Version July 2025
| Medication abortion | Dilation and evacuation | |
| Setting | Usually requires admission to a hospital (eg, labor and delivery or family planning unit) | Usually performed in an outpatient setting (eg, specialty clinic, ambulatory surgery center) |
| Treatment duration | Can be unpredictable but typically 24 hours | Often predictable and short (eg, 30 minutes)* |
| Cervical preparation | Typically no | Typically with osmotic dilators and/or medication (ie, misoprostol, mifepristone). Often requires a separate outpatient visit, sometimes one or two days prior to D&E¶. |
| Feticidal injection | Typically used at ≥20 or 22 weeks of gestation | Typically not used |
| Pain management | Typically with regional or systemic analgesiaΔ | Typically with intravenous sedation |
| Management of the placenta | Placenta often delivers within four hours of the fetus, but D&E (or other interventions) may be needed | Placenta is removed during the D&E procedure |
| Patient experience |
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| Pathologic examination | Permits morphologic and pathologic evaluation of an intact fetus | Can be limited, but may be possible depending on the diagnosis in question |
Second-trimester pregnancy termination can be performed with medication abortion or D&E. Both are safe and effective. The choice of procedure is often determined using shared decision-making based on multiple factors, including patient preferences about setting, treatment duration, and experience. However, many settings lack the availability of a clinician with the skills and experience to provide one or both approaches. Thus, patients may need to choose the available option or travel to an often distant health care facility that provides the procedure of their choice.
Other factors (eg, maternal medical comorbidity, congenital uterine anomaly, placental abnormality) may also affect choice. This is discussed in related UpToDate content.
D&E: dilation and evacuation.
* The entire procedure may be just as long or longer than medication abortion, as patients undergoing D&E typically receive one to two days of outpatient cervical preparation (to decrease cervical trauma and facilitate evacuation of the uterus).
¶ Protocols for cervical preparation prior to D&E vary and are described in related UpToDate content.
Δ Pain management for second-trimester medication abortion is similar to that used during labor.
