This procedure requires cervical preparation so you should plan to be at the clinic for the whole day.

 

VIDEO: Dilation & Evacuation

This method can be used from 14 weeks’ gestation up to 24 weeks’ gestation. Up to 18 weeks it may be under general anaesthetic or conscious sedation. At 18 weeks or above the procedure is done under general anaesthetic.

This method uses instruments and suction to remove the pregnancy. You will need cervical preparation on the day of surgery, or the day before surgery.

A healthcare professional will show you into the treatment area. You will be asked to lie on a couch with supports for your legs. You will meet your surgeon, and if appropriate your anaesthetist, where you can ask any last-minute questions. Any sedation or anaesthesia will be given before the procedure begins. A nurse will stay with you to support and monitor you throughout.

The surgeon will examine you and place a speculum into your vagina. The opening of your cervix may be stretched with thin rods called dilators. The pregnancy is removed using instruments and gentle suction.

You will not feel pain during this procedure but may feel some discomfort if you have your treatment with conscious sedation. The treatment takes about 10-20 minutes. Afterwards you will be taken to the recovery area and monitored until we consider you are ready for discharge. You will have a light snack before going home and will be given an anti-sickness drug.

You should read about cervical preparation and the relevant sedation or anaesthetic options below:

• local anaesthetic
• conscious sedation
• general anaesthetic

Risks and complications

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 procedure (variable)
• Pain during the procedure (variable)
• Injury to the cervix (1 in 5,000)
• Psychological problems (variable)

These may require transfer to hospital or surgical procedures, and may have serious long-term health effects.

• 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)

Extra procedures that may be necessary

• Repeat surgical procedure 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)

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

This method involves the administration of medications that induce labour. This procedure takes place over 2 days.

First appointment: You are given a mifepristone tablet to swallow. This medication makes the uterus more sensitive to a medication called misoprostol, which is used to induce contractions. You will go home and return for the rest of your treatment on a different day. If you vomit within 1 hour of taking the mifepristone you may need to return to the clinic for another dose. If you are 22 weeks pregnant or more, it is necessary to administer an injection to the fetus to stop the hearbeat before the induction takes place.  If you are rhesus negative, you will also have an anti-D injection.

Second appointment: You will be admitted to the clinic and misoprostol is administered as a vaginal pessary, every few hours until all the fetus and placenta are passed. You are awake throughout the process and will be given painkillers and gas and air as needed. The healthcare professional looking after you will try to make the process as comfortable as possible.

On average it takes about 6 hours for the labour and delivery, but this can vary. In some cases it may be quicker but in others it may take over 24 hours and you will need to stay overnight in the clinic. In a minority of procedures, the placenta does not pass spontaneously and it is necessary to perform a procedure, usually under general anaesthetic, to remove it.

You may see large blood clots or the fetus and placenta during this procedure.  The midwife will try to make sure that you see very little, but sometimes this is not possible as events can be rapid.

It is normal to have some light bleeding 1-2 weeks after treatment and you may have spotting until your next menstrual cycle.  Using sanitary pads may make it easier to keep track of your bleeding

Side effects

It is normal to experience bleeding and cramping.  You may also:

• feel dizzy
• feel nauseous or have to vomit
• have headache
• have diarrhoea
• have temporary flushes or sweats

A nurse or midwife will be with you at all times and will give you medicine to help control any side effects or pain you might have.

Risks and complications

Significant, unavoidable or frequently occurring risks

These are usually easy to treat and rarely have any long-term health effects.

• Unpredictable time to complete the procedure
• Side effects of drugs, such as nausea, vomiting, diarrhoea, headache, dizziness, fever/chills (common)
• Retained placenta (1 in 60)
• Infection (may be up to 1 in 400)
• Unpredictable, irregular, or prolonged bleeding after the termination of pregnancy (variable)
• Pain during the procedure (common)

These may require transfer to hospital or surgical procedures, and may have serious long-term health effects.

• Psychological problems (variable)
• Continuing pregnancy/failure to deliver (1 in 150)
• Haemorrhage – very heavy bleeding (1 in 200)
• Rupture of the uterus/womb (1 in 1,000)

Extra procedures that may be necessary

• Surgical termination of pregnancy or uterine aspiration
• Blood transfusion
• Laparoscopy or laparotomy – operation to look inside the abdomen
• Hysterectomy – surgical removal of the womb (very rare)

Death is very rarely linked to treatment - less than 1 in 100,000 for all terminations of pregnancies.