Q: Dilation and Evacuation?

Posted Tuesday, May 08, 2007 11:48 AM

Q: My friend miscarried, and had a D&E. What is this, and why did she need one? Can it increase the risk of more pregnancy problems later?

Dr. Joseph Hill: D&E (dilation and evacuation) is a minor surgical procedure which involves mechanically opening (dilating) the cervix and cleaning out (evacuating) the uterus. It may be performed after a missed abortion (the embryo or fetus dies, but no bleeding or cervical opening occurs) or inevitable abortion (the embryo or fetus dies, and painful or heavy bleeding occurs). If tissue from the pregnancy remains in the womb after miscarriage, it can cause heavy bleeding or infection -- a D&E aims to avoid this.

There are alternatives to a D&E, including expectant management (a "wait and see" approach for spontaneous loss) and medical management (using medications to bring about spontaneous contractions and ultimate expulsion). D&E, however, is the most expedient management. The chance of a D&E causing complicating problems later is very small (less than 1%).