Dr Komala's Women Clinic - LAVH


The doctor recommends the Dilation and Evacuation (D&E) procedure for abortion and removal of the fetal and placental tissues in a missed miscarriage. Although the method is safe and effective, it may have some complications. The steps for this procedure include cervix preparation, anesthesia, and surgery.

What is D&E?

Dilation and Evacuation (D&E) is a surgical procedure. The procedure involves dilation of the cervix and removal (evacuation) of the fetal and placental tissues. The doctor recommends this procedure either for abortion or to remove pregnancy tissues completely after a miscarriage. If the doctor removes the intact fetus, the procedure is known as Intact Dilation and Evacuation.

It is one of the most common methods for pregnancy termination in the second trimester. Clinicians prefer this method because of several advantages over the labor induction method. The morbidity and mortality rate of D&E is lower than labor induction. Further, D&E does not need hospital admission and is less costly.

When Do Doctors Advise You to Undergo D&E?

Doctors may advise women to undergo D&E either for abortion or the surgical management of miscarriage.

  • Abortion: D&E is a general method for abortion during the second trimester. Through this procedure, surgeons remove the complete uterine tissues. Abortion, during the second trimester, is usually due to severe abnormalities in the fetus. Other reasons for abortion include pregnancy due to rape or incest and legal restrictions resulting in delayed abortion.
  • Miscarriage: The doctor also performs D&E as part of surgical management of miscarriage. Several women prefer D&E over labor induction as they find the procedure more scheduled and predictable. The complication rate for this procedure is low.

What is a Missed Abortion?

Missed abortion is also known as a missed miscarriage or silent miscarriage. As the name suggests, this condition refers to the loss of the fetus without the woman receiving any indications. Unlike other miscarriages, women who suffer missed miscarriages do not experience symptoms, such as cramps and bleeding.

In a missed abortion, the embryonic tissues and the placenta are present in the uterus even after pregnancy loss. Although the exact cause of missed abortion remains unknown, approximately 50 percent are due to chromosomal abnormalities.

Women who smoke excessively or suffer from autoimmune disease or endocrine disorders have a high risk of missed abortions. Many women blame themselves for missed abortions. However, it is worth noting that exercise, travel, sex, and stress do not contribute to missed abortions. The doctor may not provide an explanation for a missed abortion. The embryo stops growing without any apparent reason.

How Do Doctors Perform the D&E Procedure?

The doctor performs the D&E procedure through the following steps:

  • Preoperative Cervix dilation: The doctor preoperatively uses the osmotic dilators to dilate the cervix. Dilating the cervix reduces procedure-related complications, such as uterine perforation or cervical injury. Several hours before the surgery, the doctor may also administer misoprostol to soften the cervix.
  • Anesthesia: The type of anesthesia depends on a patient’s condition. The doctor may prescribe analgesics to reduce pain during the procedure. In some cases, the doctor may administer intravenous sedatives. Other options for anesthesia include spinal anesthesia and general anesthesia.
  • Surgery: The doctor injects antibiotics to prevent infection during and after the surgery. The doctor uses an antiseptic solution to clean the cervix and vagina. The surgeon uses an instrument to hold the cervix and dilates it with a probe. The doctor inserts a hollow tube into the uterus and attaches the cannula with the pump via a tube. The pump generates a low-intensity vacuum to evacuate the tissues. The doctor then uses forceps to remove all the large tissues and curette to scrape the uterine lining. To ensure the complete removal of all tissues, the doctor uses a gentle suction at the final stage of the procedure.

What are the Complications of the D&E Procedure?

The surgical evacuation of the uterus has a complication rate of about 6%. Like any other procedure, D&E also carries certain risks. Some of them are:

  • Infection: It is a common complication and may occur in around 4% of women. The doctor administers antibiotics to prevent a microbial attack.
  • Bleeding: Bleeding may also occur for about two weeks after D&E. The doctor prescribes medicines to prevent bleeding.
  • Retained tissues:  Complications of retained tissue may manifest in around 4% of women. It is prudent to perform transvaginal ultrasonography to confirm the completion of the procedure.
  • Perforation: Perforation is uncommon during the procedure and may occur in around 0.1% of women. Most perforations are not clinically significant.

Cervical trauma: Cervix dilation significantly reduces the risk of cervical trauma. It is uncommon and occurs in less than 0.1% of women.

The entire surgery takes around 30 minutes. There is no need to stay overnight at the hospital, and doctors discharge patients on the same day. The doctor may prescribe certain medications that help reduce pain and the risk of infection. Medicines also contract the uterus.

The doctor advises the patient to rest on the day of surgery. Patients return to normal activities from the day after surgery. The doctor may also advise the patient to avoid sexual intercourse for a week after the surgery. The couple should use condoms to prevent infection when they resume sexual intercourse.

Consult your doctor if you experience any procedure-related complications, such as bleeding, progressively increasing vaginal discharge, swelling and pain in the genital area, and abdominal pain that cannot be managed by medicines. You should also book an appointment with the doctor if there is no menstrual period one and a half months after the procedure.

D&E is an effective and safe method. Studies have concluded that there are no effects on infertility and pregnancy outcomes in subsequent pregnancies after D&E. At least one study found no difference in miscarriage, cervical incompetence, and preterm delivery due to surgical procedures for managing miscarriages. However, there was a higher postpartum hemorrhage incidence.

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