Paying physicians for high-quality care.

1910 n engl j med 350;18 www.nejm.org april 29, 2004 1999, nearly a third of all recognized pregnancies ended in abortion, either induced or spontaneous, yet only 4 percent of all maternal deaths during that time were associated with any type of abortion.3 Dr. Marchetti asks why dilatation and evacuation is not used to evacuate the uterus in the case of fetal death. In fact, the procedure is routinely used for that purpose. She also points out that the difference between the death of a fetus in utero, out of sight, and in full view during a destructive procedure is the degree to which the event offends our sensibilities. We agree. Michael F. Greene, M.D. Jeffrey L. Ecker, M.D.