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Dilation and Evacuation, commonly known as D&E, is a surgical procedure typically performed in the second trimester of pregnancy (after 14 weeks). It involves using forceps and vacuum suction. D&E is the standard method for performing an abortion in the second trimester and can also be used to remove tissue following a miscarriage.

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How It Works

Dilation and Evacuation has two main components: cervical dilation and uterine evacuation. 

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Cervical preparation and dilation - Because a D&E is performed later in pregnancy, the cervix needs to be opened wider than for a first trimester procedure. This is done with one or more methods: 

• Osmotic dilators - Small, sterile rods made from a material like seaweed (laminaria) or a synthetic gel (Dilapan) are inserted into the cervix. They absorb moisture from the body and expand, gradually opening the cervix over several hours or overnight.

• Medication - Drugs like misoprostol may be administered orally or vaginally to help soften and dilate the cervix. 

 

Evacuation - Once the cervix is adequately dilated, the uterine contents, including the fetus, are removed using a combination of instruments: 

• Suction - A thin tube (cannula) is inserted through the cervix into the uterus and connected to a pump that provides a gentle vacuum.

• Surgical instruments - Forceps may be used to remove the fetus, typically in pieces.

• Curette - A scraping tool may be used to ensure the uterus is completely emptied. 

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A D&E may be performed to terminate a pregnancy as well as to remove any remaining tissue after a miscarriage to prevent infection.

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Risks and Complications

Risks can include: 

• Bleeding (hemorrhage)

• Cervical injury

• Infection

• Remaining tissue in the uterus (incomplete abortion)

• Uterine perforation (a rare hole in the wall of the uterus)​​​​​​​