Abortive Procedure (Dilation & Evacuation) Gynecologic Surgery

Dilation and evacuation (D&E) is a procedure that empties the uterus by gently opening the cervix (the opening to the uterus) and removing pregnancy tissue with suction and surgical instruments.

Overview

Dilation and evacuation (D&E) is a procedure that empties the uterus by gently opening the cervix (the opening to the uterus) and removing pregnancy tissue with suction and surgical instruments. Cervical preparation may be started hours to a day before the procedure using small dilators or medicines. D&E is commonly used in the second trimester. It may be done to end a pregnancy, to manage a miscarriage, or when a pregnancy has ended but tissue remains in the uterus. The procedure is performed in a clinic or hospital with pain control options that can include local anesthesia, sedation, or general anesthesia.

Overview Preparation Clinical Info Recovery FAQ References

Also known as: D&E, Dilation and Evacuation, Second-trimester surgical abortion

Recovery
2–7 days
Return to Work
1–3 days

Preparation & Next Steps

Everything you need to know before and after your procedure

Before Care

  • Confirm pregnancy location and gestational age, often with ultrasound and exam
  • Complete blood tests such as blood type, Rh factor, and hemoglobin as requested by the clinic
  • You may be offered Rh immune globulin if you are Rh negative
  • Review all medicines and supplements with the clinic, including blood thinners and pain relievers
  • Follow any fasting instructions if sedation or anesthesia is planned
  • Arrange a ride home and support if you receive sedation or general anesthesia
  • Plan time away from work, school, or caregiving on the procedure day
  • Wear comfortable clothing and bring a supply of sanitary pads
  • Bring a photo ID, insurance card if applicable, and a payment method
  • Follow the clinic’s instructions for cervical preparation (medicines or dilators) if scheduled

After Care

  • Expect cramping and bleeding or spotting; these usually lessen over several days
  • Use pain relief as directed by the clinic or as labeled on over-the-counter products
  • If antibiotics are provided, take them exactly as instructed
  • Many clinics advise using pads instead of tampons at first and avoiding vaginal insertion and sex for a period; follow your clinic’s guidance
  • Avoid strenuous activity until bleeding and cramps improve; light walking is usually fine
  • Do not drive, drink alcohol, or make important decisions for a period after sedation, as instructed by the clinic
  • Schedule or complete any recommended follow-up visit or check-in
  • Contraception can often be started the same day; ask the clinic about your options
  • Contact the clinic if you have very heavy bleeding, fever, worsening abdominal pain, fainting, or foul-smelling discharge
  • Seek emotional support if helpful; clinics can share counseling or hotline resources

Clinical Information

Important medical details about this procedure

Indications

  • Ending a pregnancy in the second trimester
  • Management after miscarriage or fetal demise
  • Fetal conditions diagnosed by testing
  • Maternal medical conditions where pregnancy poses health risks
  • When medication methods are not preferred or not effective

Alternatives

  • Medication abortion with mifepristone and misoprostol in earlier pregnancy
  • Induction of labor
  • Dilation and curettage (D&C) or suction aspiration in earlier pregnancy
  • Expectant management for some miscarriages

Risks

  • Bleeding that may rarely require treatment
  • Infection
  • Injury to the cervix or uterus
  • Retained tissue requiring repeat procedure
  • Reactions to anesthesia or medicines
  • Scar tissue inside the uterus (rare)

Contraindications

  • Suspected or confirmed ectopic pregnancy
  • Untreated pelvic infection
  • Severe bleeding or clotting disorders without a plan for management
  • Allergy to planned medicines or anesthetics
  • Lack of access to appropriate anesthesia or aftercare

Recovery Timeline

What to expect during your recovery

Most people feel better within a few days. Light bleeding or spotting can last up to 1 to 2 weeks. Activity level depends on how you feel and clinic guidance.

Typical Range

2–7 days

Return to Work

1–3 days

Recovery Milestones

Day 0–1

Rest at home; avoid driving after sedation

Day 1–2

Resume light daily activities and short walks as comfortable

Day 2–3

Return to usual non-strenuous activities if feeling well

Day 4–7

Gradually increase activity; discuss exercise timing with the clinic if unsure

Frequently Asked Questions

Common questions and expert answers about this procedure

What is a D&E and how is it done?

D&E gently opens the cervix and removes pregnancy tissue using suction and instruments. It is done in a clinic or hospital with anesthesia or sedation options.

How is D&E different from D&C or suction aspiration?

D&C and suction aspiration are more common earlier in pregnancy. D&E is often used in the second trimester and uses a combination of suction and instruments after more cervical preparation.

How long does the procedure take?

The procedure itself often takes 10 to 30 minutes. Total visit time is longer because of check-in, cervical preparation, anesthesia, and recovery.

What pain control is used?

Options include local anesthesia with numbing medicine, IV sedation, or general anesthesia. The choice depends on the setting and availability.

Will this affect future fertility?

Serious complications that affect fertility are uncommon. Most people can get pregnant in the future if they choose to.

Do I need Rh immune globulin?

People who are Rh negative are often offered Rh immune globulin after abortion or miscarriage to protect future pregnancies. Practices can vary by gestational age and local guidance.

How far into pregnancy is D&E used?

It is commonly used in the second trimester. Exact timing and availability vary by clinic and local laws.

What follow-up is typical?

Some clinics schedule an in-person or phone check-in. Follow the clinic’s instructions and contact them if concerning symptoms occur.