Beyond the First Trimester D&E Abortion (Dilation and Evacuation)

D&E Abortion (Dilation and Evacuation)

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Information on Abortion by D&E

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  • D&E is a surgical procedure combining dilation, vacuum aspiration, forceps, and curettage.
  • It is the most common second-trimester abortion method and is also performed for an incomplete, late miscarriage.
  • The risk of complications lies at 5%, which is slightly higher than first-trimester abortions, since risks increase with gestational age — e.g., injury to the uterus or cervix.

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What Is a D&E Abortion (Dilation and Evacuation Abortion)

Some surgical abortion methods, such as vacuum aspiration and D&C, can only be used until the 15th week of pregnancy. Later abortions require different methods because of fetal size. 94-98% of these are D&E abortions. During a D&E abortion, the fetus is dismembered using forceps for easier removal.

While D&Es are commonly done in a clinic, they can also be performed in a hospital.

A D&E abortion is usually an outpatient procedure. While the surgery takes only 30 minutes, the entire procedure is completed within two consecutive days.

Unlike during a D&C, the cervix is dilated slowly over a 1-2-day period. This allows complete access to the uterus, thereby limiting the likelihood of permanent injury.

These added procedural protocols increase the cost of an abortion.

D&E Abortion: The Procedure

D&E abortions are completed in two steps on consecutive days:

1. Preparation Stage — Day 1

Consent Forms and Payment

By law, abortion is a free choice and may not be coerced. Therefore, abortions are only performed with the written permission of the woman.

Bloodwork and Ultrasound

Before initiating dilation, blood is drawn to determine your Rh factor and blood type in case the need for blood transfusions arises.

A pre-abortion ultrasound identifies how far along you are in the pregnancy and reveals the position of the fetus and placenta.

Feticide

An injection to induce fetal demise is sometimes given through the woman's abdomen or cervix. This is an elective step taken by 50% of physicians in the US.

Antibiotics

A single dose of oral antibiotics is given to prevent infection.

Dilation

The cervix is softened and gradually dilated (opened) over a 24-hour period using osmotic dilators. Seaweed stalks (laminaria) or hydrogel rods are used for this purpose as they slowly expand by absorbing the moisture in the woman's cervix. After the placement of the dilators, the woman is free to leave the clinic until her appointment the following day.

2. Evacuation Stage — Day 2

Anesthesia

D&Es are typically performed using a paracervical block (local anesthetic injected into your cervix) and intravenous conscious sedation.

Removal of Fetus and Placenta

The doctor uses a speculum to open the woman's vagina, making her cervix visible. A tube is inserted into her uterus, by which all amniotic fluid is suctioned out. Using forceps, the fetus is then dismembered and extracted in pieces. After the extraction, suction and curettage ensure that the uterus is completely emptied. An ultrasound is commonly used to confirm that the abortion is complete.

Recovery Room

Immediately after the procedure, the woman will be observed for an hour and given discharge instructions and a two-week follow-up appointment. A partner, friend, or family member will need to drive the patient home.

What to Expect After a D&E

Side Effects

After the procedure, vaginal bleeding can be expected for a few days or even up to two weeks. Cramping may continue for several weeks, causing the uterus to return to its pre-pregnancy size. Lactation is possible, causing breasts to swell, hurt, and leak colostrum. Seek medical help if you are experiencing excessive bleeding or pain, running a fever, or feeling unsure about any side effects.

⚠️ Menstruation should resume after four to eight weeks, but conception is possible before your first period.

Things to Avoid

Since the cervix stays slightly open for three to four weeks, medical providers advise you to refrain from the following activities to avoid infection:

  • sexual intercourse
  • tampons
  • swimming pools/bathtubs
  • sauna visits

Potential Risks of a D&E

Before the procedure, your doctor will inform you of the possible risks of a D&E abortion. Approximately 5% of women encounter complications such as retaining fetal tissue (1%), cervical laceration (3%), uterine perforation, infection (0.1-4%), extramural delivery (delivery due to dilation before the surgery), and hemorrhage (>1%).

ℹ️ For more information, go to Risks and Side Effects of Abortion.

Apart from considering the physical risks, stay in tune with your heart and mind to evaluate whether this is the right path for you. In counseling, we regularly encounter women who struggle with their choice after having had an abortion.  Therefore, it is crucial that you take the time you need. If you feel uneasy about having a D&E and unsure whether this is the path for you, pay attention to your gut intuition. You are not obligated to keep your appointment.

Reasons for a D&E Abortion

The reasons women pursue D&E abortions are as unique as their lived experiences.

Perhaps you have received the heartbreaking news of a fetal anomaly and are wondering whether to have an abortion.

Maybe you are encountering a severe medical issue that is putting your life or health at risk.

Perhaps you just found out you were pregnant, or you could not get an appointment sooner because of finances or abortion restrictions.

Or maybe you are experiencing an unexpected crisis in your relationship, causing you to doubt whether you should go through with the pregnancy.

Where to Go from Here?

Your questions go way beyond investigating which abortion method to use. Any of these situations would bring an overload of thoughts and emotions. It would be hard to know where to start.

Take a deep breath! You usually do not have to decide on the spot, even if your doctor makes it sound that way. An abortion at a later stage of pregnancy can be an agonizing experience. Therefore, it is crucial to explore your options. If you are considering a second-trimester abortion, you probably live in an area where abortion is permitted, or you might be operating under an exempt status. Unless you are experiencing a medical emergency, you are probably given ample time to consider your next steps and determine which path is most in line with who you are.

Allow us to remove some of the confusion by assisting you in ordering your thoughts.

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