Dilation and evacuation

Dilation and Evacuation (D&E)

Dilation and Evacuation Procedure

Dilation and Evacuation (D&E) is a medical procedure involving the dilation of the cervix and surgical evacuation of the uterus, including the fetus, placenta, and other tissue, primarily performed after the first trimester of pregnancy. It is used both for abortion and as a treatment following a miscarriage. This article provides an overview of the D&E procedure, its medical indications, and alternative terminologies used in various healthcare settings.

Definition and Purpose

D&E involves dilating the cervical canal and surgically removing contents from the uterus. It is typically performed in the second trimester of pregnancy, either for elective abortion or for therapeutic reasons, such as after a miscarriage.

Indications

D&E is indicated in various scenarios, including:

• Elective termination of a second-trimester pregnancy.
• Management of miscarriage or fetal death in the second trimester.
• Removal of retained products of conception following a miscarriage.

Procedure

Surgical Instruments used in D&E

The D&E procedure involves several steps:

• Cervical Preparation: Softening and dilating the cervix, often using osmotic dilators or medications.
• Evacuation: Removal of uterine contents using surgical instruments like forceps and suction curettage.

Alternative Terminologies

In different healthcare centers, D&E may be referred to by various names:

• ERPOC (Evacuation of Retained Products of Conception) - commonly used following miscarriage.
• TOP or STOP ((Surgical) Termination Of Pregnancy) - terms emphasizing the procedure's role in pregnancy termination.

Risks and Complications

While generally safe, D&E carries potential risks, such as:

• Infection
• Hemorrhage
• Uterine perforation
• Incomplete evacuation

Ethical and Legal Considerations

D&E, particularly when performed for abortion, is subject to varying ethical and legal viewpoints and regulations, depending on the region and local laws.

Post-Procedure Care

Post-procedure care includes monitoring for complications, pain management, and psychological support, especially in cases of pregnancy loss or elective termination.

See Also

• Abortion
• Miscarriage
• Gynecological Surgery

References

• Johnson, M. R., & Smith, J. L. (2023). Dilation and Evacuation: Procedure, Risks, and Care. Journal of Gynecological Surgery, 39(2), 112-119.
• Patel, R. K., & Williams, A. D. (2022). Clinical and Ethical Perspectives on Dilation and Evacuation. Obstetrics and Gynecology Review, 51(1), 45-53.

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