DILATATION AND EVACUATION PROCEDURE
Definition: Dilation and evacuation is the dilation of the cervix and surgical evacuation of
the uterus (potentially including the fetus, placenta and other tissue) after the first trimester of
pregnancy. It is a method of abortion as well as a common procedure used after miscarriage to
remove all pregnancy tissue.
Indications
Diagnostic
1. Infertility
2. Dysfunctional uterine bleeding
3. Pathological amenorrhea
4. Endometrial tuberculosis
5. Endometrial carcinoma
6. Postmenopausal bleeding
7. Chorion epithelioma
Therapeutic
1. Dysfunctional uterine bleeding
2. Endometrial polyp
3. Removal of IUD
4. Incomplete abortion
5. Evacuation of hydatidiform mole
6. Prior to insertion of intra radium implants
7. To prevent cervical stenosis
8. To drain pyometra
Contraindications
1. Vaginal and cervical infection
2. Pelvic infection
3. Suspected uterine pregnancy
Articles
1. Dilators (hegar’s dilators)
2. Vulsellum
3. Uterine sound
4. Vacuum evacuator
5. Sim’s or Cusco’s vaginal speculum
Complications
1. Injury to the cervix
2. Uterine perforation
3. Bowel injury
4. Pelvic inflammation
Remote complications
1. Cervical incompetence due to injury to internal os, resulting in midtrimester abortion
2. Uterine synechiae due to injury to uterine muscle resulting in secondary amenorrhea
DIALATION AND EVACUATION PROCEDURE:
Pre-procedure: Before the D&E, a thorough medical evaluation and counseling session
occurs. The healthcare provider explains the procedure, addresses concerns, and obtains
informed consent from the patient.
Cervical Preparation: The cervix is gradually dilated using specialized instruments or
medications such as misoprostol. Dilating the cervix is crucial for safe uterine access
during the procedure.
Anesthesia: Local, regional, or general anesthesia is administered to ensure the patient's
comfort during the procedure. The choice of anesthesia depends on the patient's health
status and preferences.
Evacuation of Uterine Contents: During the procedure, the healthcare provider uses a
combination of suction and medical instruments to gently remove the pregnancy tissue
from the uterus. This process is performed with precision and care to minimize risks and
complications.
Post-procedure Care: After the D&E, patients are monitored closely in a recovery area.
They are provided information on what to expect regarding physical recovery and
emotional well-being. Follow-up appointments are scheduled to monitor recovery
progress.
HOW TO PREPARE FOR DILATION AND EVACUATION:
Dilation and Evacuation (D&E) is a medical procedure typically used for abortions in the second
trimester of pregnancy or for specific medical conditions. It's important to note that I am not a
medical professional, and you should always consult a qualified healthcare provider for
personalized advice and guidance. However, I can offer you some general information about
preparing for a D&E procedure:
Consultation with a Healthcare Provider: Your first step is to consult a healthcare
provider specializing in reproductive health or gynecology. They will assess your
situation, discuss your options, and provide information about the procedure, its risks,
benefits, and what to expect.
Medical History and Evaluation: During your consultation, your healthcare provider
will gather your medical history, perform a physical examination, and may order tests to
ensure that you are a suitable candidate for the D&E procedure.
Counseling and Informed Consent: Your healthcare provider will explain the
procedure in detail, including its purpose, the steps involved, potential risks, and
alternatives. You will be able to ask questions and receive counseling to help you make
an informed decision.
Pre-Procedure Instructions: Your healthcare provider will provide specific instructions
to prepare for the procedure. These instructions might include information about fasting
before the process, medications you should or should not take, and any other necessary
preparations.
Arrangements for the Day: Make arrangements for someone to accompany you to the
medical facility on the day of the procedure. Depending on the anesthesia, you might
need someone to drive you home afterwards.
Clothing and Personal Items: Wear comfortable attire on the day of the procedure, and
bring any necessary personal items like identification, insurance information, and any
medical records your healthcare provider has asked you to get.
Hygiene: Follow any instructions your healthcare provider gives you regarding
showering or hygiene before the procedure. You might be asked to avoid using lotions,
perfumes, or other products on the day of the process.
Medications: If your healthcare provider recommends pre-procedure medications, follow
their instructions carefully. This might include medications to help dilate the cervix or to
reduce anxiety.
Fasting: If your procedure requires anesthesia, you may need to fast for a specific period
before the process. Follow your healthcare provider's guidelines regarding food and drink
intake.
Emotional Support: Preparing for a medical procedure can be emotionally challenging.
Contact friends, family, or a counselor for emotional support, and consider discussing
your feelings with your healthcare provider.
Remember, the preparation process may vary based on your circumstances and the medical
facility's protocols. Always follow your healthcare provider's instructions closely to ensure a safe
and successful procedure.
Recovery after Dilation and evacuation
Recovery after a Dilation and Evacuation (D&E) procedure can vary depending on individual
factors, the complexity of the system, and the specific circumstances. D&E is a medical
procedure often performed to terminate a pregnancy or manage certain gynecological conditions.
Here's a general overview of what you might expect during the recovery period:
Immediate Recovery: After the procedure, you will likely spend some time in a
recovery area under medical supervision. This is to monitor your vital signs and ensure
you are stable after the anesthesia wears off.
Pain Management: You might experience cramping and discomfort after the procedure.
Your doctor will prescribe pain medications to manage any pain you might have. It's
essential to follow their instructions and take the medicines as prescribed.
Physical Rest: Resting is crucial during the initial recovery period. You might feel tired
due to the anesthesia and the procedure itself. Plan to take it easy for a day or two after
the process.
Vaginal Bleeding: Some vaginal bleeding or spotting is normal after a D&E. The
amount and duration of bleeding can vary, but it's generally recommended to use pads
instead of tampons during this time. Contact your healthcare provider if you experience
heavy bleeding, severe pain, or other concerning symptoms.
Activity Restrictions: Your doctor might recommend avoiding strenuous physical
activities, heavy lifting, and sexual intercourse for a certain period after the procedure.
This is to prevent complications and give your body time to heal.
Follow-Up Appointment: You will likely have a follow-up appointment with your
healthcare provider within a week or two after the procedure. This is to ensure that you're
healing correctly and to address any concerns you might have.
Emotional Support: D&E procedures can have emotional implications, primarily if they
were performed for pregnancy termination. It's essential to have a support system, which
could include friends, family, or mental health professionals if needed.
Return to Work: The time it takes to return to work will depend on the nature of your
job and how you're feeling. Some people might need a few days off, while others require
a week or more.
It's important to note that the information provided here is a general guideline. Your doctor will
give specific post-procedure instructions based on your situation. If you have any questions or
concerns, or experience unusual symptoms during your recovery, don't hesitate to contact your
healthcare provider for guidance.
NURSES RESPONSIBILTY:
1. Monitor the vitals of patient throughout the procedure
2. Provide continuous support to the patient both physically and emotionally
3. Instruct patient for proper hygiene and diet after the completion of procedure
4. Advise for prescribed antibiotics and follow-ups.
