Dilation and Evacuation (D&E)

Definition - What does Dilation and Evacuation (D&E) mean?

Dilation and evacuation (or D&E) is a surgical procedure that involves opening the cervix wide enough to evacuate the contents of the uterus (i.e. fetus and placenta). It is used as a mode of inducing abortion as well as a preventive strategy against infection following an abortion to ensure complete removal of the contents of the uterus. D&E is done in the second trimester of pregnancy, which begins at 13 weeks from a woman’s last menstrual period. Occasionally, the procedure requires inducing labor with medications.

FertilitySmarts explains Dilation and Evacuation (D&E)

A D&E is usually a two-day procedure and ideally requires admission into a healthcare facility. After performing the necessary laboratory tests and an ultrasound, the physician prescribes antibiotics to prevent infection. The physician then cleans the vagina with an antiseptic solution. A medication is next injected into the cervix to numb the area. Approximately 12-24 hours prior to the procedure, the physician inserts multiple synthetic dilator sticks into the cervix to dilate (or open) the cervix. These dilators gradually absorb moisture and expand, widely opening the cervix. The woman will feel some pressure or intermittent cramping as her cervix dilates. A medication, called misoprostol, which helps soften the cervix may also be given a few hours before surgery.

Next day, an instrument known as a speculum is passed into the vagina, to keep it open. A long tube (called cannula) is then passed through the vagina into the uterus to help remove tissue from the lining. A surgical instrument resembling a scoop, termed as a curette is used to scrape the residual uterine lining. Forceps are inserted to remove larger fetal parts. Finally, suction is done to ensure complete removal of the products.

Commonly, a D&E causes some bleeding and cramping. Less frequent complications include heavy or prolonged bleeding, blood clots, damage to the cervix or uterus, fainting spells, infection, and more rarely amniotic fluid embolism (a fatal condition in which the amniotic fluid finds its way into the mother's blood).

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