Dilation and evacuation

What the name means

"Dilation" refers to opening the cervix. "Evacuation" refers to emptying the uterus. Together they describe the procedure used most often for abortion later in pregnancy. It is written as dilation and evacuation on first mention and as D&E after that.

When it is used

D&E is used when a pregnancy has progressed beyond the range where vacuum aspiration alone is typically used. The exact point differs by clinical guidance, by facility, and by individual situation.

People reach a D&E by many different routes. Some receive a diagnosis later in pregnancy. Some could not get an earlier appointment because of distance, cost, waiting times, or legal restrictions. Some did not know they were pregnant. Some changed their situation or their mind. The reasons are not the subject of this page, and nothing here assumes one.

A note on language: "late-term abortion" is not a clinical term and does not correspond to a defined stage of pregnancy. It is used loosely in political conversation, which is why professional language guidance discourages it and why this site does not use it as a label.

Why the cervix is prepared in advance

For a D&E the cervix normally needs to be opened more than for an earlier procedure, and doing that gradually is safer than doing it quickly. Preparation is usually started hours in advance, and sometimes a day or more in advance.

Preparation can involve medicines, or small devices placed in the cervix that expand slowly and open it gently, or a combination. Because of this, a D&E often involves more than one appointment, or an overnight stay.

The clinical team explains what is planned, when each part happens, and what to expect between appointments. Those instructions come from people who know the individual situation. Nothing on this page replaces them.

The appointment sequence, in outline

First contact and assessment. Confirming the pregnancy and its duration, usually with an ultrasound. Health history. Tests the service uses. Consent and a conversation about the plan.

Cervical preparation. As described above. This may be its own appointment.

The procedure. Carried out by trained clinicians. Sedation or anaesthesia is normally used. The procedure itself is usually measured in minutes rather than hours, although the appointment as a whole is considerably longer.

Recovery at the facility. Monitored for a period, then discharged with instructions and contact details.

This page does not describe the instruments used or the steps of the procedure in detail. That detail does not help most readers prepare, and it is often reproduced elsewhere in order to distress people rather than to inform them.

Anaesthesia and sedation

Because of the nature of the procedure, D&E is usually done with sedation or general anaesthesia rather than local anaesthetic alone. What is offered depends on the facility and on health history.

Two practical consequences:

• There are usually instructions about eating and drinking beforehand. Follow the instructions the facility gives, not a general rule found online.
• Someone else will normally need to take you home, and driving yourself afterwards is usually not permitted.

Aftercare in general terms

• Cramping and bleeding afterwards are usual, and patterns vary widely.
• The clinical team gives instructions on activity, on what to use for pain, and on what to watch for.
• A follow-up arrangement is usually made. What it involves depends on the service.
• Contraception can be discussed if the person wants to. It is a choice, not a requirement.

The recovery page covers general expectations, and the urgent help page sets out the signs that mean contacting a clinician promptly or getting emergency medical help.

Risks

Serious complications from D&E are uncommon when the procedure is performed by trained clinicians in an appropriate setting. As with any procedure, uncommon does not mean impossible, and the risk picture depends on the individual situation and on how far the pregnancy has progressed.

The safety page explains how this site handles risk language, including why it never makes an unconditional claim that a procedure is safe for everyone in every context.