How a D&E Differs From a D&C

Both Are Surgeries for Ending an Unhealthy Pregnancy

Concerned patient being shown test results from doctor
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Most pregnancies go off without a hitch: After 40 weeks or so, a healthy baby is born and a family grows by one. Sadly, though, sometimes things don't go as expected: There's a problem that makes it necessary to end the pregnancy or it ends spontaneously in a miscarriage. Depending on how advanced the pregnancy is, this may be achieved with one of two surgical procedures: dilation and evacuation (D&E) and dilation or curettage (D&C.

A D&C, in which the cervix is widened to make is possible for a doctor to use a sharp sugical instrument called a curette to remove tissue from the lining of the uterus. (The term D&C sometimes is used to refer to vaccum aspiration, another procedure for ending a pregnancy.)

Dilation and curettage is done during the first 13 weeks of pregnancy. In the case of a pregnancy that's further along a D&E is required. Some typical reasons a woman might need a D&E: The baby has a serious abnormality or has died in the womb and would be stillborn; the membranes have ruptured prematurely; or there's a serious risk to the woman's health if the pregnancy is continued.

What a D&E Is Like

Both D&Cs and D&Es involve dilating the cervix and clearing the uterus of pregnancy tissue. Here's what happens during each of these steps in a D&E:

Step 1: Dilation

The first step in a D&E is preparing the cervix by gradually softening and dilating it starting a day or two before the actual procedure.

This is usually done with an "osmotic dilator," made from either dried, compressed seaweed stalks (called laminaria) or hydrogel rods that are placed in the cervical canal where they absorb moisture a gradually expand. Taking it slow is important: Rapid mechanical dilation has been shown to increase the risk of second-trimester pregnancy loss in future pregnancies.

Drugs also can also be used to prepare the cervix the day of the procedure, but they are not as effective as osmotic dilators—meaning mechanical dilation may be necessary anyway unless it's very early in the second trimester.

Step 2: Evacuation

The second step in a D&E is the evacuation of the fetus and the placenta from the uterus. Before this is takes place, the woman is given general anesthesia and an antibiotic to prevent infection. While she's under anesthesia, the surgeon performing the D&E typically will use a combination of suction, forceps, and curettage to empty the uterus. Some doctors use an injection to ensure fetal death has occurred before the evacuation, but this is controversial.

A D&E is difficult but in general perfectly safe. Complications such as a cervical laceration; perforation of the uterus; infection, or  hemorrhage are rare. What's more, women who have a D&E do not experience problems in future pregnancies related to the procedure.

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Article Sources

  • American College of Obstetricians and Gynecologists. "Induced Abortion." May 2015.