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J Reprod Med. 1985 Aug;30(8):601-6.

Midtrimester abortion with Laminaria and vacuum evacuation on a teaching service.

Abstract

Midtrimester abortion by the dilatation and evacuation (D&E) method has generated controversy among health-care providers; many authorities insist that this procedure should be performed only by a small group of experts. Our institution has been providing abortions for patients who were at 13-16 1/2 menstrual weeks on a teaching service with Laminaria and vacuum evacuation (midtrimester D&E). The procedures were performed under local anesthesia in a separate, specially staffed, in-hospital pregnancy termination unit on an ambulatory basis. Twelve resident physicians at different training levels performed 87% of the procedures under the direct, hands-on supervision of a small but experienced faculty group. Records of 1,392 consecutive patients who underwent midtrimester D&E at Brigham and Women's Hospital between January 1, 1979, and December 31, 1980, were analyzed. There were no maternal deaths or life-threatening complications. Immediate and late morbidity was minimal. There were no major complications that necessitated laparotomy. Despite the use of Laminaria overnight, a "no-touch" rather than full sterile technique and no prophylactic antibiotics, infectious complications were minimal. We conclude that midtrimester D&E can be performed safely and efficiently by resident physicians in an appropriate teaching facility under close supervision. That ultimately can increase accessibility to the D&E procedure by increasing the number of physicians trained in this modality.

PIP:

Midtrimester abortion by the dilatation and evacuation (D&E) method has generated controversy among health care providers; many authorities insist that this procedure should be performed only by a small group of experts. The author's institution has been providing abortions for patients who were at 13-16 1/2 menstrual weeks on a teaching service with laminaria and vacuum evacuation (midtrimester D&E). The procedures were performed under local anesthesia in a separate, specially staffed, in-hospital pregnancy termination unit on an ambulatory basis. 12 resident physicians at different training levels performed 87% of the procedures under the direct, hands-on supervision of a small but experienced faculty group. Records of 1392 consecutive patients who underwent midtrimester D&E at Brigham and Women's Hospital between January 1, 1979 and December 31, 1980 were analyzed. There were no maternal deaths or life-threatening complications. Immediate and late morbidity was minimal. There were no major cmplications that necessitated laparotomy. Despite the use of laminaria overnight, a "no-touch" rather than full sterile technique and no prohylactic antibiotics, infectious complications were minimal. The authors conclude that midtrimester D&E can be performed safely and efficiently by resident physicians in an appropriate teaching facility under close supervision. That ultimately can increase accessibility to the D&E procedure by increasing the number of physicians trained in this modality.

PMID:
4045833
[Indexed for MEDLINE]
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