Dilation and Evacuation Abortion:

Dilation and Evacuation (D & E) abortion procedures account for approximately 11% of all abortions performed in the United States with less that 1% performed after 20 weeks. Of course, using even the conservative estimate of over 1 million abortions performed in the United States alone each year, 11% translates into 110,000 and 1% is actually 10,000 abortions performed using this procedure.

Dilation and evacuation (also sometimes called dilation and extraction) refers to the dilation of the cervix and the subsequent surgical evacuation of the contents of the uterus. The procedure is a method of abortion as well as a therapeutic procedure used after a miscarriage to prevent infection by ensuring that the uterus is fully evacuated.

Procedure

The D & E procedure is performed in two steps.

• The first step in a D&E is to dilate the cervix. This is often begun about a day before the surgical procedure by enlarging the opening of the cervix using surgical instruments, such as a curette or forceps, which are inserted into the uterus. A natural fiber, called Laminaria, is then inserted into the cervical opening during a pelvic exam to facilitate dilation. The laminaria remains in the cervix over several hours or overnight as it absorbs moisture and swells, pressing the cervix open.
• In the second step, after administering either a local anesthetic or general anesthesia, the physician removes the fetus, again using a curette and forceps, along with suction aspiration. Forceps are inserted into the uterus through the vagina and used to separate the fetus into pieces, which are then removed one at a time. Finally, vacuum aspiration is used to ensure no fetal tissue, which could cause serious infection, remains in the uterus. Once this has been completed, the arms, legs, head, torso, etc., are all counted and examined to ensure that the entire fetus was removed. The second step of the procedure usually takes between ten and fifteen minutes.

Side Effects and Risks

More than 97% of all second trimester abortions take place without any complications. Of the remaining percentage, 2.5% experience infection, retained tissue and heavier bleeding. Risk of major complications such as perforation or laceration of the uterus or cervix, prolonged infection or prolonged hemorrhage, all of which require additional medical attention, is slightly higher than in the first trimester. Complications severe enough to cause damage to the reproductive system, damage a woman's health, or threaten her life, are rare.