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Dilatation and Evacuation

1. What is dilatation & Evacuation?

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

 

2. 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 removal of tissues from the uterus 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 bleeding.

 

3. Preparation for D & E

  • The woman needs to be on empty stomach for 6hours prior to the procedure (to make anesthesia 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/womb is gently suctioned out making sure that the uterus is completely empty.
  • She is given appropriate antibiotics

4. 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 anesthesia.
  • Once the woman is awake and her vital signs are stable, she is allowed to go home in about 6 hours after the procedure.

 

5. Risks

  • The overall (significant) complication rate for surgical evacuation of the uterus is approximately 6%. Women who are obese, who have significant pre-existing medical conditions are more at risk of complications.
  • Bleeding after a miscarriage is common: heavy bleeding necessitating blood transfusion is uncommon.
  • Persistent pregnancy or placental tissue within the uterus may present with bleeding and infection and may require repeat procedure.
  • Pelvic infection is common and is usually prevented by giving antibiotics.
  • Perforation of 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.
  • Usually, evacuated tissue is sent for histological examination to exclude molar/ectopic pregnancy
  • Rarely adhesions can form within the womb and this can happen with repeated procedures.

 

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

  • Fever of 100.4degree F or higher
  • Vaginal discharge that has increased in amount or is foul smelling
  • Pain in the lower abdomen
  • Nausea and Vomiting