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What is dilation and evacuation abortion?

Having a dilation and evacuation (D&E) abortion is similar in many ways to having a vacuum aspiration procedure. Because your pregnancy is further along, however, your cervix needs to be opened wider to allow the pregnancy tissue to pass, which requires the clinician to soften and dilate your cervix ahead of time. This process of cervical preparation can take anywhere from a few hours in the early second trimester to a day or two for later procedures.

There are two main methods of cervical preparation: osmotic dilators and misoprostol, one of the drugs used in medication abortion. Osmotic dilators are short, thin rods made of seaweed (Laminaria) or synthetic material (Lamicel or Dilapan). After inserting a speculum, the clinician places one or more osmotic dilators in the cervical opening. The placement takes only a few minutes. The dilators absorb moisture and expand over the next several hours, gradually stretching the cervix open. You may feel pressure or intermittent cramping as your cervix dilates. If you are having a later second-trimester abortion, you may have more osmotic dilators placed on the following day. Once osmotic dilators are inserted, it is important to keep your appointment to complete the abortion; if you miss your appointment and the osmotic dilators are left in the cervix, you are at increased risk of infection, bleeding, and miscarriage.

Misoprostol is a prostaglandin that softens the cervix. The small misoprostol tablets can be swallowed or placed between your cheeks and gums, under your tongue, or in the vagina a few hours before your abortion. Side effects with the doses used for cervical preparation are uncommon but may include cramping, nausea, mild diarrhea, or a transient fever. Sometimes osmotic dilators and misoprostol are used together, particularly for later abortions or intact D&Es.

The osmotic dilators are removed at the time of the abortion. Your provider may recommend stronger pain medication or sedatives than would be necessary for vacuum aspiration, in addition to local anesthesia in the cervix. If necessary, the provider uses dilator instruments to enlarge the cervical opening further. Then the clinician removes the fetal and placental tissue with vacuum aspiration, forceps, and a curette (a small, spoon like instrument). This takes a few minutes, and you may feel a tugging sensation and some strong cramping as the uterus empties.

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Our Bodies, Ourselves: A New Edition for a New Era

America's best-selling book on all aspects of women's health With more than four million copies sold, "Our Bodies, Ourselves" is "the" classic resource that women of all ages can turn to for...

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.