Second‐Trimester Surgical Abortion Is Safe: Audit of Complication Rates at an Australian Tertiary Hospital

Background An estimated 73.3 million abortions occur annually worldwide. Second‐trimester abortion is known to carry a higher risk of complications than first‐trimester abortion, though the absolute risk is thought to be low. There is limited Australian data about second‐trimester surgical abortions and no studies have looked at surgical complications. Aims This study aimed to determine the complication rate of second‐trimester surgical abortions at an Australian tertiary maternity hospital across a 5‐year period. Materials and Methods A retrospective audit was conducted from 1 January 2019 to 31 December 2023. Inclusion criteria were women and pregnant people with a gestation of 14 + 0 to 23 + 6 weeks who underwent dilation and evacuation for termination of pregnancy. The primary outcome was the rate of complications. Results Two thousand, one hundred and sixty‐four D&Es were performed for termination of pregnancy across the study period. Forty‐seven of these women experienced complications, equating to a complication rate of 2.17%. The major complication rate was 0.55% ( n = 12). The overall complication rate was significantly lower in women under 20 weeks' gestation compared to women over 20 weeks (1.71% vs. 4.19%, p = 0.007). This difference was significant when comparing minor complication rates only (RR 0.32, 95% CI 0.16–0.61); major complication rates demonstrated no significant difference between gestation groups (RR 1.12, 95% CI 0.25–5.15). Conclusions This study demonstrates that surgical second‐trimester abortions are safe. Increased complication risk with increased gestational age is evident, highlighting the importance of timely access to abortion care.