To the Editor: Drs Sprang and Neerhof1 assert that intact D&X places women "at increased
risk of 2 additional complications" relative to other surgical midtrimester
procedures, namely uterine rupture as a result of instrumentally performed
internal podalic version and uterine or cervical laceration by scissors used
to collapse the fetal skull.
As a second-year medical student, I recently observed a number of second-trimester
D&X and dilatation and evacuation (D&E) procedures and feel compelled
to comment. First, if the version is performed manually, as it was in all
cases I observed, there is no introduction of instruments into the uterus
for this step of the procedure and therefore, in fact, a reduced risk of perforation
resulting from D&E. Second, the insertion of scissors into the fetal skull
is not, as the authors state, a "blind" procedure; uterine or cervical laceration
would require gross error on the part of the physician.