The Procedure for Dilation and Evacuation

I was listening to a podcast where a lady shared her story, it was discovered that a child was found dead in her womb and a procedure to get the baby out had to be done, the surgical procedure is called, "dilation and evacuation". The patient of course will be placed on anesthesia during the procedure, but for some reason, it seems the one she was given wared off or something of the sort and she experienced the pain in full force. The way she described her experience was scary, she screamed so much that her husband wanted to break into the surgery room until security agents stopped him I wondered why the anesthesia did not work well and why they couldn't do something else to make sure she did not go through that intense form of pain.

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Dilation and evacuation (D$E) is a procedure carried out to end a pregnancy in the second trimester, at 14-27 weeks of pregnancy, the procedure can be done for several reasons, if the child has been found to have a serious health issue, if the mother has serious health issues, when proposed abortion was not done earlier in the pregnancy, or to remove the tissues in the uterus after a miscarriage. A D$E procedure removes the fetal tissues and placenta, it also clears out some of the uterus lining.

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Here's how the procedure is done.

The woman is asked to empty her bladder before she enters the procedure room, medications are given in advance and calculated too so the procedure is carried out when it is at maximal effect. The bimanual examination is done to check out the uterine size, position, and adequacy of cervical dilation. All osmotic dilators that have been placed need to be accounted for, if found that the cervix has not been adequately prepared, an additional dose of misoprostol will be administered, or the woman will be placed on another set of dilators.

The speculum will be placed, the cervix will be cleaned with an antiseptic solution, the paracervical block will be performed and the tenaculum will be placed. Traction is placed on the tenaculum to bring the cervix down the vagina. Dilation adequacy will be checked again by attempting to pass the largest diameter dilation without using force.

Uterine aspiration will be performed making use of the largest available cannula, gentle traction will be maintained on the tenaculum to maintain the cervical canal, and the closed forceps is passed through the cervix in a vertical direction.

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To evacuate the tissue, the forceps are closed around the fetal tissue and rotate to 90 degrees in order to assist with dis-articulation before withdrawal. This procedure is repeated until fetal removal is complete as it is the majority or all of the placenta. With the removal of all the fetal tissues, suction aspiration is done to make sure there is no tissue left. The fetal tissue is also examined to ensure there is a complete evacuation.

Just like other procedures, D$E also has risks, an injury can be done to the cervix, serious bleeding, infection, uterine rupture, perforation, when all pregnancy tissues are not eliminated from the uterus, the need for surgery to repair the uterus or cervix.

After the procedure, the patient is advised to rest at home for at least one day, cramps are expected to be experienced for some days, but medications are prescribed to help subside the pain, it is also advisable that patients don't have sex for at least 1 week, birth controls are advised when sex happens. Some bleeding may be experienced in the first 2 weeks after D$E, menstrual pads are advised instead of tampons.

An Emergency care should be instantly contacted if a woman feels these symptoms after a D$E procedure; when the woman feels achy or unwell, vomiting, fast heart rate, swelling of the abdomen, pain in the stomach that consistently gets worse, signs of depression that lasts for 2 weeks or more, new symptoms springing up too.

For Further Studies.

https://www.ippf.org/sites/default/files/ippf_cccg_chapter_5_abortion_a3.pdf

https://www.medicoverhospitals.in/procedures/dilation-and-evacuation/

https://www.saintlukeskc.org/health-library/understanding-dilation-and-evacuation-de#

https://www.cham.org/HealthwiseArticle.aspx?id=tw2462

https://www.singhealth.com.sg/patient-care/conditions-treatments/surgical-dilatation-and-evacuation

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Hi, I am Tobi, a writer, speaker, relationship blogger, and lover of good music. I love making friends and learning from people. If you want to hear me speak about relationships and general life issues, you can find my YouTube channel, where you can watch any episode for free. Please do not forget to subscribe, friends. I sincerely appreciate every love I get from here. Kindly do well to keep them coming. ‎