Dilation and evacuation (D&E) is a surgical procedure used to end a pregnancy or manage a miscarriage during the second trimester, typically between 12 and 24 weeks of gestation. It involves two main steps: gradually opening (dilating) the cervix, then removing the pregnancy tissue from the uterus using suction and surgical instruments. D&E is the most common method for second-trimester procedures and is considered safe, with major complications occurring in fewer than 2% of cases.
How D&E Differs From a D&C
You may have heard of a D&C, or dilation and curettage, which is a similar but simpler procedure generally used earlier in pregnancy or for diagnostic purposes. A D&E is performed at 14 weeks of gestation or later, when the pregnancy is further along and requires more cervical preparation and different instruments. Because the uterus is larger and the tissue is more developed at this stage, D&E involves specialized extraction forceps in addition to suction, and the cervix needs to be opened wider than it would for a first-trimester procedure.
Preparing the Cervix
Before the actual evacuation, the cervix needs to be softened and gradually opened. This preparation is a critical part of the process and reduces the risk of complications like cervical tearing or heavy bleeding.
For procedures between 20 and 24 weeks, clinical guidelines from the Society of Family Planning recommend at least one day of cervical preparation using osmotic dilators. These are small rods made of materials that absorb moisture and slowly expand over several hours, gently widening the cervical opening. They’re placed during an office visit the day or evening before the procedure. Medication that softens cervical tissue may also be given alongside the dilators, though medication alone (without dilators) at later gestational ages has been linked to longer procedure times and more complications.
At earlier gestational ages, preparation may be shorter or involve fewer dilators. Your provider will tailor the approach based on how far along the pregnancy is.
What Happens During the Procedure
On the day of the D&E, you’ll typically receive sedation or anesthesia. The specific type varies by facility: some offer moderate sedation where you’re relaxed but conscious, while others provide general anesthesia where you’re fully asleep.
Once the anesthesia takes effect, the provider performs a pelvic exam to assess the size and position of the uterus. A speculum is placed to visualize the cervix, and an instrument called a tenaculum is used to stabilize it. If additional dilation is needed beyond what the osmotic dilators achieved, the provider may use graduated metal dilators to widen the opening further.
The uterus is then emptied using a combination of suction and surgical instruments. An electric or manual vacuum aspirator creates negative pressure to remove tissue, while extraction forceps are used to ensure complete removal. A curette, a spoon-shaped or looped instrument, may be used at the end to gently check the uterine walls. When the walls feel uniformly smooth with a slightly gritty texture, it indicates the procedure is complete. The entire evacuation typically takes 10 to 30 minutes, though the total time in the facility is longer due to preparation and recovery.
Why a D&E May Be Needed
People undergo D&E for several reasons. It may be recommended after a diagnosis of a serious fetal anomaly, which is often detected at the anatomy scan around 18 to 20 weeks. It’s also used to manage a second-trimester miscarriage or fetal loss, and it’s the standard surgical option for elective pregnancy termination in the second trimester.
Compared to the alternative at this stage, which is labor induction (using medication to induce contractions and deliver), D&E has some notable advantages. A retrospective study of patients who had procedures between 17 and 24 weeks found that those who underwent D&E had a significantly lower rate of preterm birth in subsequent pregnancies compared to those who had labor induction: 6.9% versus 30.2%. D&E also tends to be faster and more predictable in timing than induction, which can take many hours.
Risks and Complication Rates
D&E is a low-risk procedure when performed by an experienced provider. In a large study from UCSF, the major complication rate (defined as complications requiring hospital admission, blood transfusion, or major surgery) was 1.7%. Uterine perforation, where an instrument creates a small hole in the uterine wall, occurred in just 0.1% of cases. Significant blood loss of 500 milliliters or more happened in about 2.3% of procedures. Infection after the procedure was rare, occurring in roughly 0.1% of cases in that study.
Risk increases with gestational age, meaning procedures closer to 24 weeks carry somewhat higher complication rates than those at 14 or 16 weeks. Proper cervical preparation is one of the most important factors in keeping risks low.
Recovery and What to Expect After
Most people can go home the same day, usually after an hour or two of monitoring. Cramping similar to strong period pain is common on the day of the procedure and may continue as a milder ache for a day or two. Over-the-counter pain relief is usually sufficient.
Vaginal bleeding typically lasts one to two weeks. The first day or so tends to be heavier, similar to a heavy period, then gradually lightens and may turn brown before stopping. Light everyday activities can usually be resumed within a day or two, and most people return to their normal routine within a week. If you work, plan for anywhere from a few days to a full week off.
For the first two to three weeks after the procedure, you’ll generally be advised to avoid using tampons, douching, and sexual intercourse to reduce infection risk. Strenuous exercise and heavy lifting are also typically restricted during this window. Fertility returns quickly: ovulation can resume as early as two weeks after the procedure, so contraception should be discussed with your provider if needed.
Emotional Recovery
The physical recovery from D&E is relatively quick, but emotional recovery varies widely depending on the circumstances. Someone who chose the procedure after a devastating fetal diagnosis may grieve intensely for weeks or months. Someone who had a D&E for an elective termination may feel relief, sadness, or a complicated mix of both. There is no “normal” emotional response, and the range of feelings people experience is broad. Many hospitals and clinics offer counseling resources or can connect you with support groups specific to pregnancy loss or termination.