What's a D&E?

Dilation and Evacuation is a Second Trimester Surgical Pregnancy Termination

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Dilation and evacuation, or D&E, is a surgical procedure used to end a pregnancy or complete a pregnancy loss during the second trimester

In a wanted pregnancy, a woman might have a D&E because of a stillbirth, an abnormality in the fetus or premature rupture of membranes. Or, she might need to have one because there is a serious risk to her health if the pregnancy is continued. 

Although ending a wanted pregnancy can be extremely difficult, it is sometimes medically necessary.

The Difference Between D&E and D&C

A D&E is different from a D&C. A D&C is a surgical treatment used in the first trimester to end a pregnancy or complete an incomplete miscarriage. It stands for "dilation and curettage" but may also mean a vacuum aspiration

The difference between procedures lies in the techniques used by the physician (we'll discuss D&E techniques below). The choice of procedure depends on how far along the pregnancy was at the time of the miscarriage. A D&C is used earlier in a pregnancy than a D&E.

However, it's not uncommon for women to use these terms interchangeably. As noted above, vacuum aspirations are frequently referred to as D&Cs, even though the former doesn't involve a sharp curette (an instrument used to remove tissue). Similarly, someone who had a miscarriage in the first trimester might refer to her treatment as a D&E, and someone might call her treatment in the second trimester a D&C.

Terminology aside, there isn't a huge difference among these procedures from a patient's perspective if she is dealing with a pregnancy loss. All surgical pregnancy loss treatments involve a procedure in which the cervix is dilated and the uterus is cleared of pregnancy tissue.

Step 1 - Dilation

Dilation and evacuation is a two-part process.

 The first step in a D&E is preparing the cervix by gradually softening and dilating it starting a day or two before the actual procedure.

This is usually done with an "osmotic dilator," which is comprised of either dried, compressed seaweed stalks or hydrogel rods. These expand in the cervical canal by gradually absorbing moisture there.

Osmotic dilators are used so that surgeons don't need to use extensive mechanical dilation during the procedure. Rapid mechanical dilation has been shown to increase the risk of second-trimester pregnancy loss in future pregnancies.

Drugs (misoprostol or mifepristone) can be used to prepare the cervix the day of the procedure, but they are not as effective as osmotic dilators and therefore more often also require mechanical dilation. However, women who are having a D&E early in the second trimester may be dilated with medication alone.

Step 2 - Evacuation

The second step in a D&E is the evacuation of the fetus and the placenta from the uterus.

The day of the procedure, women are given anesthesia, as well as antibiotics to prevent infection.

A combination of suction, forceps and curettage (use of a curette) are usually used to evacuate the uterus during a D&E. Some doctors use an injection to ensure fetal death has occurred before the evacuation, but this is controversial.

Once evacuation is complete, the surgeon will then check to make sure that all of the products of conception have been removed.

Is Dilation and Evacuation Safe?

Generally, yes. In the U.S., women very rarely die from a pregnancy termination that is legally conducted. And fewer than 5 percent of women have retained products of conception or a complication following a D&E. In those rare cases when complications do occur, they may include:

Usually, women who have a D&E do not experience problems in future pregnancies related to the procedure.

Sources:

Overview of second-trimester pregnancy termination. UpToDate. November 17, 2015.

Second-trimester pregnancy termination: Dilation and evacuation. UpToDate. November 17, 2015.

Stillbirth. Merck Manual.

Abortion Procedures. American Pregnancy Association.

Dilation and Evacuation. Michigan Department of Community Health.

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