Dilation and evacuation
Encyclopedia
Dilation and evacuation literally 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 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.
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 gentle vacuum to remove tissue in 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 gently scrape the lining of the uterus and remove tissue in the uterus. Lastly, the vacuum is used to ensure no fetal tissue remains in the uterus (such tissue can cause serious infections in the woman). The pieces are also examined to ensure that the entire fetus was removed.
may be performed prior to the surgical procedure. 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).
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...
and surgical evacuation of the contents of the uterus
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
. It is a method of abortion
Abortion
Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...
as well as a therapeutic procedure used after miscarriage
Miscarriage
Miscarriage or spontaneous abortion is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, generally defined in humans at prior to 20 weeks of gestation...
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.
Usage
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. Sometime in the second trimester, however, it becomes necessary to use instruments to help remove the fetus. This instrumental procedure is normally what is meant when the term dilation and evacuation is used.Description
The first step in a D&E is to dilateCervical dilation
Cervical dilation is the opening of the cervix, the entrance to the uterus, during childbirth, miscarriage, induced abortion, or gynecological surgery...
the cervix
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...
. This is often begun about a day before the surgical procedure, and often involves the insertion of multiple laminaria
Laminaria
Laminaria is a genus of 31 species of brown algae , all sharing the common name "kelp". This economically important genus is characterized by long, leathery laminae and relatively large size. Some species are referred to by the common name Devil's apron, due to their shape, or sea colander, due to...
sticks into the cervix. Enlarging the opening of the cervix enables surgical instruments such as a curette
Curette
A curette is a surgical instrument designed for scraping biological tissue or debris in a biopsy, excision, or cleaning procedure. In form, the curette is a small hand tool, often similar in shape to a stylus; at the tip of the curette is a small scoop, hook, or gouge...
or forceps
Forceps
Forceps or forcipes are a handheld, hinged instrument used for grasping and holding objects. Forceps are used when fingers are too large to grasp small objects or when many objects need to be held at one time while the hands are used to perform a task. The term 'forceps' is used almost exclusively...
to be inserted into the uterus
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
.
The second step is to remove the fetus
Fetus
A fetus is a developing mammal or other viviparous vertebrate after the embryonic stage and before birth.In humans, the fetal stage of prenatal development starts at the beginning of the 11th week in gestational age, which is the 9th week after fertilization.-Etymology and spelling variations:The...
. Either a local anesthetic
Local anesthesia
Local anesthesia is any technique to induce the absence of sensation in part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with...
or general anesthesia is given to the woman. A cannula
Cannula
A cannula or canula is a tube that can be inserted into the body, often for the delivery or removal of fluid or for the gathering of data...
is passed into the uterus. The cannula is attached by tubing to a bottle and a pump that provides a gentle vacuum to remove tissue in the uterus. Forceps
Forceps
Forceps or forcipes are a handheld, hinged instrument used for grasping and holding objects. Forceps are used when fingers are too large to grasp small objects or when many objects need to be held at one time while the hands are used to perform a task. The term 'forceps' is used almost exclusively...
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
Curette
A curette is a surgical instrument designed for scraping biological tissue or debris in a biopsy, excision, or cleaning procedure. In form, the curette is a small hand tool, often similar in shape to a stylus; at the tip of the curette is a small scoop, hook, or gouge...
is used to gently scrape the lining of the uterus and remove tissue in the uterus. Lastly, the vacuum is used to ensure no fetal tissue remains in the uterus (such tissue can cause serious infections in the woman). The pieces are also examined to ensure that the entire fetus was removed.
Variations
FeticideFeticide
Feticide is an act that causes the death of a fetus. In a legal context, "fetal homicide" or "child destruction" refers to the deliberate or incidental killing of a fetus due to a criminal human act, such as a blow to the abdomen of a pregnant woman...
may be performed prior to the surgical procedure. The tissues of the dead fetus will soften, making dismemberment easier. The standard D&E procedure is difficult after 20 weeks gestational age
Gestational age
Gestational age relates to the age of an embryo or fetus . There is some ambiguity in how it is defined:*In embryology, gestational age is the time elapsed since conception. This interval is also termed fertilisation 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
Intact dilation and extraction
Intact dilation and extraction is a procedure done in late term abortion. It is also known as intact dilation and evacuation, dilation and extraction , intrauterine cranial decompression and, vernacularly in the United States, as partial birth abortion...
by the American Medical Association
American Medical Association
The American Medical Association , founded in 1847 and incorporated in 1897, is the largest association of medical doctors and medical students in the United States.-Scope and operations:...
, and referred to as "intact dilation and evacuation" by the American Congress of Obstetricians and Gynecologists
American Congress of Obstetricians and Gynecologists
The American Congress of Obstetricians and Gynecologists , formerly the American College of Obstetricians and Gynecologists, is a professional association of medical doctors specializing in obstetrics and gynecology in the United States. It has a membership of over 55,000 and represents 90 percent...
(ACOG).