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

ObjectiveInduction 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 DesignThis 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.ResultsBoth 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.ConclusionsUmbilical cord transection immediately prior to D&E is a feasible, efficacious and safe way to induce fetal demise without performing additional procedures.Implication statementThis 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.