with 1 hour of rest. The oxytocin is increased by 50 U in each successive period, until a final concentration of 300 U in 500 mg.
Complications of Second Trimester Abortion
Complications of second trimester surgical abortion are uncommon, but risk increases with gestational age. Complications and their frequency encountered in almost 3,000 midtrimester abortions performed by laminaria followed by D&E on a referral service are listed in Table 10.11. The gestational ages were 14 to 27 weeks and mean gestational age was 20.2 weeks. The most common complication was a cervical laceration that required suturing. A major complication, defined as one necessitating transfusion, disseminated intravascular coagulation, reoperations with uterine artery embolization, laparoscopy, or laparotomy, was encountered in 1.3% of patients. History of two or more cesareans, gestational period of 20 weeks or more, and insufficient initial cervical dilation by laminaria were independent risk factors for a major complication in a multivariate analysis (366). The rates of complication in Table 10.11 cannot be directly compared to the rates of complications with labor-induction abortion described below because half of the D&E group were 20 weeks or more gestation, while only a few of the induction patients were more than 20 weeks.
The labor-induction methods share common hazards: failure of the primary procedure to produce abortion within a reasonable time, incomplete abortion, retained placenta, hemorrhage, infection, and embolic phenomena. With modern protocols, these are rare. In a series of 1,002 women treated with mifepristone and misoprostol at 13 to 21 weeks, 0.7% required a blood transfusion, 0.3% required ergot treatment for hemorrhage, and one required laparotomy for otherwise uncontrollable hemorrhage; 2.6% of patients received antibiotics for presumed pelvic infection after hospital discharge and 7.9% complained of prolonged bleeding (360). Uterine rupture was reported in women with previous cesarean delivery treated with misoprostol in the midtrimester, but in a case series of 101 women with one or more previous cesarean births and three smaller case series totaling 87 patients, no ruptures occurred (367). Larger series are needed to quantify the risk.