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Dilation and evacuation (D&E), used after 12-16 weeks, consists of opening the cervix of the uterus and emptying it using surgical instruments and suction. D&E does not require an incision; the procedure is performed vaginally. Intact dilation and extraction (D&X) refers to a variant of D&E sometimes used after 18 to 20 weeks when removal of an intact fetus improves surgical safety or for other reasons (ref 63, Hammond).

Abortion may be also performed surgically by hysterotomy or gravid hysterectomy. Hysterotomy abortion is a procedure similar to a Caesarean section and is performed under general anesthesia. It requires a smaller incision than a Caesarean section and can be used during later stages of pregnancy (63). Gravid hysterectomy refers to removal of the whole uterus while still containing the pregnancy (63).

First-trimester procedures can generally be performed using local anesthesia, while second-trimester methods may require deep sedation or general anesthesia.