Second trimester dilation and evacuation: a risk factor for preterm birth?
OBJECTIVE
To evaluate whether second trimester pregnancy termination with dilation and evacuation (D&E) vs induction of labor (IOL) affects subsequent risk of preterm birth.


METHODS
Our cohort was a retrospective cohort of women undergoing second trimester pregnancy termination for fetal anomalies, fetal death or previable premature rupture of membranes. We analyzed the rates of spontaneous delivery <37 weeks in the first pregnancy following the termination. We also compared preterm birth rates in our cohort with national averages and analyzed by the total number of prior procedures.


RESULTS
There were 173 women in our cohort. Women who had undergone a D&E (n=130) were less likely to have a subsequent preterm birth (6.9 vs 30.2%; P<0.01). This held true for a low risk subset without obstetric risk factors. There was no statistical difference in preterm birth rates for women who had undergone a D&E as compared with national averages, nor between the rates of preterm birth for women with 0, 1, 2 or 3 or more prior first or second trimester procedures.


CONCLUSIONS
We did not find that D&E was a risk factor for preterm delivery when compared with women with a prior IOL or national rates.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
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Little
Division of Family Planning, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
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Janiak
Division of Family Planning, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
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Bartz
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, USA.
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Smith
D000028:Abortion, Induced / Q000009:adverse effects* / Q000379:methods*; D000328:Adult; D005260:Female; D005313:Fetal Death; D005322:Premature Rupture of Fetal Membranes; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications; D011262:Pregnancy Trimester, Second; D047928:Premature Birth / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors