A “DNE” in pregnancy is almost certainly a reference to a D&E, or dilation and evacuation. It’s a surgical procedure used to empty the uterus during the second trimester, typically between 14 and 24 weeks. A D&E may be performed as part of a planned abortion or after a miscarriage when the pregnancy tissue needs to be fully removed. About 95% of midtrimester surgical abortions in the United States are D&Es.
How a D&E Works
The name describes the two main steps. First, the cervix is gradually dilated (opened) wider than it would be for an earlier procedure. Second, the contents of the uterus are evacuated using a combination of suction and surgical instruments. Because fetal tissue is larger in the second trimester, a standard first-trimester approach like a D&C (dilation and curettage) or simple vacuum aspiration isn’t sufficient. The cervix needs to open wider to allow the use of larger instruments and forceps.
Cervical preparation often begins a day or two before the procedure itself. Small rods made of absorbent material are placed in the cervix to gradually stretch it open, or medication is used to soften it. This preparation step is especially important for procedures at 20 weeks and beyond, where insufficient dilation raises the risk of complications.
Why a D&E Is Performed
There are several reasons someone might have a D&E. The most common is a second-trimester abortion, whether for personal reasons or because of a fetal diagnosis discovered at an anatomy scan (usually done around 18 to 20 weeks). Conditions like severe chromosomal abnormalities or structural problems that are incompatible with life are sometimes not detectable until that point in pregnancy.
A D&E is also used when a fetal death occurs in the second trimester. In these cases, the procedure ensures the uterus is completely emptied, which helps prevent infection and heavy bleeding. For women experiencing complications like significant hemorrhage or uterine infection during the midtrimester, a D&E is often the safest way to manage the situation quickly.
D&E vs. D&C: What’s the Difference
People often confuse these two procedures because the names sound similar. A D&C is typically performed in the first trimester, up to about 13 or 14 weeks. It uses a scraping instrument (curette) or gentle suction to remove tissue from the uterine lining. A D&E is the next step up, designed for later pregnancies where the tissue is too large for a curette alone. It requires more cervical dilation and uses forceps in addition to suction.
The alternative to a D&E in the second trimester is labor induction, where medication causes the body to go through a process similar to labor and delivery. Research has shown that D&E is significantly safer and more effective than induction for second-trimester procedures, with a complication rate of roughly 4% compared to 29% for medical (medication-based) approaches. Women who undergo medical abortion in the second trimester are also more likely to need a follow-up surgical procedure to remove retained tissue.
What to Expect During and After
Most D&Es are performed in a hospital operating room under either general anesthesia or deep sedation. In one hospital study, about 72% of patients received general anesthesia and 28% had deep sedation. The procedure itself is relatively quick, but you’ll spend a few hours in a recovery area afterward for monitoring.
The vast majority of patients go home the same day. In the study above, 88% of patients who had general anesthesia and 95% of those who had sedation went home without being admitted. A small percentage need to stay overnight, usually because of heavier bleeding or other complications that require observation.
In the days following a D&E, cramping similar to period cramps is normal. Light bleeding or spotting can continue for a week or two. Signs that something needs medical attention include heavy bleeding (soaking through more than one pad per hour), fever, or worsening abdominal pain, which could indicate infection or retained tissue.
Effects on Future Pregnancies
One of the biggest concerns people have is whether a D&E will affect their ability to get pregnant again. The short answer is that for most people, it does not. Some earlier studies raised the possibility that cervical dilation could weaken the cervix and lead to problems like preterm labor or cervical insufficiency (where the cervix opens too early in a future pregnancy). However, more recent research has not found a statistically significant increase in cervical insufficiency following these procedures.
There is a theoretical risk that aggressive dilation beyond about 9 millimeters could cause cervical trauma, which is one reason providers use gradual preparation methods rather than forcing the cervix open all at once. Scarring inside the uterus (sometimes called Asherman’s syndrome) is another rare possibility, but it’s uncommon with modern techniques. Most providers recommend waiting two to three menstrual cycles before trying to conceive again, giving the uterine lining time to fully recover.