Original research article Complications of surgical termination of second-trimester pregnancy in obese versus nonobese women ☆,☆☆ Lisbeth A. Murphy a , Loralei L. Thornburg b , J. Christopher Glantz b , Emilie C. Wasserman a , Nancy L. Stanwood c , Sarah J. Betstadt a, ⁎ a University of Rochester Department of OB/GYN, Rochester, NY 14642, USA b University of Rochester Department of OB/GYN, Division of Maternal Fetal Medicine, Rochester, NY 14642, USA c Yale School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, New Haven, CT 06520-8063, USA Received 9 November 2011; revised 1 February 2012; accepted 6 February 2012 Abstract Background: Obesity is becoming increasingly common in obstetric and gynecologic populations, which may affect the safety of surgical termination of pregnancy. Study Design: We performed a retrospective review of all patients undergoing second-trimester surgical termination of pregnancy by under ultrasound guidance termination between 13 0/7 and 24 0/7 weeks of gestational age (GA) to compare perioperative risks in obese and nonobese women. Complication rates, operative times and anesthesia times were compared between obese [body mass index (BMI) ≥30 kg/ m 2 ] and nonobese women (BMI b30). Results: Of 1044 women, 29.0% were obese. The mean complication rate was 6.1% and similar between groups (5.5% nonobese, 7.6% obese, p=.20). Operative times were 4.4 min longer and mean anesthesia times were 5 min longer in obese patients (pb.001 for each). There was a nonsignificant trend toward more complications with gestational ages above 18 weeks (5.5% vs. 7.7%, p=.20). A history of one or more cesarean sections had an independent association with major complications after adjustment for confounders (adjusted odds ratio 4.2, p=.001). Conclusions: Both anesthesia and operative times were modestly increased in obese women versus nonobese women undergoing second-trimester surgical termination, without significant differences in complication rates. For patients at advanced GA with prior cesarean delivery, clinicians should be aware of the potential increase in complications as well as increased operative time in obese women, and counsel appropriately. © 2012 Elsevier Inc. All rights reserved. Keywords: Obesity; Surgical termination; Second-trimester termination; Dilation and evacuation; Operative time 1. Introduction Nearly one half of the 6 million pregnancies occurring annually in the United States are unintended [1]. Of these unintended pregnancies, about 43% will end with induced abortion [1]. One third of American women have an induced abortion during their life [2]. Although surgical termination of pregnancy has previously been shown to be a safer method of pregnancy termination when compared to labor induction, death and complications can still occur, most commonly due to infection and hemorrhage [3,4]. Compli- cations from infection and hemorrhage are responsible for approximately one half of abortion-related deaths, with anesthesia complications accounting for 16% of abortion- related deaths [3]. Both pregnancy and obesity increase anesthetic risks [4]. Obesity is becoming increasingly common in obstetric and gynecologic populations in the United States. The proportion of overweight or obese women [body mass index (BMI), 25.0 kg/m 2 or more] of reproductive age in the United States increased from 37% to 59.5% in recent years Contraception 86 (2012) 402 – 406 ☆ Previous publication: This work was previously presented as a poster presentation at: Reproductive Health 2011, Association of Reproductive Health Professionals, Las Vegas, NV, September 15, 2011, Abstract/Poster #0078. ☆☆ No financial support for this study. ⁎ Corresponding author and for reprint requests, please contact: Sarah Betstadt, 601 Elmwood Ave., Box 668. Rochester, NY 14642. Tel.: +1-585- 276-5368. E-mail address: Sarah_betstadt@urmc.rochester.edu (S.J. Betstadt). 0010-7824/$ – see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.contraception.2012.02.006