Maarit J. Mentula, M.D., Maarit Niinimäki, M.D., Ph.D., Satu Suhonen, M.D., Ph.D., Elina Hemmiki, M.D., DrPH., Mika Gissler, M.Soc.Sc., Dr. Phil., Oskari Heikiheimo, M.D., Ph.D.
From the Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland (M.M., O.H.), the Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland (M.N.), the City of Helsinki Health Care Centre Unit for Maternity and Child Health Care and Health Promotion (S.S.), The National Institute for Health and Welfare, Helsinki, Finland (M.G., E.H.),
The Nordic School of Public Health, Gothenburg, Sweden (M.G.).
Objective: To assess the rate of adverse events following medical second trimester termination of pregnancy (TOP) and to compare it to those in the first trimester medical TOP.
Methods: This register based cohort study included 26,053 women, who underwent medical TOP in Finland between 1st January 2000 and 31st December 2006. Women were identified from the Abortion Registry. Adverse events related to medical TOP within 6 weeks were searched from the Hospital Discharge Registry. The rate and risk factors for adverse events were estimated during 2003 to 2006.
Results: The rate of surgical evacuation of second trimester medical TOP decreased during the first three years of the study period and thereafter stabilized at 39.5%.Second trimester TOP increased the risk of surgical evacuation (OR 9.3; 95% CI 8.1 to 10.7), especially immediately after fetal expulsion (OR 41.0; 95% CI 32.9 to 51.0). Also the risk of infection was elevated (OR 2.1; 95% CI 1.5 to 2.9). Increased length of gestation did not influence the risk of surgical evacuation or infection in the second trimester medical TOP.
Conclusions: The medical TOP during second trimester is generally safe. Surgical evacuation because of residual tissue is avoided in more than half of the cases, though it is much more common than in first trimester medical TOP. More wide use of medical TOP decreased the use of surgical evacuation. The risk of surgical evacuation and infection does not increase by gestational weeks in the second trimester TOP.