Abstract

PIP: This chapter provides a detailed description of 1st and 2nd trimester abortion techniques. In general, low morbidity is facilitated by preoperative diagnosis and evaluation, operator skill, sterile technique, avoidance of trauma, completeness of evacuation, and postoperative care. The 1st trimester technique used by the authors involves predilatation with laminaria, paracervical and intracervical blocks (anesthetic solution, 1% lignocaine with adrenaline), dilatation with either the Hawkin Ambler type or half-sized Pratt dilator, and evacuation with the van Lith or Karman type suction cannula. For 2nd trimester pregnancy termination, the authors use aspirotomy, a technique that combines the classic dilatation and evacuation method with suction curettage. An ergometrine maleate preparation is administered at the start of the procedure to produce sustained contraction of the uterine wall, decrease the chance of perforation, and accelerate the emptying process. Adrenaline in 1% lignocaine is used as a local anesthetic solution. A specially designed crushing forceps decreases the cervical dilatation required. Also presented is a technique for late 2nd trimester (16-20 weeks gestation) abortion that involves prostaglandins or the Finks dilatation and evacuation technique. The complication rate in the authors' unit for 3500 2nd trimester terminations was less than 0.5% but rose after 17 weeks of gestation.