title: Umbilical cord transection to induce fetal demise prior to second-trimester D&E abortion.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Colorado Denver School of Medicine, Department of Obstetrics and Gynecology, 12631 E. 17th Avenue, Academic Office 1, Room 4006, Aurora, CO 80045. Electronic address: Kristina.Tocce@ucdenver.edu.
authors.forename: Kristina
authors.initials: K
authors.lastname: Tocce
authors.forename: Kara K
authors.initials: KK
authors.lastname: Leach
authors.forename: Jeanelle L
authors.initials: JL
authors.lastname: Sheeder
authors.forename: Kandice
authors.initials: K
authors.lastname: Nielson
authors.forename: Stephanie B
authors.initials: SB
authors.lastname: Teal
mesh_terms: D000028:Abortion, Induced / Q000379:methods*; D000293:Adolescent; D000328:Adult; D005260:Female; D005313:Fetal Death / Q000209:etiology*; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D014470:Umbilical Cord / Q000293:injuries*
keywords: Fetal asystole; Feticide; Second-trimester termination