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Text of the page (random words):
to management 16 molar pregnancy edit dilation and evacuation is also a treatment option for a molar pregnancy especially for those who wish to maintain fertility the procedure is typically done under sonographic guidance as soon as a hydatidiform mole is suspected 17 18 description of procedure edit cervical preparation edit prior to the procedure cervical preparation with osmotic dilators or medications is recommended in order to reduce the risk of complications such as cervical laceration and to facilitate cervical dilation during the procedure 19 20 13 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 concerns within the medical community have advised against or at least asked for further research concerning the safety of performing the dilation of the cervix on the same day as the surgery for some or all second trimester pregnancies 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 21 22 however for dilation and evacuation at greater than 20 weeks gestation at least one day of cervical preparation is recommended with the option of serial dilation for more than one day 23 dilation can be achieved with either osmotic dilation or misoprostol although osmotic dilation with either laminaria or dilapan is recommended 23 anesthesia options edit most patients will be provided nsaids for pain management local anesthetics such as lidocaine are frequently injected by the cervix to reduce pain during the procedure 24 13 25 iv sedation may also be used 26 general anesthesia may be used depending on individual circumstances however it is not preferred as it adds significant anesthesia risks to the procedure 24 90 100 infection prophylaxis edit immediately prior to the procedure antibiotics of either doxycycline or azithromycin are usually administered to prevent infection 13 thromboprophylaxis edit prophylaxis for venous thromboembolism is not typically required for this procedure 27 surgical procedure edit a speculum is placed in the vagina to allow visualization of the cervix if osmotic dilators were placed prior to the procedure these are removed 28 the cervix may be further dilated with rigid dilator instruments such as hegar and pratt dilators as opposed to osmotic dilators 13 sufficient cervical dilation decreases the risk of morbidity including cervical injury and uterine perforation 22 13 uterine contents are removed using a cannula to apply aspiration followed by forceps to remove fetal parts 29 tissue inspection ensures removal of the fetus in its entirety the procedure may be performed under ultrasound guidance to aid in visualizing uterine anatomy and to assess if all tissue has been removed at the completion of the procedure 24 operative ultrasonography is beneficial because it can reduce the risk of uterine perforation 30 the procedure usually takes less than half an hour 31 uterotonics edit there is no consensus on the routine use of perioperative or postoperative uterotonic medications while many providers use these agents there is no definitive evidence to support a decreased risk for bleeding under 20 weeks gestation 13 recovery edit 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 generally the woman may return to work the following day 31 the type of anesthesia given also influences the appropriate amount of recovery time before discharge there is rarely a need for narcotic pain medications afterwards and nsaids are recommended for home pain management recovery from the procedure is typically fast and uncomplicated 28 174 some women may experience lactation after a second trimester loss or termination of pregnancy limited data exists for the efficacy of medications to suppress lactation 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 32 variations edit if the fetus is removed intact the procedure is referred to as intact dilation and extraction by the american medical association 33 and referred to as intact dilation and evacuation by the american congress of obstetricians and gynecologists acog 34 risks edit d e is a safe procedure when performed by experienced practitioners 24 the rate of mortality for all types of legal abortion procedures in the us not specifically d e is 0 43 abortion related deaths per 100 000 reported legal abortions 35 there were four identified deaths related to abortion in the us during 2019 out of 625 000 abortions 35 the strongest risk factor for mortality following abortion is increasing gestational age 36 risks of d e include bleeding infection uterine perforation retained products of conception and cervical laceration 20 hemorrhage occurs following less than 1 of all surgical abortions 13 infection rates following second trimester abortion have been reported to be 0 1 4 the risk of infection is decreased by the use of antibiotics 13 the risk of retained products of conception and uterine perforation are both under 1 27 the risk of cervical laceration is up to 3 27 even rarer a hysterectomy or damage to surrounding organs or tissues i e bowel or omentum can occur during a d e 24 20 there is no evidence that surgical abortion causes an increase in infertility or adverse outcomes in subsequent pregnancies 24 252 254 alternatives edit alternatives to d e include labor induction abortion and medical abortion complication rates after d e are lower than those of labor induction medical abortion after 13 weeks as has been established through multiple studies 31 additionally in certain clinical scenarios severe anemia for example d e may be preferred over labor induction 37 law edit the laws in the united states surrounding dilation and evacuation have been rapidly evolving since the dobbs v jackson women s health organization decision in 2022 proposals to limit abortion access sometimes target specific procedures such as d e though this also restricts access for non abortion patients such as those with pregnancy loss 7 kansas was the first state to ban d e in 2015 later it was struck down in 2016 currently d e is specifically banned in thirty four states except when deemed necessary for the preservation of the patient s life 7 twenty one states have banned a partial birth abortion referring to an intact dilation and extraction 7 three of the twenty one states have a health exception and seventeen states allow an exception for life endangerment 7 abortion laws in europe including dilation and evacuation vary by country physician training edit 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 38 39 the accreditation council for graduate medical education states that these programs must either adapt by sending residents to legal jurisdictions where they are able to obtain this training or include uterine evacuation simulations in the educational curriculum 40 see also edit abortion late term abortion intact dilation and extraction references edit johnson traci abortion types and costs webmd retrieved 2024 10 27 while doctors can do vacuum aspirations until about 14 weeks the most common type of second trimester abortion is called dilation and evacuation or d e miscarriage ebsco publishing health library brigham and women s hospital january 2007 archived from the original on 2007 09 27 retrieved 2007 04 07 dilation and evacuation d e for abortion healthwise webmd 2004 10 07 archived from the original on 2007 05 02 retrieved 2007 04 07 dilation and evacuation d e for abortion healthwise webmd 2004 10 07 archived from the original on 2007 05 02 retrieved 2007 04 07 miscarriage ebsco publishing health library brigham and women s hospital january 2007 archived from the original on 2007 09 27 retrieved 2007 04 07 haskell martin 1992 09 13 dilation and extraction for late second trimester abortion national abortion federation risk management seminar dallas texas archived from the original on september 16 2006 retrieved 2007 05 05 1 2 3 4 5 bans on specific abortion methods used after the first trimester guttmacher institute 2016 08 16 archived from the original on 2017 01 12 retrieved 2021 03 02 stubblefield phillip g carr ellis sacheen borgatta lynn july 2004 methods for induced abortion obstetrics gynecology 104 1 174 185 doi 10 1097 01 aog 0000130842 21897 53 issn 0029 7844 pmid 15229018 1 2 acog practice bulletin no 102 management of stillbirth obstetrics gynecology 113 3 748 761 march 2009 doi 10 1097 aog 0b013e31819e9ee2 issn 0029 7844 pmid 19300347 jones rachel k kirstein marielle philbin jesse 2022 11 20 abortion incidence and service availability in the united states 2020 perspectives on sexual and reproductive health 54 4 128 141 doi 10 1363 psrh 12215 pmc 10099841 pmid 36404279 s2cid 203813573 1 2 jatlaoui tara c boutot maegan e mandel michele g whiteman maura k ti angeline petersen emily pazol karen 2018 11 23 abortion surveillance united states 2015 mmwr surveillance summaries 67 13 1 45 doi 10 15585 mmwr ss6713a1 issn 1546 0738 pmc 6289084 pmid 30462632 later abortion guttmacher institute 2016 10 13 retrieved 2019 07 29 1 2 3 4 5 6 7 8 9 10 11 second trimester abortion acog www acog org retrieved 2019 07 09 screening for fetal chromosomal abnormalities www acog org retrieved 2023 10 30 1 2 management of stillbirth obstetric care consensus no 10 obstetrics gynecology 135 3 e110 e132 march 2020 doi 10 1097 aog 0000000000003719 issn 0029 7844 pmid 32080052 s2cid 211230954 acog practice bulletin no 102 management of stillbirth obstetrics gynecology 113 3 748 761 march 2009 doi 10 1097 aog 0b013e31819e9ee2 issn 0029 7844 pmid 19300347 soper john t february 2021 gestational trophoblastic disease current evaluation and management obstetrics gynecology 137 2 355 370 doi 10 1097 aog 0000000000004240 issn 0029 7844 pmc 7813445 pmid 33416290 bruce shaina sorosky joel 2023 gestational trophoblastic disease statpearls treasure island fl statpearls publishing pmid 29261918 retrieved 2023 11 15 organization world health 2014 clinical practice handbook for safe abortion world health organization reproductive health and research geneva switzerland p 37 isbn 978 92 4 154871 7 oclc 879416856 cite book cs1 maint location missing publisher link 1 2 3 fox michelle c krajewski colleen m february 2014 cervical preparation for second trimester surgical abortion prior to 20 weeks gestation sfp guideline 2013 4 contraception 89 2 75 84 doi 10 1016 j contraception 2013 11 001 issn 1879 0518 pmid 24331860 lyus richard december 22 2016 cervical preparation prior to second trimester surgical abortion and risk of subsequent preterm birth journal of family planning and reproductive health care 43 1 70 71 doi 10 1136 jfprhc 2016 101695 pmid 28007822 1 2 newmann sara j dalve endres andrea diedrich justin t steinauer jody e meckstroth karen drey eleanor a 2010 08 04 cervical preparation for second trimester dilation and evacuation the cochrane database of systematic reviews 8 cd007310 doi 10 1002 14651858 cd007310 pub2 issn 1469 493x pmid 20687085 1 2 newmann sara dalve endres andrea drey eleanor a april 2008 cervical preparation for surgical abortion from 20 to 24 weeks gestation contraception 77 4 308 314 doi 10 1016 j contraception 2008 01 004 pmid 18342657 1 2 3 4 5 6 paul maureen hrsg lichtenberg steve hrsg borgatta lynn hrsg grimes david a hrsg stubblefield phillip g hrsg creinin mitchell d hrsg 2011 management of unintended and abnormal pregnancy comprehensive abortion care john wiley sons isbn 978 1 4443 5847 6 oclc 899157428 cite book cs1 maint multiple names authors list link allen rebecca h singh rameet june 2018 society of family planning clinical guidelines pain control in surgical abortion part 1 local anesthesia and minimal sedation contraception 97 6 471 477 doi 10 1016 j contraception 2018 01 014 issn 0010 7824 pmid 29407363 cansino catherine denny colleen carlisle a sue stubblefield phillip 2021 12 01 society of family planning clinical recommendations pain control in surgical abortion part 2 moderate sedation deep sedation and general anesthesia contraception 104 6 583 592 doi 10 1016 j contraception 2021 08 007 issn 0010 7824 pmid 34425082 1 2 3 hammond casey steinauer jody chakrabarti alana june 6 2023 second trimester pregnancy termination dilation and evacuation uptodate retrieved november 14 2023 1 2 management of unintended and abnormal pregnancy comprehensive abortion care paul maureen chichester uk wiley blackwell 2009 isbn 978 1 4443 1293 5 oclc 424554827 cite book cs1 maint others link organization world health 2014 clinical practice handbook for safe abortion world health organization reproductive health and research geneva p 52 isbn 978 92 4 154871 7 oclc 879416856 cite book cs1 maint location missing publisher link stubblefield phillip g carr ellis sacheen borgatta lynn july 2004 methods for induced abortion obstetrics gynecology 104 1 174 185 doi 10 1097 01 aog 0000130842 21897 53 issn 0029 7844 pmid 15229018 1 2 3 hammond c 2009 recent advances in second trimester abortion an evidence based review am j obstet gynecol 200 4 347 356 doi 10 1016 j ajog 2008 11 016 pmid 19318143 henkel andrea johnson sarah a reeves matthew f cahill erica p blumenthal paul d shaw kate a june 2023 cabergoline for lactation inhibition after second trimester abortion or pregnancy loss a randomized controlled trial obstetrics gynecology 141 6 1115 1123 doi 10 1097 aog 0000000000005190 issn 0029 7844 pmid 37486652 s2cid 258767994 health and ethics policies of the ama archived 2020 04 26 at the wayback machine american medical association h 5 982 retrieved april 24 2007 acog statement on the us supreme court decision upholding the partial birth abortion ban act of 2003 archived 2007 06 11 at the wayback machine april 18 2007 retrieved 2007 04 22 1 2 kortsmit katherine 2022 abortion surveillance united states 2020 mmwr surveillance summaries 71 10 1 27 doi 10 15585 mmwr ss7110a1 issn 1546 0738 pmc 9707346 pmid 36417304 jatlaoui tara c boutot maegan e mandel michele g whiteman maura k ti angeline petersen emily pazol karen 2018 11 23 abortion surveillance united states 2015 mmwr surveillance summaries 67 13 1 45 doi 10 15585 mmwr ss6713a1 issn 1546 0738 pmc 6289084 pmid 30462632 borgatta lynn kapp nathalie 2...