Serious adverse effects of umbilical cord transection prior to second-trimester D&E abortion

摘要

To the Editor: Having read the article by Tocce et al. [1], we would like to comment on feticide prior to second-trimester surgical abortions. In the UK, there was a method practiced by some providers for procedures at 18-24 weeks' gestation informally called the "two-stage" procedure. This was described by Davis [2] in a letter to the Lancet in 1972. Both stages of the procedure were performed under general anesthesia. During the first stage, a forewater amniotomy was carried out after cervical dilatation not exceeding 10 mm, then the umbilical cord was brought down and cut. Following this, three 5-mm laminaria tents were inserted into the cervix. The next day, a dilatation and evacuation (D&E) was performed after bladder catheterization, removal of laminaria tents and intracervical block. In Davis' series of more than 500 cases, there were five instances of coagulo-pathy, one requiring a blood transfusion.