Does prior ultrasonography affect the safety of induced abortion at or after 13 weeks’ gestation? A retrospective study

Abstract

Introduction We aimed to assess whether ultrasonography prior to dilation and evacuation or medical abortion ≥13 weeks was correlated with safety. Material and methods We conducted a retrospective chart review of patients undergoing abortion ≥13 weeks at eight sites in Nepal from 2015 to 2019. Results We included 2294 women undergoing abortion ≥13 weeks (no upper gestational age limit); 593 underwent dilation and evacuation and 1701 had a medical abortion. Demographics differed by procedure for parity (19% vs 33% nulliparous, dilation and evacuation, and medical abortion) and gestational age (90% vs 52% were 13‐15 weeks, dilation and evacuation, and medical abortion). Ultrasonography was performed in 81% of cases overall. Complications were rare (<1% of dilations and evacuations, 1.4% of medical abortions). The most common adverse events with dilation and evacuation were hemorrhage and cervical laceration; three women required re‐aspiration. Following medical abortion, 13.5% had retained products, 12.9% with prior ultrasound and 16.3% who had not had an ultrasound. Hemorrhage and severe side‐effects occurred at similarly low rates regardless of whether ultrasonography was performed. In a logistic regression model where patient characteristics and case clustering within facilities were controlled for, we found a correlation between ultrasonography and complications when retained placenta was included in the model, but there was no correlation between ultrasonography and complications when retained placenta was excluded. Conclusions This study confirms low complication rates among women having an abortion ≥13 weeks’ gestation in healthcare facilities. Settings without universal availability of ultrasound may still maintain low, comparable complication rates.

Abortion Care Beyond 13 Weeks’ Gestation: A Global Perspective

“…Providers can accurately determine gestational age through performing a patient history and physical exam. Experienced providers demonstrate high concordance in their estimates of gestational age through physical exam as compared with measured fetal foot length after expulsion 41…”

“…In areas where ultrasonography is widely available gestational age dating using ultrasound is often standard of care, but no evidence exists that the safety of medical abortion and D&E is improved with ultrasound dating 42. In a case control study of 2294 women undergoing D&E or medical abortion at >13 weeks in Nepal, use of preoperative ultrasound was not associated with decreased odds of adverse events 41. Ultrasound may be helpful in scenarios with discrepant physical exam findings compared with expected gestational age based on last menstrual period.…”

“…Experienced providers demonstrate high concordance in their estimates of gestational age through physical exam as compared with measured fetal foot length after expulsion. 41 Routine gestational dating using preprocedure ultrasound is not necessary. 2 In areas where ultrasonography is widely available gestational age dating using ultrasound is often standard of care, but no evidence exists that the safety of medical abortion and D&E is improved with ultrasound dating.…”

Celebrating 100 years of AOGS with a focus on global health

“…The safety of non-ultrasound confirmed second trimester abortion is the focus of a retrospective study from Nepal. 7 Screening programs have dramatically reduced mortality from cervical cancer in high-income countries. In contrast, women in LMICs often present with advanced stages of the disease and often have co-existing morbidities with further additive effects.…”

“…Although ultrasonography may, in some cases, have a role in facilitating safe completion of surgical abortion by guiding the surgeon and monitoring the procedure intraoperatively, 4,5 or by diagnosing ongoing pregnancy and incomplete abortion during the follow‐up when indicated, 6 the demand for ultrasound dating has become a potential barrier to abortion access. The safety of non‐ultrasound confirmed second trimester abortion is the focus of a retrospective study from Nepal 7 …”