​​​​​

Dilation and Extraction, also known as D&X or intact dilation and extraction or induced abortion, is a procedure involving the removal of an intact fetus from the uterus. Depending on how the D&X is performed, it can also be commonly known as a partial-birth abortion, which is currently banned in the United States. D&X is different from the more common and standard second-trimester procedure, Dilation and Evacuation, or D&E, which uses a combination of surgical tools and suction.

​​​​

How It Works

Dilation and Extraction is a multi-day procedure and has three main components: fetal demise, cervical dilation and fetal extraction. There are two ways a D&X can be performed - fetal demise can be initiated either before or during fetal extraction.

​​

Fetal Demise prior to Extraction (legal)

​​

• Fetal demise - Prior to cervical dilation and fetal evacuation, the abortionist will initiate fetal demise. A medication called Digoxin is injected through the woman's abdomen and into the fetus' head or heart, causing cardiac arrest and resulting in the death of the fetus. On day two, the abortionist may perform an ultrasound to confirm the fetus has died. If it is still alive, another dose of Digoxin is administered.​

• Cervical preparation and dilation - Because a D&X is performed late in pregnancy, the cervix needs to be opened wider than for a first trimester procedure. This is done with osmotic dilators - small, sterile rods made from a material like seaweed (laminaria) or a synthetic gel (Dilapan) inserted into the cervix. They absorb moisture from the body and expand, gradually opening the cervix over several hours or overnight.

• Evacuation - Once the cervix is adequately dilated, labor begins and the deceased baby is delivered. If the baby does not come out whole, a Dilation and Evacuation or D&E is performed.

​​​​

Fetal Demise during Extraction (illegal)

​

• Cervical preparation and dilation - Because a D&X is performed late in pregnancy, the cervix needs to be opened wider than for a first trimester procedure. This is done with osmotic dilators - small, sterile rods made from a material like seaweed (laminaria) or a synthetic gel (Dilapan) inserted into the cervix. They absorb moisture from the body and expand, gradually opening the cervix over several hours or overnight.

• Evacuation - When the cervix is sufficiently dilated, the doctor uses forceps to grasp and deliver the body of the fetus feet-first (breech position), leaving the head inside the birth canal. 

• Fetal Demise - While the head remains inside the uterus, the doctor creates an opening at the base of the skull (often using surgical scissors) and then inserts a suction catheter to remove the brain tissue. This allows the skull to collapse, enabling the head to pass through the cervix easily.

• Evacuation (continued) - After cranial decompression, the entire fetus is removed intact. The doctor then checks the uterus to ensure that no tissue remains and that bleeding is controlled.

​

Performing a D&X by initiating fetal demise during extraction is commonly known as partial-birth abortion. The federal Partial-Birth Abortion Ban Act of 2003 made this practice illegal in the United States. The ban defines a partial-birth abortion as an abortion in which the person performing the abortion: (1) deliberately and intentionally vaginally delivers a living fetus until, in the case of a head-first presentation, the entire fetal head is outside the mother's body, or, in the case of a breech presentation, any part of the fetal trunk past the navel is outside the mother's body; and (2) performs the overt act, other than completion of delivery, that kills the partially delivered living fetus.

​

Risks and Complications

Risks can include: 

• Bleeding (hemorrhage)

• Cervical injury

• Infection

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