Vacuum aspiration for second-trimester abortion not recommended.

QUESTION: Recently I observed the use of vaccuum aspiration in an attempt to induce abortion in a woman 16 weeks' pregnant, after dialation of the cervix to 14 mm under paracervical block anesthesia. Only amniotic fluid and a segment of the umbilical cord could be aspirated. The patient was returned to bed, and an oxytocin (Pitocin) infusion was begun. She aborted 24 hours later with no complications. Why is this procedure considered inferior to amniocentesis and saline solution instillation as a technique for inducing abortion?

ANSWER: Transcervical rupture of the fetal membranes for the purpose of inducing second trimester abortion is unreliable as a method and is fraught with the most serious complication of intrauterine infection (Schwartz, R.H.: Septic abortion, Philadelphia, J.B. Lippincott, 1968, p. 17). On the other hand, Roufa et al. (Clinical Obstetrics and Gynecology 14:119, 1971) report no failures of abortion and only 1 significant intrauterine infection in 229 patients aborted in the second trimester by the hypertonic, intraovular, saline solution instillation method. The cervicovaginal portion of the reproductive tract is bacteriologically a contaminated area teeming with a variety of organisms. White and Koontz (Obstetrics and Gynecology 32:402, 1968) cultured the cervices of 57 pregnant women in all trimesters of pregnancy, and a significant number of these women harbored pathogens. In general the skin is preferable to the cervicovaginal tract as a route of entry into the intraovular space.