Midtrimester abortion with Laminaria and vacuum evacuation on a teaching service

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.