Second-Trimester Dilation and Evacuation


Materials and Preparation


Answers to Common Questions

  • Remember that this is a simulation. Nothing can be as exact as real life, but this is a close approximation.
  • Reiterate that what is important is for the learner to go through the steps of the procedure from start to finish, so that they are more familiar with the steps when they actually do the procedure in the office

Lab Sequence

  1. Assemble all of the equipment as aforementioned
  2. Begin counseling the patient on all the risks, benefits, and alternatives
  3. Conduct a timeout
  4. Bimanual examination for size and position of uterus and assess cervical dilation and effacement
  5. Assess location of fetus using ultrasound examination or digital examination
  6. Grasp anterior lip of cervix with appropriate instrument
  7. Attempt to perform amniotomy
  8. Choose proper instrument for extraction
  9. Initiate extraction by introducing instrument and putting traction on anterior lip Introduce forceps closed
  10. Open widely when past internal cervical os
  11. Extract material carefully using appropriate technique
  12. Keep track of parts removed
  13. Confirm the uterus is empty
  14. Examine tissue removed to ensure all parts have been extracted
  15. Remove all instruments

Competency Assessment

The resident will be able to identify indications for second trimester dilation and evacuation (D&E) and be able to counsel the patient appropriately. The resident will be able to identify the equipment and supplies necessary. The resident will be able to demonstrate in a simulated environment the steps of a D&E.

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