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Surgical versus medical methods for second trimester induced abortion

  • Review
  • Intervention




Determining the optimal method of performing second-trimester abortions is important, since they account for a disproportionate amount of abortion-related morbidity and mortality.


To compare surgical and medical methods of inducing abortion in the second trimester of pregnancy with regard to efficacy, side effects, adverse events, and acceptability.

Search methods

We identified trials using Pub Med, EMBASE, POPLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL). We also searched the reference lists of identified studies, relevant review articles, book chapters, and conference proceedings for additional, previously unidentified studies. We contacted experts in the field for information on other published or unpublished research.

Selection criteria

Randomised trials comparing any surgical to any medical method of inducing abortion at ≥ 13 weeks' gestation were included.

Data collection and analysis

We assessed the validity of each study using the methods suggested in the Cochrane Handbook. Investigators were contacted as needed to provide additional information regarding trial conduct or outcomes. Two reviewers abstracted the data. Odds ratios and 95% confidence intervals were calculated for dichotomous variables using RevMan 4.2. The trials did not have uniform interventions, therefore, we were unable to combine them into a meta-analysis.

Main results

Two studies met criteria for this review. One compared dilation and evacuation (D&E) to intra-amniotic instillation of prostaglandin F2 α. The second study compared D&E to induction with mifepristone and misoprostol. Compared with prostaglandin instillation, the combined incidence of minor complications was lower with D&E (OR 0.17, 95% CI 0.04-0.65) as was the total number of minor and major complications (OR 0.12, 95% CI 0.03-0.46). The number of women experiencing adverse events was also lower with D&E than with mifepristone and misoprostol (OR 0.06, 95% CI 0.01-0.76). Although women treated with mifepristone and misoprostol reported significantly more pain than those undergoing D&E, efficacy and acceptability were the same in both groups. In both trials, fewer subjects randomised to D&E required overnight hospitalisation.

Authors' conclusions

Dilation and evacuation is superior to instillation of prostaglandin F2 α. The current evidence also appears to favour D&E over mifepristone and misoprostol, however larger randomised trials are needed.








我們根據的試驗是搜尋自EMBASE、POPLINE和 the Cochrane Central Register of Controlled Trials (CENTRAL)。 我們也搜尋已知研究中引用的參考文獻,相關回顧性文章,相關書籍章節,及一些以前未知研究的會議紀錄。我們與這個領域的專家聯繫,以取得其他已發表或未發表的相關資訊。




我們用考科藍手冊建議的方法來評估每一個研究的效力。如果需要的話,會從研究者那裡取得關於實驗處理方式或結果的詳細資料。有二個回顧作者統整實驗數據。二分變項用RevMan 4.2軟體計算勝算比和95%信賴區間。這些試驗並沒有做一致的處置,因此,我們無法用統合分析的方法來做比較。


有兩個試驗符合這篇回顧性文章。一篇在比較擴張抽吸術(D&E)和羊水內灌注前列腺素(prostaglandin F2)。第二篇研究在比較擴張抽吸術和RU486加上misoprostol. 和羊水內灌注前列腺素的方法比起來,擴張抽吸術的輕微併發症發生率較低(勝算比0.17,95%CI 0.04−0.65),所有輕微及嚴重併發症(勝算比0.12,95%CI 0.03−0.46)也較低。而用擴張抽吸術有發生不良反應的人也比用RU486加上misoprostol的少(勝算比0.06,95%CI 0.01−0.76)。雖然用RU486加上misoprostol的人統計出來疼痛程度比用擴張抽吸術高,但效果和接受度在二組是相同的。在這兩個試驗中都有提到,有少部分隨機接受擴張抽吸術的人需要術後住院觀察一晚。





此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。



Plain language summary

Abortion after three months of pregnancy can be done by an operation or with medicines. This review looked at which way is better.

We did computer searches to find studies that compared any operation to any medicine used for abortion at this stage of pregnancy. We wrote to researchers and looked through book chapters and other articles to find more studies.

We found two studies. The first compared dilation and evacuation (D&E) to injecting a drug into the pregnant womb. The second compared D&E to drugs taken by mouth and by vagina.

The D&E operation was better than injecting medicines into the womb. Medicines taken by mouth and vagina worked as well and were as acceptable as a D&E, but caused more pain and side effects. More studies with modern medicines used for abortion after 3 months of pregnancy are needed.