Transactions of The Twenty-Second Annual Meeting of The Society for Maternal-Fetal Medicine
Impact of midtrimester dilation and evacuation on subsequent pregnancy outcome

Presented at the Twenty-second Annual Meeting of the Society for Maternal-Fetal Medicine, New Orleans, La, January 14-19, 2002.
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Abstract

Objective: This study was undertaken to evaluate the impact of second-trimester dilation and evacuation (D&E) on subsequent pregnancy outcome. Study Design: Medical record review of 600 patients undergoing midtrimester (14-24 weeks) D&E from 1996 to 2000 and evaluation of subsequent pregnancy outcome. Mann Whitney U , Spearman rho, and χ2 tests were used in statistical analysis with a P value <.05 considered significant. Results: Ninety-six subsequent pregnancies were identified, including 12 first-trimester spontaneous abortions, 1 second-trimester fetal death, 1 ectopic pregnancy, and 5 elective terminations. Seventy-seven pregnancies resulted in the delivery of a live-born infant at a median gestational age of 39.0 weeks. Five pregnancies (6.5%) were complicated by spontaneous preterm birth. Patients delivered preterm had an earlier gestational age at D&E (18.0 vs 20.0 weeks, P =.02) and a trend toward less preoperative cervical dilation (2.0 vs 3.0 cm, P =.09) than patients delivered at term. Conclusion: Second-trimester D&E is not a risk factor for midtrimester pregnancy loss or spontaneous preterm birth. Preterm delivery in future gestations appears less likely when greater preoperative cervical dilation is achieved with laminaria, possibly because of a decrease in cervical trauma. ( Am J Obstet Gynecol 2002;187:882-5.)

Section snippets

Material and methods

Retrospective review of the medical charts of all patients who underwent D&E at 14 to 24 weeks at New York Weill Cornell Medical Center was performed by a single physician (W. K. R.) from May 1996 to May 2000. Institutional review board (IRB) approval was obtained for this study. All patients were referred to our center for termination of pregnancy. Gestational age was confirmed by ultrasound in all cases.

Patients were seen in an outpatient setting for initial evaluation. Cervical dilation was

Results

From 600 second-trimester D&E procedures performed during the study period, 96 subsequent pregnancies were identified in 81 women. The median gestational age (GA) at D&E was 19.0 weeks (range 14-24 weeks). The median maternal age at D&E was 33 years (range 19-44 years). At the time of D&E, 64.6% of women were nulliparous. The median interval from D&E to subsequent delivery was 1.35 years (range 0.76-5.03). Indication for the procedure included: aneuploidy (31), structural anomaly (19), fetal

Comment

The current study demonstrates that, in experienced hands, second-trimester D&E is not associated with a high incidence of second-trimester pregnancy loss or preterm birth in subsequent gestations. In our series, there were no second-trimester spontaneous abortions and only 6.5% spontaneous preterm deliveries. Our findings are consistent with those of Schneider et al,12 who reviewed 171 patients undergoing late second-trimester D&E procedures. Follow-up, available for 150 women, revealed 61

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Reprint requests: Robin B. Kalish, MD, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, 525 E 68th St, Room J-130, New York, NY 10021. E-mail: [email protected]

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