Methotrexate does not kill immediately. Six out of ten women had fetal heart activity 4 days after methotrexate administration. Contraindications for prostglandins are high blood pressure, renal disease, smoking, anemia, age over 35, and asthma. Two days required to dilate the woman's cervix with the use of laminaria. Ultrasound is used to guide forceps into the uterus until a leg is grasped.
Baby is turned into face down position, spine up.
Baby is pulled outside of the body except for the baby's head. At this point the baby is likely to still be alive. Sliding his hand up the backbone the doctor hooks his index and ring fingers over the shoulders and uses his middle finger to hold the woman's cervix away from the baby's neck. The doctor then takes a pair of blunt-tipped surgical scissors and, after locating the base of the baby's skull, jams the scissors into the skull. He spreads the tips apart to enlarge the wound.