What is dilation and evacuation?

Dilation and Evacuation
Jump to

Dilation and evacuation (D&E): Overview

Dilation and evacuation (D&E) is a type of in-clinic abortion that can be done in the second trimester of pregnancy. It is usually done with vacuum aspiration. Sometimes surgical tools may also be used. Before the procedure, medicines can be given to reduce pain and help you relax.

An ultrasound is done before a D&E to check the number of weeks of the pregnancy. Ultrasound may also be used during the D&E to confirm that all of the tissue has been removed.

A D&E is often done in a clinic. It can also be done in a hospital. The procedure usually takes less than 30 minutes. But you may be in the clinic or hospital for a few hours.

How well does dilation and evacuation (D&E) work?

D&E is an effective method of abortion in the second trimester of pregnancy. It is also an effective way to remove tissue that remains after a miscarriage.

What are the risks of dilation and evacuation (D&E)?

D&E rarely causes any problems. But the risk of problems is higher for abortions done in the second trimester than for those done in the first trimester. Possible problems include:

  • Tissue remaining in the uterus.
  • Injury to the cervix.
  • A hole in the wall of the uterus (uterine perforation).
  • Moderate to severe vaginal bleeding.
  • Infection.

What can you expect as you recover from dilation and evacuation (D&E)?

D&E is a medical procedure. 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 similar to menstrual cramps. They help to shrink the uterus back to its nonpregnant size. You may have cramping for up to a few weeks.

After the procedure:

  • If your doctor prescribed medicines, take them exactly as directed.
  • Rest as much as you can. You can do normal activities the following day, based on how you feel.
  • Ask your doctor if you can take an over-the-counter pain medicine, such as acetaminophen (Tylenol) or ibuprofen (Advil). Do not take aspirin unless your doctor prescribed it. Be safe with medicines. Read and follow all instructions on the label.
  • Ask your doctor when it is okay for you to have vaginal sex. You can get pregnant in the weeks after an abortion. If you don't want to get pregnant, talk to your doctor about birth control options.

How is dilation and evacuation (D&E) done?

Before a D&E procedure, a device called a cervical (osmotic) dilator might be inserted into the cervix to help slowly open (dilate) the cervix. Misoprostol or mifepristone may also be given several hours before surgery. This medicine can help soften the cervix. Your doctor may also use a medicine to stop your pregnancy before the procedure. This is given by injection into the uterus, either through your belly or vagina.

During a D&E procedure, your doctor will:

  • Position you on the exam table in the same position used for a pelvic exam. Your feet will be on stirrups while you lie on your back.
  • Insert a speculum into the vagina.
  • Give you a pain medicine injection in the cervical area (paracervical block) along with a sedative. If the procedure is done in an operating room, you could receive a spinal anesthesia injection into the fluid around the spinal cord. This numbs the area below the injection site. Or your doctor may use general anesthesia, which makes you unconscious.
  • Dilate the cervical canal. An abortion in the second 12 weeks will need the cervix to be dilated more than required for a vacuum aspiration.
  • Pass a hollow tube (cannula) into the uterus. The cannula is attached by tubing to a bottle and a pump that provides a gentle vacuum to remove tissue in the uterus. You will feel some cramping during the rest of the procedure.
  • Pass a grasping tool (forceps) into the uterus to grasp larger pieces of tissue. This is more likely in pregnancies of 16 weeks or more.
  • Use suction. This may be done as a final step to make sure the uterine contents are completely removed.

Why is dilation and evacuation (D&E) done?

D&E is one method available for a second-trimester abortion. It may be done because of a severe medical problem or to remove tissue that remains after a miscarriage. It may also be done if you couldn't get an abortion earlier in pregnancy.

©2011-2024 Healthwise, Incorporated

The content above contains general health information provided by Healthwise, Incorporated, and reviewed by its medical experts. This content should not replace the advice of your healthcare provider. Not all treatments or services described are offered as services by us. For recommended treatments, please consult your healthcare provider.