Dilation and evacuation

Dilation and evacuation literally refers to the dilation of the cervix and surgical evacuation of the contents of the uterus. It is a method of abortion as well as a therapeutic procedure used after miscarriage to prevent infection by ensuring that the uterus is fully evacuated. It is commonly referred to as a D&E.

D&E normally refers to a specific second trimester procedure. However, some sources use the term D&E to refer more generally to any procedure that involves the processes of dilation and evacuation, which includes the first trimester procedures of manual and electric vacuum aspiration.

Usage
Approximately 11% of induced abortions are performed in the second trimester. In 2002, there were an estimated 142,000 second-trimester abortions in the United States. The second trimester of pregnancy begins at 13 weeks gestation. For first-trimester and early second-trimester abortions, the pregnancy may be ended by vacuum aspiration alone. Sometime in the second trimester, however, it becomes necessary to use instruments to help remove the fetus. This instrumental procedure is normally what is meant when the term dilation and evacuation is used.

Description
The first step in a D&E is to dilate the cervix. This is often begun about a day before the surgical procedure. Enlarging the opening of the cervix enables surgical instruments such as a curette or forceps to be inserted into the uterus.

The second step is to remove the fetus. Either a local anesthetic or general anesthesia is given to the woman. Forceps are inserted into the uterus through the vagina and used to separate the fetus into pieces, which are removed one at a time. Lastly, vacuum aspiration is used to ensure no fetal tissue remains in the uterus (such tissue can cause serious infections in the woman). The pieces are also examined to ensure that the entire fetus was removed.

Variations
Feticide may be performed prior to the surgical procedure. The tissues of the dead fetus will soften, making dismemberment easier. The standard D&E procedure is difficult after 20 weeks gestational age due to the toughness of the fetal tissues.

If the fetus is removed intact, the procedure is referred to as intact dilation and extraction by the American Medical Association, and referred to as "intact dilation and evacuation" by the American College of Obstetricians and Gynecologists (ACOG).