Second-Trimester Abortion in the United States

Abstract

This overview of a conference attended primarily by physicians largely deals with 2 current trends in late abortion: sharp decrease in mortality from 2nd trimester abortions since legalization in 1973, to 6.5 per 100,000 procedures in 1977, and replacement of saline instillation by dilatation and evacuation (D & E) as the most widely used 2nd trimester abortion procedure, particularly in the early second trimester. In 1972, 18% of abortions were second trimester, while in 1977, 9% of the 1,320,320 reported legal abortions were 2nd trimester. In 1977 there were 6 deaths from late abortions in the U.S., down from a high of 18 in 1973. However, 57% of deaths following legal abortion between 1972 and 1977 took place in the second trimester. Older women and blacks run particularly high risks from 2nd trimester abortions. Research results indicated that 86% of the 104 deaths from late abortions occurring between 1975 and 1977 could have been prevented through improved physician technique, reduction of restrictive legislation, and increase of women using effective contraception and seeking early abortions. D&E accounted for 73% of abortions between 13 and 15 weeks' gestation, although after 16 weeks instillation techniques continue to be the method of choice. A 1977 study by the Center for Disease Control found that the major complication rate for D & E abortions was 60% lower than that for saline with lower rates of fever, endometritis, hemorrhage and retained products of conception, but higher rates of cervical injury and uterine perforation. Comparative mortality rates from the 2 procedures are somewhat unclear due to recent fluctuations. This report also discusses the possible limits that may be imposed on late abortions by legislation, by the unwillingness of physicians and hospitals to perform them, and by the refusal of insurers to provide coverage.