This document discusses different procedures for dilatation and evacuation (D&E). It describes both one-stage and two-stage D&E procedures. For one-stage, the dilatation of the cervix and evacuation occur in the same sitting under general or local anesthesia. For two-stage, the first phase involves slow dilatation of the cervix, followed by rapid dilatation and evacuation in the second phase. Preliminaries, instrumentation, complications, and post-abortion care are also outlined. Suction evacuation and menstrual regulation procedures are additionally summarized.

1. DILATATION AND
EVACUATION
NUR FARRA NAJWA BINTI ABDUL
AZIM
082015100035

4. TYPES
ONE STAGES
OPERATION
Dilatation and
evacuation done
in the same
sittings
TWO STAGED
OPERATION
1st phase
Slow dilatation of
cervix
2nd phase
Rapid dilatation of
cervix and
evacuation

7. ONE STAGE PROCEDURE

9. PRELIMINARIES
• ANESTHESIA—either general or local is used. In
some cases, the operation may be performed with
intravenous diazepam sedation.
• LITHOTOMY position.
• Full SURGICAL ASEPSIS is to be taken:
– Surgical team is to wear sterile cap, mask, thorough
hand wash and to wear gown and gloves
– Vulva and vagina are to be swabbed with antiseptic
solution
– Cervix is cleaned with povidone-iodine solution
– Leggings.
• To empty the EMPTY THE BLADDER before she is
placed on the table or catheterization
• Vaginal examination is done

10. Cont.
• Pudendal block or perineal infiltration with 1%
lignocaine is sufficient.
• It may be applied even without anesthesia,
especially in parous women.
• The instrument should be assembled
• The vacuum is tested prior to its application

12. POST ABORTION CARE
• Emergency treatment of abortion
complication
• Family planning counselling and referral
services
• Involve male partners also

13. TWO STAGE PROCEDURE

20. MANAGEMENT OF UTERINE
PERFORATION
STOP ALL PROCEDURE !!
Don’t forgot to resuscitate and
give antibiotics

21. SUCTION EVACUATION
Procedure in which product of
conception is sucked out from uterus
with help of a cannula fitted to a
suction device

22. INDICATION
• MTP during 1st trimester *
• Inevitable abortion
• Recent incomplete abortion
• Hydatidiform mole

23. PROCEDURES
Preliminaries:
• As mentioned before
• GA is usually not needed
• If patient is apprehensive,
• IV Diazepam 5-10 mg (conscious sedation)
• Supplemented by paracervical block isquite
effective
• Patient is put on the table after bladder is
emptied

32. MENSTRUAL REGULATION
Aspiration of the endometrial cavity
within 14 days of missed period
in a woman with previous normal cycle

33. MENSTRUAL REGULATION EQUIPMENT
- KARMANN CANNULA AND SYRINGE

34. PROCEDURE
• Operation is done as an out patient
• Aseptic precautions
• Sedation or paracervical block anesthesia may be employed
• Introduction of posterior vaginal speculum & Allis forceps
• Gentle dilatation of cervix using 4-5mm size dilators
• Insertion of 5-6mm suction cannula (Karman’s) & attached to
50mL syringe
• Cannula is rotated, pushed in & out with gentle strokes

35. Cont.
• Operator should examine the aspirated tissues
by floating it in a clear plastic dish over a light
source
• Placenta tissue appears fluffy and feathery
when floats in normal saline
• Help to detect failed abortion, molar
pregnancy or ectopic pregnancy

40. REFERENCES
• Mudaliar and Menon’s Clinical Obstetrics, 11th
edition, Sarala Gopalan and Vanita Jain,
Ventouse
• DC Dutta’s Textbook of Obstetrics, 9th edition,
Hiralal Konar, Ventouse
• Essential Of Obstrectric, Lakshmi Seshadri,
Gita Arjun, Ventouse