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Re: D&E practiceFrom: Griffiths Malcolm (Malcolm.Griffiths@ldh-tr.anglox.nhs.uk)Thu Jan 31 05:20:37 2002
Apologies to anyone who is unhappy about termination of pregnancy. In UK the procedure D&E is only performed by 1% of ob/gyn in NHS practice. The vast majority are done in private practice - largely in charity run termination services. Accordingly I am one of the few offering this procedure within an NHS setting. I was originally trained in this technique as a resident and have extended my range on the basis of experience and being "self taught". My own practice has largely been to dilate the cervix in millimetres to the number of weeks gestation, with some variation and latitude. I find that upto 18 weeks I can largely achieve this using the osmotic dilator Dilapan. There is little coverage of the technique in UK textbooks, the only references are one which says that "dilatation upto or above 20mm may be needed", and one in what is effectively a medicolegal text for ob/gyn, which is written by the guy who taught the guy who taught me. He says 14mm upto 16 weeks. I have come across some guidelines put out by one of the charity run termination services that restricts operating doctors to 12-14mm for any D&E. Given that the Sopher's forceps which I use for the procedure measure ~19mm across, this seems inappropriate. My understanding had been that uterine perforation or incomplete operations were more likely with inadequate dilatation. I wonder therefore if anyone out there doing these procedures might comment or refer me to an authorative source. Respecting sensitivities of all, you may prefer to do so off the list. Malcolm Griffiths Clinical director & consultant - obstetrics & gynaecology Luton & Dunstable Hospital NHS Trust, Luton, LU4 0DZ, UK Tel:+(44) 1582 497533 Fax: +(44) 1582 497376 ********************************************************************** This email and any files transmitted with it are confidential and intended solely for the use of the individual or entity to whom they -- are addressed. If you have received this email in error please notify the system manager.
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