National Abortion Federation
John Ashcroft, Attorney General of the U.S.A.
April 5, 2004
Q = Question
A = Answer
15 Q. You have mentioned a number of reasons why you believe that
16 it is safe, and I would like to break that down and take then
17 one by one and ask you some more questions about them. First,
18 you mentioned that there are fewer passes with instruments.
19 Why is this a safety advantage?
20 A. When you are passing instruments into the uterus, you
21 always have the ability to inadvertently go through the wall of
22 the uterus and perforate the uterus and deliver something that
23 you don’t intend to deliver. That could include maternal
25 Q. Is that something of concern to you?
1 A. Uterine perforation is a medical emergency. A bowel injury
2 or an injury to maternal tissues is also an emergency,
3 mandating exploration of the maternal abdomen to repair damage.
4 Q. When you refer to a bowel injury, is that something that
5 can result from a uterine perforation?
6 A. Yes.
7 THE COURT: Have you ever perforated a uterus or done
8 any of these things?
9 THE WITNESS: Yes.
10 THE COURT: Were you ever sued for malpractice?
11 THE WITNESS: Yes.
12 THE COURT: Involving an abortion?
13 THE WITNESS: Yes.
14 Q. Have you ever perforated the uterus using the intact
15 approach to D&E?
16 A. No.
17 Q. Doctor, how is it that you are —
18 THE COURT: Just one SEFPBLGTD did in the malpractice
19 suit against you, Doctor, did the plaintiff recover?
20 THE WITNESS: No.
21 THE COURT: Was there settlement?
22 THE WITNESS: No. We won.
23 MS. CHAITEN: May I inquire, your Honor?
24 THE COURT: Sure.
25 MS. CHAITEN: Thank you.
1 Q. Dr. Fredriksen, how is it that uterine perforation during a
2 D&E in the second trimester?
3 A. Perforation is much more common with forcible dilatation of
4 the uterus, but it can be an inadvertently happened when you
5 are using forceps to grab tissue. There can be irregularities
6 in the uterine wall which make you think there are fetal parts
7 there and there are not. There can be irregularities in the
8 thickness of the uterine wall, including with a scarred uterus.
9 Or you can very easily go through the scar, the prior scar, or
10 have the scar open, and you then have a chance of delivering
11 anything from the maternal abdomen.
12 Q. Doctor, you mentioned that uterine perforation is more
13 common with forcible dilatation of the uterus. What is
14 forcible dilatation of the uterus?
15 A. Forcible dilatation of the cervix is a gradual process by
16 which you use metal dilators to introduce them into the uterus
17 and essentially force them through the uterus. That can cause
18 damage to the cervix.
19 Q. Do you use forcible dilatation in any second trimester
20 intact — I’m sorry. Let me rephrase.
21 Do you ever use forcible dilatation in a second
22 trimester D&E procedure?
23 A. I do not.
24 Q. Doctor, is there a high risk of uterine perforation from
25 repeated instrumentation of the uterus during a second
1 trimester D&E?
2 A. The more passes that you do, there is a chance for passing
3 those instruments through the uterus.
4 Q. But is it a significant risk of that happening? Is there a
5 high risk of that happening?
6 A. In the second trimester, because we use cervical dilators,
7 cervical dilatation by laminaria or misoprostol, it is less
8 frequent than with a first trimester termination. But it still
9 can occur.
10 THE COURT: Does that translate that it is a low risk,
12 THE WITNESS: It is low risk in occurrence, yes.
13 THE COURT: Thank you.
14 Q. Then why are you concerned about it?
15 A. Because it is a medical emergency and places the patient at
16 the necessity of doing a subsequent abdominal operation to
17 explore damage.
18 THE COURT: That is if it happens?
19 THE WITNESS: Correct.
20 THE COURT: But it is a low risk event. Next
22 Q. Doctor, you also testified that intact D&E can reduce the
23 risk of cervical laceration. Why is that?
24 A. Cervical laceration can actually nick an internal branch of
25 the cervical artery as well as lacerate the endocervical canal
1 and cause bleeding. The leading cause for this is bony
2 pieces — pieces of bony parts of the fetus which can be very
3 sharp, and when you pull them through the cervix can lacerate
4 the cervix and cause hemorrhage.
5 Q. What causes the presence of sharp bony parts in the first
7 A. The dismemberment process that is necessary to empty the
9 Q. Are these fragments present in an intact evacuation?
10 A. No, they are not.
11 Q. Why not?
12 A. Because the fetus is delivered almost or virtually intact,
13 and thereby you don’t have those bony fragments.
14 Q. Dr. Fredriksen, is there a high risk of cervical laceration
15 or uterine perforation from bony fragments during a D&E?
16 A. If you end up having a situation where you end up having
17 multiple fetal parts, there is always a risk of cervical