Dilation and evacuation (D&E) is a second-trimester surgical abortion that involves the dilation of the cervix and the removal of fetal tissue with forceps.
This type of abortion is performed between 14 and 24 weeks of gestation. In this blog post, we will discuss what to expect during a D&E procedure.
What is dilation and evacuation (D&E)?
Dilation and evacuation (D&E) is a second-trimester surgical abortion that involves the dilation of the cervix and the removal of fetal tissue from the uterine cavity with forceps.
It is a surgical procedure and one of the methods available to completely remove the fetus and all of the placental tissue in the uterus after the first trimester of pregnancy.
A D&E may be performed for surgical abortion or surgical management of a miscarriage. Induced abortion after the first trimester of pregnancy is rare.
Why it’s done?
A D&E procedure may be performed for a variety of reasons, including:
- To terminate a pregnancy that is no longer wanted or needed
- To terminate a pregnancy that is the result of rape or incest
- To terminate a pregnancy that is not developing normally
- To remove pregnancy tissue after a miscarriage (spontaneous abortion)
- Incomplete abortion
- Molar pregnancy
- Unintended and abnormal pregnancy
- Incomplete medical abortion
What to expect before a D&E procedure?
Before a D&E procedure, you will likely have a consultation with your doctor to discuss your medical history and the reasons why you are considering a D&E procedure.
You will also be given a physical exam and likely an ultrasound to date the pregnancy and confirm that it is in the second trimester.
You will be asked to sign a consent form before the procedure.
Some women choose D&E over labor induction for a second-trimester loss because it can be a scheduled surgical procedure, offering predictability over labor induction, or because they find it emotionally easier than undergoing labor and delivery.
What to expect during a D&E procedure?
Before the procedure, cervical preparation with osmotic dilators or medications is recommended to reduce the risk of complications such as cervical laceration and to facilitate cervical dilation during the procedure.
During a D&E procedure, you can expect the following:
- You will be given a sedative to help you relax.
- A posterior vaginal speculum will be inserted.
- Your cervix will be dilated with graduated metal dilators of gradually increasing size.
- Ovum forceps will be used to remove the fetus and placenta from the uterus.
- The uterine cavity is finally curetted by a flushing curette.
- Inj. Methergin 0.2 mg is to be administered.
- Instruments are removed, and the uterus is massaged.
- You may have cramping during the procedure.
- The procedure usually takes about 30 minutes.
A normal recovery includes irregular bleeding or spotting for the first 2 weeks. Use sanitary pads until you stop bleeding. Using pads makes it easier to monitor your bleeding. Cramps are similar to menstrual cramps. You may have them for several hours and maybe for a few days, as the uterus shrinks back to its non-pregnant size.
What to expect after a D&E procedure?
After a D&E procedure, you can expect the following:
- You will be monitored for a few hours after the procedure to make sure you are recovering well.
- You may have cramping and bleeding for a few days after the procedure.
- You will be able to go home the same day as the procedure.
- If your doctor prescribed medicines, take them as directed.
- You can do normal activities the next day, based on how you feel. Acetaminophen (such as Tylenol) or ibuprofen (such as Advil) can help relieve cramping pain.
- You should avoid sex, tampon, and douching for two weeks after the procedure.
- Use birth control when you start having sex again to prevent unwanted pregnancy.
- You should follow up with your doctor for a checkup within two to three weeks after the procedure.
If you have any questions or concerns about the procedure, be sure to talk to your doctor.
What are the risks associated with D&E?
There are several risks associated with D&E, including
- Uterine perforation
- Cervical laceration or cervical injury
- Retained products of conception (Tissue remaining in the uterus)
- Heavy vaginal bleeding
- Rare risk of hysterectomy
There is no evidence that surgical abortion causes an increase in infertility or adverse outcomes in subsequent pregnancies.
Be sure to discuss the risks with your doctor before the surgical evacuation of the uterus.
What is the difference between D&C and D&E?
A D&C is a dilation and curettage procedure to remove tissue from inside your uterus by using a curette. It is used to diagnose or treat conditions such as heavy bleeding, missed abortion, or molar pregnancy.
A D&E is a dilation and evacuation procedure. It is used to remove the contents of the uterus in the second trimester of pregnancy by using an ovum forceps.
Both procedures usually take about 30 minutes. Recovery times are similar, and both procedures have similar risks.
Your doctor will recommend the best procedure for your situation. If you have any questions or concerns, be sure to talk to your doctor.