Physiological and reproductive outcomes
Michel Tournaire, Sophie Gaudu, Philippe Faucher (France)
Surgical abortion. The influence of surgical abortion on subsequent reproductive outcome, reported for several decades in the literature can be summarized with seven criteria.
Medical abortion. Despite the increasing proportion of abortion by means of medication, limited information is available regarding the effects of this procedure on subsequent pregnancies.
A recent (2008) metaanalysis including eight studies on reproductive outcome compared the influence of medical and surgical abortion. The incidence of miscarriage and post partum hemorrage was significantly lower for the pregnancy immediatly following a medical abortion. No other significant difference was found.
For the outcome of the future pregnancies, medical abortion may thus be safer than the surgical option.
Second trimester abortion: medical or surgical abortion?
Michel Tournaire, M. Bornes, S. Gaudu, F. Lewin
Hopital Saint Vincent de Paul, Paris, France
The methods for second trimester abortion vary according to countries and institutions.
Medical methods using preparation of the cervix and misoprostol are predominant in
Europe. Surgical dilatation and evacuation requires practitioners trained for this technique.
It is used for almost all second trimester abortions in the USA and is available in some
institutions in Australia, England, France and the Netherlands. Complications are more
frequent with medical method : retention of placenta that needs secondary surgical
removal, hemorrhage with transfusions and rupture of the uterus, risk that is increased in
the cases of previous cesarean section. Surgical method can be complicated by
perforation of the uterus and laceration of the cervix. The risk for premature birth in
subsequent pregnancies seems to be low for the two methods. Emotional consequences
have been found identical with both techniques. The choice of the method is not based on
scientific data but on the practitioner’s experience. If the two methods could be available in the same institution, this would allow, well informed women to participate using their choice.