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Second-trimester pregnancy termination: Dilation and evacuation

Cassing Hammond, MD
Section Editor
Jody Steinauer, MD, MAS
Deputy Editor
Sandy J Falk, MD, FACOG


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 (CDC) reported that 7.1 percent of abortions were performed between 14 to 20 weeks and 1.3 percent at or after 21 weeks [3].

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 [6]. 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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Literature review current through: Nov 2017. | This topic last updated: Dec 06, 2017.
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