Dilation and evacuation versus medication abortion at 15–24 weeks of gestation in low-middle income country: A retrospective cohort study

Abstract

Objective

To compare the effectiveness and safety of dilation and evacuation (D&E) to that of medication abortion at 15–24 weeks in a low-middle income country.

Study design

We conducted a retrospective cohort on effectiveness and safety of D&E vs medication abortion at 15–24 weeks in an Ethiopian setting over a year (January 1–December 31, 2023). We looked at success (need for additional procedure) of both abortion procedures and their complication rates. Hemorrhage, infection, uterine perforation/rupture, and cervical tear were the complications we compared between the groups (D&E group vs medication abortion group). P-value less than 0.05 and Adjusted odds ratio (AOR) with 95% CI were used to present results significance.

Results

A total of 225 abortion cases (162 medication abortion cases and 63 D&E cases) at gestational age of 15–24 weeks were included in the final analysis. The mean gestational age was 18 ± 2.8 weeks in the D&E group compared to 21 ± 3 weeks in the medication abortion group (p-value < 0.001). The overall procedure effectiveness between the abortion procedures was similar (95.2% vs 96.9% in the D&E group and medication abortion groups, p-value = 0.542). D&E (AOR = 2.92 [95% CI = 0.62–13.69]) was not associated with increased overall complications compared to medication abortion, after controlling for parity, gestational age, and history of prior uterine scar.

Conclusion

We found both abortion methods (D&E and medication abortion) are effective with comparable complication rates.

Implications

D&E and medication abortion are safe and effective methods of abortion for gestations up to 24 weeks even in a low-middle income country (LMIC) setting; as such, greater resources are needed to ensure to increase availability of D&E in order for women to have a choice in their treatment options.