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.
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