Umbilical cord transection to induce fetal demise prior to second-trimester D&E abortion.

OBJECTIVE

Induction of fetal demise via transabdominal injection has been used to facilitate second-trimester abortion but requires a second procedure and has associated risks. The method of amniotomy, cord transection and documentation of fetal asystole immediately prior to dilation and evacuation (D&E) is an alternative approach; however, characteristics of this method have not been described.

STUDY DESIGN

This descriptive report from a single center involves a large case series of D&Es ranging from 16 to 23 weeks of gestation. Umbilical cord transection (UCT) was attempted immediately prior to D&E in 407 cases, which were reviewed to determine success, time to fetal asystole and complications.

RESULTS

Both UCT and asystole were achieved in 100% of cases. Mean time from UCT to asystole was 3.35±2.11 min. When compared to cases performed at less than 20 weeks of gestation, mean time to asystole was slightly longer in the ≥20-week group (3.7±2.4 min vs. 3.1±1.9 min; p=.008). Few patients had minor (4.6%) or major (0.3%) complications; time to asystole was not associated with complications.

CONCLUSIONS

Umbilical cord transection immediately prior to D&E is a feasible, efficacious and safe way to induce fetal demise without performing additional procedures.

IMPLICATION STATEMENT

This study demonstrates the feasibility, effectiveness and safety of utilizing umbilical cord transection to induce fetal demise in a large cohort. This method is an alternative to other feticidal procedures.