[3] Dilation and evacuation procedures have been increasingly banned in US states since the Dobbs v. Jackson Women's Health Organization decision overruled the right to an abortion.
[4] Dilation and evacuation (D&E) is one of the methods available to completely remove the fetus and all of the placental tissue in the uterus after the first trimester of pregnancy.
[9] Other factors that often lead to an abortion in the second trimester are late testing for pregnancy, insurance or funding barriers, or delayed provider referral.
[11][10] Other medical indications for an abortion in the second trimester include preeclampsia with severe features or preterm premature rupture of membranes prior to a viable fetal age.
[12] Additionally, a subsequent dilation and curettage procedure for retained placental products may be required after an induction of labor for a miscarriage.
Although pregnancy loss is emotionally distressing, there are rarely medical complications associated with a short (<1 week) delay to management.
[16][17][10] Although there is no consensus as to which method of cervical preparation is superior in terms of safety and technical ease of the procedure, one particular concern is reducing the risk of preterm birth.
The concern is that performing the dilation too soon before the surgery could increase the risk of preterm birth should the woman ever carry a subsequent pregnancy to term.
While many providers use these agents, there is no definitive evidence to support a decreased risk for bleeding under 20 weeks gestation.
[10] D&E is usually performed in the outpatient setting, and the patient can be safely sent home the same day after a period of observed recovery, ranging from 45 minutes to several hours.
However, one randomized control trial found cabergoline to be effective in preventing breast symptoms of engorgement, leakage, and tenderness after a second-trimester loss or termination of pregnancy.
[33] Risks of D&E include bleeding, infection, uterine perforation, retained products of conception, and cervical laceration.
Complication rates after D&E are lower than those of labor induction (medical abortion) after 13 weeks, as has been established through multiple studies.
[34] The laws in the United States surrounding dilation and evacuation have been rapidly evolving since the Dobbs v. Jackson decision of 2022.
A national survey of 190 US obstetrics and gynecology residency program directors in 2018 found that 22% considered their graduates to have had enough training in dilation and evacuation to be competent.
After Dobbs v. Jackson, almost half of the US obstetrics and gynecology programs are located in states that have implemented abortion restrictions, which will further limit training in dilation and evacuation.