In experienced hands, dilation and evacuation in
the early second trimester is as safe as medical
induction of labor. This procedure becomes technically
more difficult in the later second and third
trimesters. At more advanced gestational ages, labor
induction is safer and dilation and evacuation should
be reserved for physicians with more extensive experience
and skills in this procedure. Induction of labor
has been greatly aided by the availability of prostaglandin
preparations. There is considerable experience
with the use of prostaglandin E2 (PGE2) to
induce labor in women with fetal demise. During the
past decade, misoprostol has largely replaced PGE2
for induction of labor in cases of fetal death due to
similar efficacy with fewer side effects.34 Adverse
effects of prostaglandins include fever, nausea, emesis,
and diarrhea, particularly if a PGE2 preparation is
used. Pretreatment with antiemetics, antipyretics, and
antidiarrheals may reduce symptoms.