A D&E, short for dilation and evacuation, is a surgical procedure used to empty the uterus during the second trimester of pregnancy, typically after 13 weeks. It is the most common method for second-trimester abortions and is also used to manage miscarriages and fetal demise. The American College of Obstetricians and Gynecologists calls D&E the “predominant approach to abortion after 13 weeks” and the medically preferred option because it results in the fewest complications compared to alternatives.
How a D&E Differs From a D&C
You may have heard of a D&C, or dilation and curettage, which is a simpler procedure typically performed in the first trimester. A D&E is a more involved version used later in pregnancy, when the uterus contains more tissue and the cervix needs to be opened wider. While a D&C relies mainly on scraping or gentle suction, a D&E uses a combination of specialized surgical forceps and vacuum aspiration to fully evacuate the uterus. The added complexity means a D&E requires more cervical preparation, takes longer, and involves more careful handling of the uterine lining.
Why a D&E Is Performed
There are several reasons someone may need a D&E. It is used for elective pregnancy termination in the second trimester, for removing tissue after a miscarriage or stillbirth, and for pregnancies ended due to serious fetal abnormalities discovered during mid-pregnancy screening. In all of these situations, the goal is the same: safely and completely emptying the uterus so it can heal.
Preparing the Cervix
Because the cervix needs to open much wider for a D&E than for an early-pregnancy procedure, preparation usually begins the day before. The most common method involves placing small, thin rods called osmotic dilators into the cervix. These rods absorb fluid from surrounding tissue and slowly swell over several hours, gently stretching the cervical opening. One type, made from dried seaweed stems, reaches its full effect after about 24 hours. A synthetic version expands to roughly three to four times its original size within four to six hours and continues widening over the next day.
For procedures between 20 and 24 weeks, at least one day of cervical preparation with these dilators is recommended. A provider may also prescribe a medication taken by mouth 24 to 48 hours before the procedure that softens and ripens the cervix by blocking progesterone. Evidence shows this medication makes the procedure easier without adding side effects. Same-day preparation is possible in some cases using faster-acting dilators combined with other cervical-softening drugs, but this approach is generally reserved for highly experienced providers.
What Happens During the Procedure
On the day of the D&E, the dilators placed the day before are removed. The provider uses a speculum to visualize the cervix, then uses suction and specialized forceps to carefully empty the uterus. Ultrasound guidance is sometimes used to help the provider see inside the uterus during the process. The surgical portion itself is relatively brief. If instruments need repositioning, providers typically reassess within five to seven minutes using ultrasound to guide the next steps.
Pain management varies. Options range from local numbing of the cervix (a paracervical block) combined with oral or IV sedation, all the way to general anesthesia where you’re fully asleep. The level of sedation depends on the facility, the gestational age, and your preference. Many clinics and hospitals offer moderate sedation, meaning you’re deeply relaxed and may not remember much of the procedure, but you’re not fully unconscious.
Recovery and What to Expect After
Most people experience mild cramping and light bleeding or spotting for several days after a D&E. These symptoms are normal and typically manageable with over-the-counter pain relief. The majority of patients return to regular activities within about five days, though the exact timeline varies from person to person.
Your cervix needs time to close and return to its normal size after being dilated, which takes roughly a week. During that window, you’re at higher risk for infection because bacteria can enter the uterus more easily. Providers generally recommend avoiding sex and tampons until the cervix has closed, usually about one week after the procedure.
Complication Rates
D&E is considered a safe procedure, particularly when compared to the main alternative for second-trimester cases: labor induction. One study comparing the two approaches found that the overall rate of adverse outcomes (including infection, cervical injury, the need for additional procedures, or hospital readmission) was 10% for D&E patients versus 43% for those who underwent labor induction. Among patients under 20 weeks, the gap was even wider: 9% for D&E compared to 50% for induction.
Labor induction also resulted in a two-day longer hospital stay on required IV antibiotics for infection at a significantly higher rate. Additionally, 28% of induction patients needed a follow-up surgical procedure to remove retained tissue, while no D&E patients required a repeat procedure. These findings are a key reason medical organizations consider D&E the safer choice for second-trimester uterine evacuation.
Effects on Future Fertility
A common concern is whether having a D&E will affect the ability to get pregnant later. Multiple studies show that surgical abortion has little impact on future pregnancies. Some research has found a slight increase in the risk of premature birth, miscarriage, or low birth weight in later pregnancies, but other studies have not confirmed this association.
One rare complication worth knowing about is the formation of scar tissue bands inside the uterus, a condition called Asherman’s syndrome. This is more likely to occur after multiple uterine procedures rather than a single D&E, and it can interfere with future fertility. For most people who undergo one D&E, the procedure does not create meaningful barriers to becoming pregnant again.