The first step in a D&E is to
dilate the
cervix. This is often begun about a day before the surgical procedure, and often involves the insertion of multiple
laminaria sticks into the cervix. Enlarging the opening of the cervix enables surgical instruments such as a
curette or
forceps to be inserted into the
uterus.
[2]
The second step is to remove the
fetus. Either a
local anesthetic or
general anesthesia is given to the woman. A
cannula is passed into the uterus. The cannula is attached by tubing to a bottle and a pump that provides a vacuum to remove the fetus from the uterus.
Forceps are inserted into the uterus through the vagina and used to extract any remaining tissue. This is more likely in pregnancies of 16 weeks or more. A
curette is used to scrape the lining of the uterus and remove tissue in the uterus. Lastly, the vacuum is used to ensure removal of fetal body remains in the uterus (such fetal remains can cause serious infections in the woman). The pieces of the fetal body are also examined to ensure that the entire fetus was removed