Abstract
This chapter discusses late midtrimester abortion. Dilation and evacuation (D&E) is becoming firmly established as the most satisfactory method of terminating second trimester pregnancy up to the 18th week. The chief differences in the D&E procedures from the 12th to 18th weeks as performed by different operators lie in (1) the method of cervical dilation and (2) the type of analgesic being used. The methods of cervical dilation include use of laminaria for 12 hours preceding the procedure, or forcible dilation with metal dilators. Both methods have strong advocates but laminaria seem to be increasing in popularity as causing less cervical injury, although their use is more time-consuming. A second difference in the earlier midtrimester surgical techniques lies in the use of either paracervical block or general anesthesia. Admittedly more bleeding occurs with the latter, which also incurs additional expense and time. The advantages of paracervical block are speed, economy, and the advantages of having a conscious patient.
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