Induced abortion, by dilation and evacuation
CPT4 code
Name of the Procedure:
Induced Abortion by Dilation and Evacuation (D&E)
Summary
Dilation and Evacuation (D&E) is a medical procedure used to terminate a pregnancy, typically performed in the second trimester. The process involves dilating the cervix and then removing the fetus and other pregnancy tissues from the uterus using specialized instruments.
Purpose
This procedure addresses the medical condition of an unwanted or non-viable pregnancy. It aims to safely terminate the pregnancy and remove all fetal and placental tissues to prevent complications such as infection or excessive bleeding.
Indications
- Unwanted pregnancy
- Fetal abnormalities incompatible with life
- Maternal health conditions that necessitate termination
- Pregnancy complications posing severe risks to the mother
Preparation
- Pre-procedure consultation and consent
- Physical examination and ultrasound to assess gestational age
- Blood tests, including Rh factor
- Cervical preparation with dilators or medications the day before or a few hours prior
- Fasting and adjustment of regular medications as advised by the doctor
Procedure Description
- Anesthesia: Administered local anesthetic, sedation, or general anesthesia, depending on the patient's needs.
- Cervical Dilation: Gradual dilation of the cervix using metal dilators or osmotic dilators.
- Evacuation: Insertion of a cannula into the uterus, connected to a suction device to remove uterine contents. Curettes and forceps may also be used to ensure complete evacuation.
- Inspection: Ensuring all fetal and placental tissue has been removed.
Duration
The procedure typically takes between 10 to 20 minutes, although preparation may extend the total time to a few hours.
Setting
This procedure is typically performed in a hospital, outpatient clinic, or specialized surgical center.
Personnel
- OB/GYN physician or specialist surgeon
- Anesthesiologist or nurse anesthetist
- Registered nurses
- Surgical assistants
Risks and Complications
- Common: Cramping, bleeding, and mild infection
- Rare: Severe bleeding, uterine perforation, damage to surrounding organs, or adverse reaction to anesthesia
Benefits
- Safe termination of pregnancy
- Prevention of complications associated with non-viable pregnancies
- Psychological reassurance for conditions necessitating termination
Recovery
- Observation for a few hours post-procedure
- Prescription pain relief and antibiotics, if necessary
- Rest for 1-2 days, avoiding strenuous activities
- Follow-up appointment within 1-2 weeks to ensure complete recovery
Alternatives
- Medical abortion (usage of medication to induce abortion)
- Continued pregnancy with delivery options
- Risks and benefits of each alternative should be discussed with the healthcare provider
Patient Experience
Patients may experience cramping and discomfort similar to menstrual pain. Some may feel drowsy or experience emotional distress. Pain management options include over-the-counter pain relievers and prescribed medications. Supportive measures and counseling may be provided to address emotional well-being.