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Dilation and evacuation (D&E) is done in the second 12 weeks (second trimester) of pregnancy. It usually includes a combination of vacuum aspiration, dilation and curettage (D&C), and the use of surgical instruments (such as forceps).
An ultrasound is done before a D&E to determine the size of the uterus and the number of weeks of the pregnancy.
A device called a cervical (osmotic) dilator is often inserted in the cervix before the procedure to help slowly open (dilate) the cervix. Dilating the cervix reduces the risk of any injury to the cervix during the procedure. Misoprostol may also be given several hours before surgery. This medicine can help soften the cervix.
D&E usually takes 30 minutes. It is usually done in a hospital but does not require an overnight stay. It can also be done at a clinic where doctors are specially trained to perform abortion. During a D&E procedure, your doctor will:
The uterine tissue removed during the D&E is examined to make sure that all of the tissue was removed and the procedure is complete.
Doctors may use ultrasound during the D&E procedure to confirm that all of the tissue has been removed and the pregnancy has ended.
Dilation and evacuation (D&E) is a surgical procedure. A normal recovery includes:
Ask your doctor if you can take acetaminophen (such as Tylenol) or ibuprofen (such as Advil). They may help relieve cramping pain. Be safe with medicines. Read and follow all instructions on the label.
Call your doctor immediately if you have any of these symptoms after an abortion:
Call your doctor for an appointment if you have had any of these symptoms after a recent abortion:
Dilation and evacuation (D&E) is one of the methods available for a second-trimester abortion. A D&E is done to completely remove all of the tissue in the uterus for an abortion in the second trimester of pregnancy.
Dilation and evacuation may also be used to remove tissue that remains after a miscarriage.
Dilation and evacuation is a safe and effective method. It has become the standard treatment of care in Canada for an abortion in the second trimester of pregnancy.
The risks of dilation and evacuation (D&E) include:
Risks are higher for surgical abortions done in the second trimester of pregnancy than for those done in the first trimester, particularly if they are done after 16 weeks of pregnancy.
Other rare complications include:
A repeat vacuum aspiration and medicine to stop bleeding are used to treat retained products of conception or blood clots.
An abortion is unlikely to affect your fertility, so it is possible to become pregnant in the weeks right after the procedure. Avoid sexual intercourse until your body has fully recovered, for at least 1 week or as advised by your doctor. When you do start having intercourse again, use birth control, and use condoms to prevent infection.
Counselling for a second-trimester abortion may be more involved than for an early abortion because of the length of the pregnancy and the reason for the abortion.
Should you have continuing emotional reactions after an abortion, seek counselling from a grief counsellor or other licensed mental health professional.
Depression can be triggered when pregnancy hormones change after an abortion. If you have more than 2 weeks of symptoms of depression, such as fatigue, sleep or appetite change, or feelings of sadness, emptiness, anxiety, or irritability, see your doctor about treatment.
The hospital or surgery centre may send you instructions on how to get ready for your surgery or a nurse may call you with instructions before your surgery.
If you have an abortion in an outpatient centre and there is a complication, you may be taken to a hospital.
Right after surgery, you will be taken to a recovery area where nurses will care for and observe you. You will probably stay in the recovery area for a period of time and then you will go home. In addition to any special instructions from your doctor, your nurse will explain information to help you in your recovery. You will go home with a page of care instructions including who to contact if a problem arises.
Current as of: February 11, 2020
Author: Healthwise Staff
Medical Review:Sarah Marshall MD - Family Medicine & Anne C. Poinier MD - Internal Medicine & Kathleen Romito MD - Family Medicine & Adam Husney MD - Family Medicine & E. Gregory Thompson MD - Internal Medicine & Rebecca H. Allen MD, MPH - Obstetrics and Gynecology & Kirtly Jones MD - Obstetrics and Gynecology & Femi Olatunbosun MB, FRCSC - Obstetrics and Gynecology
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