Abstract

PIP: The principal methods of midtrimester abortion are induction of labor or surgical evacuation. Induction of labor includes mechanical stimulation with a catheter, bougie, or metreurynter; amnioinfusion methods, either with hypertonic saline solution, hyperosmolar urea, or PGF2alpha; and pharmacological stimulation, either with PGF2alpha suppositories, or intramuscular injection of 15-methyl PGF2alpha. Surgical evacuation includes hysterotomy, now almost completely abandoned unless in special circumstances, and dilatation and evacuation (D&E). In 1972 D&E was the predominant method used in abortion in the 13-15 week interval, with 73.3% of cases, while it accounted for only 16.7% of interventions in the 16-20 week period. Cervical dilatation can be done with laminaria in a variety of different protocols. D&E procedures require skill and experience, time, and an array of different instrumentation. Midtrimester pregnancy must be carefully evaluated prior to intervention by pelvic examination, sonographic examination, and laboratory tests. Individual counseling of patients by a trained abortion counselor is very helpful. Complications associated with amnioinfusion procedures include failed abortion, gastrointestinal effects, bleeding, perforation, cervical laceration and infection. This study includes a detailed description of operative technics in D&E abortions at fetal ages from 11-12 weeks, to 21-22 weeks. Complications associated with D&E are failure to dilate, trapped calvarium, fragmented placenta, hemorrhage, perforation, cervical laceration and infection. Major complication rates for D&E and saline instillation are 0.69 and 1.78/100 abortions, respectively, at 13-16 weeks. Major complications with PGF2alpha instillation are 1.6 times the risk with saline infusion. Incidence of risk increases after 16 weeks gestation. D&E procedures can at times be very demanding for the assisting staff.