Surgical versus medical methods for second trimester induced abortion
RHL practical aspects by Cheng L
FIRST CONTACT (PRIMARY CARE) LEVEL
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
Second-trimester induced abortions – whether by dilatation and evacuation (D&E) or by a medical method – should be performed in a hospital by suitably trained staff. The review concluded that D&E is safer than medical methods. However, to perform D&E safely, specialized training and an adequate caseload are required for providers to acquire and maintain skills, respectively. Medical abortion with oral mifepristone (200 mg) followed 36–48 hours by misoprostol (800 µg vaginally followed by 400 µg orally every 3 hours) should be considered as an alternative to D&E. Medical methods are less skill-dependent compared with the D&E. Moreover, medical methods may be safer as they avoid the need for an anaesthetic and the risk of surgical complications such as cervical laceration and uterine perforation. But practitioners must be aware of the complications of medical abortion such as nausea, vomiting, diarrhoea, painful uterine contractions, fever and uterine rupture. Adequate follow-up is required in order to ensure that complete abortion is achieved.
AT HOME OR IN THE COMMUNITY
This document should be cited as: Cheng L. Surgical versus medical methods for second trimester induced abortion: RHL practical aspects (last revised: 1 November 2008). The WHO Reproductive Health Library; Geneva: World Health Organization.