Does ultrasonography affect the safety of induced abortion at or after 13 weeks gestation? A retrospective review in Nepal.

INTRODUCTION We aimed to assess whether ultrasonography prior to dilation and evacuation or medical abortion ≥13 weeks was correlated with safety. MATERIAL AND METHODS We conducted a retrospective chart review of patients undergoing abortion ≥13 weeks at 8 sites in Nepal from 2015-2019. RESULTS We included 2,294 women undergoing abortion ≥13 weeks (no upper gestational age limit); 593 underwent dilation and evacuation and 1,701 medical abortion. Demographics differed by procedure for parity (19% versus 33% nulliparous, dilation and evacuation and medical abortion) and gestational age (90% versus 52% were 13-15 weeks, dilation and evacuation and medical abortion). Ultrasonography was performed commonly, amongst 81% of cases overall. Complications were rare (<1% among dilation and evacuation, 1.4% among medical abortion). Most common adverse events with dilation and evacuation were hemorrhage and cervical laceration; 3 women required re-aspiration. Following medical abortion, 13.5% had retained products: 12.9% among those with prior ultrasound and 16.3% who had not had an ultrasound. Hemorrhage and severe side-effects occurred at similarly low rates regardless of whether ultrasonography was performed. In a logistic regression model where patient characteristics and case clustering within facilities were controlled for, we found a correlation between ultrasonography and complications when retained placenta was included in the model, but there was no correlation between ultrasonography and complications when retained placenta was excluded. CONCLUSIONS This study confirms low complications rates among women having abortion ≥13 weeks gestation in health care facilities. Settings without universal availability of ultrasound may still maintain low, comparable complication rates.