Background and safety of surgical abortion between 14 and 16 weeks gestation: A retrospective multicentre observational study

BACKGROUND: Surgical abortion between 12 and 14 weeks of gestation (WG) is a widely accepted, standardized practice in France. In 2022, legislation extended the legal limit to 16 WG, yet implementation remains uneven. Some centers remain reluctant to perform procedures beyond 14 weeks due to perceived safety concerns. OBJECTIVES: To assess the risk of complications associated with surgical abortion between 14 and 16 WG. We also sought to describe the characteristics of women receiving at this period abortions and document the local implementation of this technique. METHODS: We conducted a retrospective multicenter observational study in two French hospitals. We included all women undergoing surgical abortion between 12 and 16 weeks of gestation from January 2023 to Novembre 2024. We compared clinical outcomes, care pathways, and complication rates between two groups: 12-14 and 14-16 week procedures. MAIN FINDINGS: Among 244 patients, the overall rate of hemorrhage ≥ 500 mL was similar in both groups (4.27 % vs. 5 %; p = 0.45). Complication rates were low in both groups (6.71 % vs. 8.75 %; p = 0.57). Later abortions were associated with a history of violence (aOR 7.04, 95 % CI [1.24-39.88]; p = 0.03), greater distance from the center (aOR 1.04, 95 % CI [1.01-1.08]; p = 0.01), and later timing of request (aOR 18.29, 95 % CI [6.18-54.07]; p < 0.001). CONCLUSION: Surgical abortion up to 16 weeks appears safe. Improving access requires both provider training and better care coordination.