Dilatation & Evacuation (D&E) and D&E with prostaglandin priming
If the pregnancy is farther advanced than 12 weeks’ amenorrhoea, the intervention is sometimes preceded by a preparatory treatment with prostaglandin. D&E is a method in which the pregnancy is removed instrumentally and then completed with a curettage. Depending on the duration of the pregnancy, a preparatory treatment is sometimes needed to gain sufficient access for the instruments.
For a pregnancy duration exceeding 18 weeks’ amenorrhoea, a preparatory treatment is always needed to attain a suppler cervix and initial dilation. The woman receives misoprostol (Cytotec®) administered orally or vaginally. She receives naproxen as analgetic.
For a pregnancy duration from 20 weeks, the doctor may decide that an additional pre-treatment under PSA is necessary. In this, the membranes are broken and the umbilical cord is severed. The instrumental abortion is then carried out approximately six hours later.
Up to 17 weeks’ amenorrhoea, the woman may choose whether she wants local anaesthesia or PSA (procedural sedation and analgesia, also called light sedation). From 18 weeks’ amenorrhoea, PSA is always used.
For a pregnancy termination in the second trimester, the woman is not allowed to actively participate in traffic for 24 hours after the treatment.