To the Editor: We thank Drs. Rowlands and Oloto for their interest in Our study [1]. They bring attention to a "two-stage" D&E procedure that was previously utilized in the UK [amniotomy and umbilical cord transection (UCT) was followed by laminaria placement; dilation and evacuation (D&E) was then performed the following day]. Their description and report further supports the feasibility of performing UCT prior to D&E. However, this protocol was discontinued due to disseminated intravascular coagulopathy (DIC) and hemorrhage in a significant number of patients. Drs. Rowlands and Oloto express concern that substances released into the maternal circulation by damaged trophoblast tissue triggered DIC. Although this may be an etiology to be considered, other possibilities include infection risk related to prolonged rupture of membranes (ROMs), placement of laminaria in the face of prolonged ruptured membranes and prolonged fetal death. The technique we described minimizes these risks since UCT is performed immediately prior to evacuation of the uterus. The time of exposure to damaged trophoblast tissue should be negligible since the mean time to asystole was 3.35±2.11 min with a range of < 1 to 11 min [1], and there is no prolonged ROM or hours of exposure to foreign bodies after ROM. The single case of hemorrhage > 1000 mL in our case series was transferred to an outside emergency department, and we are unable to provide details regarding the presence or absence of DIC in this patient.
展开▼
