Janna Westerhuis MD, & Daan Schipper MD, medical director Bloemenhovekliniek, Heemstede, Holland
Since 1973, second trimester pregnancy terminations have been carried out using the D & E method introduced to us by Arnold Finks. This method has been subjected to adjustments by the introduction of prostaglandin induction with F2, Sulproston, E2 gel and now misoprostol. With the assistance of prostaglandin alone, a fully successful method has never been found within the reduced time frame of around 8 hours, which is dependant on the maximum time women can stay in the clinic (limit of 24 hours). Furthermore, it has always been strongly asserted in the Netherlands that attempts should be made to reduce the suffering of the woman during the abortion procedure as far as possible.
This is why there is still a great deal of emphasis placed on maintaining the skills and training of young doctors in this surgical technique. An approach has since been developed in Heemstede which occupies the middle ground between surgical abortion and procedures involving the use of medication.