To compare the complication rates of surgical versus medical abortion between 14 and 16 weeks of gestation (primary objective), and to assess patient experience (secondary objective).

This prospective bicentric cohort study was conducted in Marseille, France, and included adult patients undergoing abortion between 14 and 16 weeks of gestation. Medical abortion was performed at Hôpital Nord (from May 2023), and surgical abortion at Hôpital de la Conception (from January 2025). The primary outcome was the occurrence of early complications (hemorrhage >500 mL, blood transfusion, scheduled or emergency surgical intervention, cervical laceration, or uterine perforation) or late complications (pelvic inflammatory disease (PID), unplanned consultation, or hospitalisation). Secondary outcomes included patient-reported experience (pain, anxiety, and satisfaction). Follow-up continued to six weeks after the procedure.

Seventy-four patients were included (41 surgical abortions and 33 medical abortions). Baseline characteristics were comparable between groups. Effectiveness defined as abortion of the fetus was 100% for surgical abortion versus 91% for medical abortion (p = 0.084). Overall, complications occurred in 26% of patients, with a trend toward a higher rate in the medical group (36% vs 17%, p = 0.059). Surgical reinterventions for retained products occurred exclusively after medical abortion (24% vs 0%; p < 0.001). Four cervical lacerations were reported in the surgical group. Prolonged hospitalization occurred in 48% of patients in the medical group, never exceeding one night, compared with none in the surgical group (p < 0.001). Gestational age and parity were not significantly associated with complications (all p > 0.05). Maximum pain scores were higher in the medical group (VAS 7.1 ± 2.7 vs 1.5 ± 2.5; p < 0.001). Pre-procedure anxiety was higher in the surgical group (severe anxiety in 63% vs 14%, p = 0.003), but decreased after abortion in both groups with no intergroup difference. Patient satisfaction was higher after surgical abortion (82% positive experience vs 42%, p = 0.004).

Both medical and surgical methods are effective for abortions between 14 and 16 weeks of gestation. Overall complication rates were not significantly different between methods, except for the higher rate of surgical reintervention after medical abortion. Patient experience appeared less favorable after medical abortion, highlighting the need to optimize pain management and the management of retained products in order to support informed patient choice.