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Dilatation and Evacuation abortion treatment

 

Dilatation and Evacuation (D&E)

Click here to download the Dilatation and Evacuation section from the bpas guide 

You should plan to be at the clinic for the whole day.

This method uses medical instruments and suction to remove the pregnancy. It is usually performed from 15 weeks of pregnancy. You will be asleep (under general anaesthetic) for this procedure.

When you arrive, a healthcare professional will talk with you and answer your questions.

Preparing the cervix (neck of the womb)
Medication called misoprostol will be used to help open your cervix for the procedure. These tablets are either placed in your vagina 3 hours before the procedure or under your tongue 2 hours before the procedure. They may cause side effects such as nausea, vomiting, chills, diarrhoea, cramping or vaginal bleeding.

About the procedure
You will be asked to change into a gown and then you will be shown to the treatment area and asked to lie down on a trolley. Your anaesthetist will meet you, answer your questions and take you into theatre. A small cannula (a very fine plastic tube) will be placed in a vein, normally on your hand.

Medications will be given through the cannula to put you to sleep (general anaesthetic).

Once you are asleep, your legs will be placed in supports. The doctor will examine your uterus (womb). A speculum will be inserted into your vagina. The opening of your cervix may be stretched with thin rods called dilators. The pregnancy is removed using narrow forceps passed through the neck of the womb. A tube is then inserted through the cervix into the uterus. A suction machine will be used to gently empty your uterus. You will not feel any pain during the procedure.

A D&E takes about 10-20 minutes from start to finish. You will wake up in the recovery area and will be observed for about 1-2 hours before going home.

Click here to read about your anaesthetic.
After a general anaesthetic, you should not drive for 24 hours.

How will I feel after my surgical treatment?
After your treatment, you will normally wake up or come around in the recovery area, where once you can sit up, you will be invited to sit in a reclining chair. Specially trained staff will look after you and when they are satisfied that you have recovered safely from your anaesthetic or sedation, you will be able to move from recovery to another area of the clinic.

You may have some cramping and you will also have some light vaginal bleeding. If you have pain or other symptoms like nausea, we will give you medicines to relieve them. The staff will let you know what to expect. They will encourage you to get up and about as soon as possible and they’ll offer you a drink. Once you are ready you’ll be able to get dressed. You will then be taken to the refreshment room, where you can have a light meal and continue to recover.

Risks and complications of Dilatation and Evacuation
Significant, unavoidable or frequently occurring risks
These are usually easy to treat and rarely have any long-term health effects.
Retained products of conception - where the pregnancy has been successfully ended but some of the pregnancy tissue is  left behind in the womb (1 in 800)
Infection (1 in 2,500 as reported to bpas but may be higher)
Unpredictable bleeding after the abortion (variable)
Pain during the procedure (variable)
Injury to the cervix (1 in 5,000)

These may require transfer to hospital or surgical procedures, and may have serious long-term health effects
Psychological problems (variable)
Haemorrhage - very heavy bleeding (1 in 800)
Perforation of the uterus/womb (1 in 2,500)
Injury to bowel, bladder, or serious injury to cervix (very rare)
Death (less than 1 in 100,000)

Extra procedures which may be necessary
Repeat surgical abortion or uterine aspiration
Blood transfusion
Laparoscopy or laparotomy - operation to look inside the  abdomen
Repair of damage to cervix, uterus, bladder, bowel or blood  vessels
Hysterectomy - surgical removal of the womb (1 in 5,000)