Demographic,Clinical, and Counseling Factors Associated with the Selection of Pregnancy Termination Method in the Second Trimester for Fetal and Pregnancy Anomalies

ObjectiveDespite women's preference for induction of labor (IOL) or dilation and evacuation (D&E) for pregnancy termination in the setting of second trimester fetal or pregnancy abnormality, many women are not given a choice between delivery methods. We investigated patient and clinical related factors associated with selecting IOL or D&E.MethodsThis retrospective cohort experienced pregnancy termination at 17–24 weeks of gestation for fetal anomaly, intrauterine fetal demise, or premature previable rupture. We compared the demographic, reproductive, social, and clinical experience variables between women who select IOL and D&E, adjusting for confounders through logistic regression.ResultsOne hundred eleven women (21.6%) selected IOL and 403 (78.4%) selected D&E. Greater proportions of women of color (p < .01), lower education (p < .01), lower employment (p < .01), and lower status jobs (p < .01) selected IOL. Women selected D&E more often for chromosomal anomaly (p < .01). In adjusted analyses, women with intrauterine fetal demise (odds ratio OR], 9.8; 95% confidence interval CI], 2.8–34.7), premature previable rupture (OR, 110; 95% CI, 23.0–526.8), prior substance use disorder (OR, 35.5; 95% CI–2.7, 473.7), or counseling from obstetrics (OR, 3.3; 95% CI–1.3, 8.4), pediatrics (OR, 3.3; 95% CI–1.3, 8.6), or social services (OR, 12.6; 95% CI, 4.2–37.3) had higher odds of selecting IOL.ConclusionsPatient characteristics, medical factors, and type of counseling are associated with the selection between D&E and IOL for anomalous pregnancies. Institutional, regional, and state policies should permit women both delivery methods to preserve autonomous decision-making at the time of pregnancy termination.