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Dilation and Evacuation (D&E)
This procedure is called dilation and evacuation or D&E. It is mostly used after 13 weeks of pregnancy (in the second trimester). The procedure is usually done in a doctor’s office or clinic, but may be done in a hospital. Your doctor may use ultrasound to decide how far along you are in your pregnancy before a D&E.
To prepare for the procedure, the doctor will open (dilate) the cervix (opening to the uterus). This may be done in two ways and take several hours. Your doctor may choose to soften your cervix before the procedure with a medication. Or, the cervix may be opened by inserting one or more small sponge-like sticks, into the opening of the cervix. The sticks expand over time as they absorb moisture and slowly open your cervix. The sticks may be inserted at your first visit, for the abortion to be completed on the next day. Your doctor may also choose to open the cervix right before the abortion by putting in and taking out smooth metal rods that increase in size until the cervix is opened the exact amount needed.
Most women feel some pain during the procedure. The pain is like menstrual cramps, but can be stronger. Your doctor can tell you about ways to help with the pain like relaxation techniques and pain medicine that is taken by mouth or by a shot. Sometimes general sedation (going to sleep) is offered. It is important that you ask about the options available for pain. Talk with your doctor about any risks with each type of pain management.
After dilation, the fetus, and placenta are removed, using forceps or other instruments. This procedure will take about 15 to 30 minutes. You may have uterine cramping afterwards. You will stay at the doctor’s office for about thirty minutes after the procedure to make sure you are not having heavy bleeding and are doing well, before being allowed to leave.
Risks and Complications
Below are possible risks with this type of abortion. Not all risks may apply to you. Talk with your doctor about what risks apply to you.
Risks may include: infection, heavy bleeding, a hole or tear in the wall of the uterus, and injury to the cervix. A rare, but possible risk, is having some pregnancy tissue stay inside after the procedure. This can lead to heavy bleeding or infection. Serious complications may require additional surgery or being in the hospital. i
Having more than one abortion could increase the possibility of early delivery, having a low birth weight baby, or a condition where the cervix opens too early, increasing the risk of miscarriage in a future pregnancy.
It is rare, but some women may have feelings of sadness, guilt, anger, trouble sleeping or doing daily activities after their abortion. These symptoms can also occur after the birth of a baby or after a miscarriage. Call your doctor or local community mental health, health department, or human services office for help if you have any of these symptoms that are strong or lasting.
As with any medical procedure, death is a risk. However, death related to abortion occurs in less than one of every 100,000 abortions. ii
Risks and Complications associated with Pregnancy and Delivery
Most pregnancies are normal. Most women who have good care during pregnancy and delivery will give birth to a baby without problems. However, some women may have health conditions or pregnancy problems that may require special care or hospitalization during pregnancy. Just as there are risks with abortion, there are risks with continuing a pregnancy to full term.
Some of the pregnancy problems that may lead to hospitalization include a pregnancy growing outside the uterus (tubal pregnancy), miscarriage, excessive vomiting during pregnancy, urinary tract infection, heavy bleeding or infection, diabetes, blood clots, preeclampsia and eclampsia (causing swelling, high blood pressure and possible seizures), premature labor, death of the fetus, newborn or maternal death.
Maternal death occurs approximately 17 times out of every 100,000 live births in the U.S. iii
Many services may be available if you choose to continue your pregnancy. Contact your local health department, the Michigan Department of Health and Human Services, or your local county Department of Human Services to learn about help in your community.
If you would like information about adoption, contact your county Department of Human Services or a private adoption agency.
i M. Paul, E.S. Lichtenberg, L. Borgatta, D.A. Grimes, P.G. Stubblefield, M.D.Creinin; Management of Unintended and abnormal pregnancy: comprehensive Abortion Care. Wiley-Blackwell, 2009, p. 136.
ii M. Paul, E.S. Lichtenberg, L. Borgatta, D.A. Grimes, P.G. Stubblefield, M.D. Creinin; Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care. Wiley-Blackwell, 2009, p. 225
iii CDC Pregnancy Mortality Surveillance System, December 2016 https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pmss.html