INTRODUCTION: One percent of abortions take place after 20 weeks of gestation in England and Wales. Overall rates of complications with second-trimester abortion are low, but they increase with gestational age. Dilation and evacuation (D&E) is the most common method of surgical abortion at this stage in pregnancy. The British Pregnancy Advisory Service (BPAS) provides nearly half of all abortions in England and Wales. In 2017, BPAS added mifepristone to their regimen of osmotic dilators for cervical ripening before D&E. This retrospective study analyzed the risk for complications associated with the use of mifepristone for cervical ripening. METHODS: The British Pregnancy Advisory Service provided data for D&E procedures that occurred between 22 and 23 6/7 weeks, between February 2012 and February 2017 (osmotic dilators only), and November 2017 to November 2022 (mifepristone and osmotic dilators). Using time as a proxy for mifepristone, the association between mifepristone use and D&E complications was established using multivariate logistic regression. RESULTS: There were 6,516 D&E procedures at BPAS during this time. Those who received mifepristone were more likely to experience any complication (odds ratio [OR] 2.40; 95% CI, 1.62, 3.54). They also had higher odds of bleeding (OR 3.08; 95% CI, 1.12, 8.48). Odds for cervical injury (OR 2.21; 95% CI, 0.84, 5.80) and infection (OR 1.89; 95% CI, 0.46, 7.69) were not different. CONCLUSION: The addition of mifepristone to osmotic dilators was associated with an increase in the odds of complications of D&E, without attenuating the risk of complications related to cervical dilation.