Intact Dilation and Evacuation (Dilation and Extraction)
This method is used after 18 weeks from the last menstrual period. Intact dilation and evacuation is a procedure used so a fetus can be removed intact. With this method, the largest part of the fetus (the head) is reduced in diameter to allow ease of passage through the cervix and vagina. This may be a multiple-day procedure. For this procedure, the physician will:
- Perform laboratory tests to confirm the pregnancy, test for Rh status, and test for anemia and red blood cell count.
- Take a medical and obstetrical history, including a history of allergies and all current medications.
- Examine the uterus and perform an ultrasound to confirm how far along the pregnancy is.
- Educate the patient about the abortion process, side effects, and clear instructions for assessing emergency services. Prescribe antibiotics to prevent infection.
- Insert a speculum into the vagina, to hold it open. The physician cleans the vagina and cervix with an antiseptic solution. At this time, a numbing agent (local anesthetic) may be injected in the cervix.
- Insert osmotic dilators (small tubes that absorb moisture from the tissues surrounding the cervix and swell) approximately 2 or more days before the surgical procedure to open the cervix, allowing access to the uterus. Misoprostol may also be given several hours before surgery. This medicine can help soften the cervix.
- Inject medicine through the abdomen or vagina into the amniotic fluid or the heart of the fetus. This causes the death of the fetus and makes fetal tissue more pliable.
Day of Surgery:
- Insert a speculum into the vagina, to hold it open. The physician cleans the vagina and cervix with an antiseptic solution. At this time, the osmotic dilators are removed from the cervix and a pelvic exam is performed.
- Inject pain medication in the cervix along with a sedative or general anesthesia and medication that slows uterine bleeding and reduces blood loss.
- Perform an ultrasound to confirm the absence of a fetal heartbeat and guide the physician in locating the position of the fetus.
- Insert forceps (a grasping instrument) into the uterus to grasp the legs of the fetus.
- Pull one or both legs out of the cervix leaving the head still inside the uterus.
- Make an incision at the base of the skull and inserts a suction cannula into the opening. The brain is suctioned out, which causes the skull to collapse and allows the fetus to pass through the cervix.
- Remove the placenta.
- Suction the uterus to remove any remaining placental tissue.
Common side effects include:
Less frequent complications can include:
- Heavy or prolonged bleeding
- Blood clots
- Damage to the cervix or uterine lining
- Tingling or numbness in the arms and legs
- Blurry vision
- Dilators dislodging from cervix
- Infection due to remaining tissue or infection caused by an STD or bacteria being introduced to the uterus can cause fever, pain, abdominal tenderness and possibly scar tissue
Rare complications can include:
- Spontaneous rupture of membranes
- Onset of labor and fetal expulsion before surgery
- Dilators migrate into uterine cavity
- Allergic reaction
- Toxic Shock Syndrome
- Uterine hemorrhage
- Perforation of the uterus
- Tissue remaining in the uterus (incomplete abortion)
- Injury to the bowl or bladder
- Scar tissue in uterus or cervix
- Placenta Previa in future pregnancies
- Infertility due to the consequences of infection or damage to cervix
- Pulmonary Embolism
- Amniotic Fluid Embolism