Midtrimester pregnancy termination: a study of the cost effectiveness of dilation and evacuation in a free-standing facility.

: In 1980, dilation and evacuation (D and E) in a free-standing facility was approved by the North Carolina Medical Care Commission as a method of management of 2nd-trimester pregnancy terminations. This paper reports the experience of the 1st 100 such terminations performed at the Crist Clinic, Jacksonville, and compares them with 100 2nd-trimester saline infusion abortions managed at the same clinic in 1979-80. Patients in both groups were comparable in terms of age, gravidity, race, and marital status. Women undergoing D and E were judged to be 13-16 weeks pregnant; however, 5 were noted to be 13 weeks and 12 were 16 weeks gestation. Among the saline patients, who were judged to be at least 16 weeks pregnant, 2 were found to be 16 weeks and 20 were 18 weeks gestation. The range of clinical error was comparable in both groups. An average of 2.12 hours of recovery time before discharge was required by the D and E patients. Among saline patients, the average time from instillation to evacuation was 37.7 hours with 2 days of hospitalization. Overall, 3 complications were noted in the D and E group and 16 in the saline group. Only 1 complication in the D and E group was judged to be major (hemorrhage requiring transfusion), while there were 6 major complications in the saline group (1 grand mal seizure, 5 transfusions). 8 women in the saline group required curettage for retained placenta and there were 2 failed abortions. 2 women required hospitalization after D and E, and 3 saline patients were hospitalized beyond the expected 3-day period. The total cost of the saline procedure was set at $550, compared with $340 for D and E. The low incidence of complications among D and E patients is notable in light of 2 factors: 1) most complications occur early in the experience with a new surgical technique; and 2) the direct dilation of the cervix utilized in this series is more likely to lead to cervical tearing than laminaria use. It is concluded that the reduced financial costs achieved by use of the D and E procedure are not at the expense of increased medical risks.