:Adult; D015331:Cohort Studies; D004107:Dilatation and Curettage; D005260:Female; D006801:Humans; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011453:Prostaglandins / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D011453:Prostaglandins