OBJECTIVES: To determine the incidence of hysterotomy in second trimester termination of pregnancy, including differences in women that abort following medical induction and those that fail to abort requiring surgical abortion, and the factors that influence choice of surgical operation. METHOD: Records of all women (n=1080) who presented for elective second termination of pregnancy (14-20weeks) in the years 2008 until 2010 were reviewed retrospectively. Theatre records were also used to verify the operation. The women were divided into two groups according to the method of abortion they finally responded to: a medical group that aborted following medical induction (n=1715), and a surgical group that failed to abort following medical induction (n=88). Apart from demographics, the surgical group was studied further in detail of previous uterine operation, surgical operation done for current abortion, complication profile and seniority of operating surgeon. RESULTS: Failed medical induction accounted for 5% of all second trimester abortions. The incidence of hysterotomy was 52% in the surgical group and 2.5% of all the second trimester abortions. Hysterotomy was more common in higher gestations (p=0.005). Suction curettage was frequent as a surgical abortion method in gestations below 16 weeks. Nulliparous women were more likely to fail to abort than multiparous women (p=0.002) and those with twin pregnancy more likely to abort on medical induction (p<0.001). Surgical evacuation was done mostly by registrars and consultants (senior members of staff). The two common complication profiles were haemorrhage and incomplete evacuation of the uterus. No cases of uterine perforation were identified, and there were no intensive care unit admissions and no deaths.

abstract: This thesis reviews the initial cases of fetal surgery to correct myelomeningocele, a severe form of spina bifida, and discusses the human and social dimensions of the procedure. Myelomeningocele is a fetal anomaly that forms from improper closure of the spinal cord and the tissues that surround it. Physicians perform fetal surgery on a developing fetus, while it is in the womb, to mitigate its impacts. Fetal surgery to correct this condition was first performed experimentally in the mid-1990and as of 2020, it is commonly performed. The initial cases illuminated important human and social dimensions of the technique, including physical risks, psychological dimensions, physician bias, and religious convictions, which affect decision-making concerning this fetal surgery. Enduring questions remain in 2020. The driving question for this thesis is: given those human and social dimensions that surround fetal surgery to correct myelomeningocele, whether and when is the surgery justified? This thesis shows that more research is needed to answer or clarify this question. / Dissertation/Thesis / Masters Thesis Biology 2020