Dilation and evacuation
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Dilation and evacuation (also sometimes called dilation and extraction) 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.
In various health care centers it may be called by different names:
- D&E (Dilation and evacuation)
- ERPOC (Evacuation of Retained Products of Conception)
- TOP or STOP ((Surgical) Termination Of Pregnancy)
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.
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. Sometimes in the second trimester, however, it becomes necessary to use instruments to remove the fetus. This instrumental procedure is normally what is meant when the term dilation and evacuation is used.
The first step in a D&E is to dilate the cervix. This is often begun about a day before the surgical procedure, and often involves the insertion of multiple laminaria sticks into the cervix. 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. A cannula is passed into the uterus. The cannula is attached by tubing to a bottle and a pump that provides a vacuum to remove tissue from the uterus. Forceps are inserted into the uterus through the vagina and used to extract any remaining tissue. This is more likely in pregnancies of 16 weeks or more. A curette is used to scrape the lining of the uterus and remove tissue in the uterus. Lastly, the vacuum is used to ensure removal of fetal body remains in the uterus (such fetal remains can cause serious infections in the woman). The pieces of the fetal body are also examined to ensure that the entire fetus was removed.
Fetus termination may be performed prior to the surgical procedure via an injection to stop the heartbeat. 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 Congress of Obstetricians and Gynecologists (ACOG). When this intact evacuation is done with a live fetus which dies midway through, it has also been termed a partial birth abortion.
- "Miscarriage". EBSCO Publishing Health Library. Brigham and Women's Hospital. January 2007. Retrieved 2007-04-07.
- "Dilation and evacuation (D&E) for abortion". Healthwise. WebMD. 2004-10-07. Retrieved 2007-04-07.
- Guttmacher Institute: "Facts On Induced Abortion in the United States", May 2006. Accessed May 2006.
- Haskell, Martin (1992-09-13). "Dilation and Extraction for Late Second Trimester Abortion". "National Abortion Federation Risk Management Seminar". Dallas, Texas. Retrieved 2007-05-05.
- Health and Ethics Policies of the AMA American Medical Association. H-5.982 Retrieved April 24, 2007.
- ACOG Statement on the US Supreme Court Decision Upholding the Partial-Birth Abortion Ban Act of 2003 (April 18, 2007). Retrieved 2007-04-22.