Second-trimester pregnancy termination: Dilation and evacuation
- Cassing Hammond, MD
Cassing Hammond, MD
- Associate Professor in Obstetrics & Gynecology
- Northwestern University
Second-trimester (14 to <28 weeks of gestation) pregnancy terminations comprise 10 to 15 percent of the approximately 42 million abortions performed annually worldwide [1,2]. The United States Centers for Disease Control and Prevention reported that 7.0 percent of abortions were performed between 14 to 20 weeks and 1.3 percent at or after 21 weeks .
The most common surgical technique for second-trimester termination in the United States is dilation and evacuation (D&E), and will be the focus of this topic [4,5]. Other surgical approaches include intact D&E, which is a variant of D&E, and hysterotomy . Hysterotomy is rarely used except when it is unsafe to dilate the cervix or induce labor, or when there is no trained D&E provider. Some patients with severe cervical stenosis or leiomyomas that completely obstruct the cervix and vagina may require hysterotomy.
Second-trimester surgical pregnancy termination is reviewed here. An overview of second-trimester pregnancy termination and the technique for induction abortion are discussed separately. (See "Overview of second-trimester pregnancy termination" and "Second-trimester pregnancy termination: Induction (medication) termination".)
The dilation and evacuation procedure for second-trimester pregnancy termination consists of two components:
●Preparation and dilation of the cervix with osmotic, pharmacologic, and/or mechanical dilators
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- PREPROCEDURE PREPARATION
- Cervical preparation
- - Osmotic dilators
- - Dilators with misoprostol or mifepristone
- Injection to induce fetal demise
- Prophylactic antibiotics
- Cervical dilation
- Uterine evacuation
- - Intact dilation and evacuation
- Use of uterotonics
- Assessment for retained products of conception
- OUTCOME AND COMPLICATIONS
- Retained products of conception
- Uterine perforation
- Cervical laceration
- FUTURE OBSTETRIC OUTCOMES
- SPECIAL CIRCUMSTANCES
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS