D&E abortion

D&E is performed under anesthesia, most commonly sedation with light general anesthesia, although local paracervical block or regional anesthesia may be used. It may be performed with or without ultrasound guidance. Performance under ultrasound guidance has greatly improved our understanding about what actually occurs during a D&E. Prior to the procedure, the cervix is usually softened and passively dilated using osmotic dilators and/or misoprostol. This facilitates cervical dilation during the procedure without injury to the cervix.

The first step in the procedure itself is dilation of the cervix. The second step is insertion of a vacuum curette through the cervix. Under ultrasound, the tip of that curette is placed up against the fetal chest or abdomen. The suction is turned on. Amniotic fluid is removed and the fetus dies instantly due to removal of the fetal heart, lungs, and abdominal contents.

This leaves the fetal cranium and skeleton with soft tissue to be removed. The thorax, pelvis, cranium, and each arm and leg are removed separately using surgical instruments. The fetal cranium will usually have to be crushed in order to be extracted. Use of ultrasound greatly facilitates this part of the procedure although it may be done safely without ultrasound guidance. In the absence of ultrasound, the tissue will be carefully inspected to ensure all fetal tissue is removed. It is important to recognize that this is the removal of dead tissue to protect the patient from bleeding and infection well after the fetus died instantly. The fetus is almost never dismembered alive.

After removal of all fetal tissue, the uterine cavity is thoroughly curetted to ensure that all placental tissue, blood, and membranes are removed. The uterus will then be massaged to ensure it is firmly contracted to minimize post operative bleeding. The entire procedure usually takes less than 30 minutes and is well tolerated.

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