Outpatient Abortion for Fetal Anomaly and Fetal Death From 15-34 Menstrual Weeksʼ Gestation: Techniques and Clinical Management

OBJECTIVE:To determine the safety of providing outpatient abortion services for women with complicated advanced pregnancies. METHODS:During a 10-year period, 124 abortions were performed after 14 menstrual weeksʼ gestation at an outpatient abortion facility for indications of fetal anomaly, diagnosed genetic disorder, or fetal death. Gestational lengths ranged from 15-34 menstrual weeks. Fetal diagnoses included a variety of chromosomal abnormalities, malformations, and death. Techniques for performing the late abortions included a serial multiple laminaria method of cervical dilation. Abortions performed after 20 menstrual weeks were effected by instillation of intra-amniotic hyperosmolar urea or induction of fetal death by injection of digoxin and/or hyperosmolar urea into the fetus, followed by artificial rupture of membranes, induction of labor, and assisted expulsion or instrumental extraction of the fetus. At less than 20 weeks, dilation and evacuation following serial multiple laminaria treatment of the cervix was the method of choice. RESULTS:The median gestational age was 23 menstrual weeks. The median procedure time for all cases was 12 minutes and median blood loss was 125 mL. Procedure time increased with length of gestation (P=.00). Blood loss was only slightly increased by gestation length (P=.154) and not by procedure time (P=.299). Complication rates were not significantly related to gestation length (P=.895). There was one major complication in this series. There were no uterine perforations and one cervical laceration. CONCLUSION:Outpatient abortion may be performed safely in most cases of fetal disorder, including death, through 34 menstrual weeks under proper conditions. (Obstet Gynecol 1993;81:301-6)