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Dilatation and Evacuation

Dilatation and Evacuation (D&E): Procedure Overview and Risks

What are dilatation and evacuation?

Dilatation and evacuation is a method by which pregnancy tissues from the womb (uterus) are suctioned out by dilating (opening) the cervix under anaesthesia. D&E abortion is a safe and effective method when performed by trained, experienced providers.

When is this procedure performed?

This procedure is performed
  • To ensure complete removal of pregnancy-related tissues from the uterus after an incomplete abortion.
  • When the patient prefers uterine tissue removal over medical termination
  • When medical management is ineffective and fails to remove the pregnancy-related tissues from the uterus.
  • If there is excessive bleeding during the medical management and tissues have to be immediately removed from the womb to stop the bleeding,

Preparation for D and E

  • The woman needs to be on an empty stomach for 6 hours prior to the procedure (to make anaesthesia safe).
  • One tablet may be inserted in the vagina 4 hours before the procedure to facilitate opening of the cervix.
  • Under anaesthesia, vacuum aspiration (suction evacuation) of the contents of the uterus or womb is gently suctioned out, making sure that the uterus is completely empty.
  • She is given appropriate antibiotics.

After the procedure

  • Pulse, blood pressure, and other vital signs are monitored for about 2–4 hours in the recovery room until she comes out of anaesthesia.
  • Once the woman is awake and her vital signs are stable, she is allowed to go home about 6 hours after the procedure.

Risks

  • The overall (significant) complication rate for surgical evacuation of the uterus is approximately 6%. Women who are obese and have significant pre-existing medical conditions are more at risk of complications.
  • Bleeding after a miscarriage is common, but heavy bleeding necessitating a blood transfusion is uncommon.
  • Persistent pregnancy or placental tissue within the uterus may present with bleeding and infection and may require a repeat procedure.
  • Pelvic infection is common and is typically treated with antibiotics.
  • Perforation of the uterus can happen in 1 in 1000 cases. If the perforation has damaged the intestine or other organs, extra procedures like laparoscopy or laparotomy may be needed to repair the injured organ.
  • Typically, evacuated tissue is sent for histological analysis to rule out a molar or ectopic pregnancy.
  • Rarely, adhesions can form within the womb, and this can happen with repeated procedures.

The lady needs to call the medical team if the following symptoms are present:

  • A fever of 100.4 degrees F or higher
  • Vaginal discharge that has increased in amount or is foul-smelling
  • Pain in the lower abdomen
  • Nausea and vomiting

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