From the Guidelines
At 17 weeks of pregnancy, a surgical dilation and evacuation (D&E) procedure is recommended rather than dilation and curettage (D&C) due to its safety and effectiveness at this gestational age. The indications for a 17-week pregnancy termination via D&E include situations where the pregnancy poses a significant risk to the mother's health or the fetus has severe abnormalities.
Key Considerations
- D&C is typically used for pregnancies up to 12-14 weeks, while medical termination with medications like mifepristone and misoprostol is generally limited to pregnancies under 10-12 weeks 1.
- The procedure involves dilating the cervix (often with osmotic dilators placed 24 hours before the procedure) and then removing the pregnancy tissue using specialized instruments.
- Local or general anesthesia would be used, and the procedure typically takes 15-30 minutes.
- Recovery involves monitoring for bleeding, cramping, and infection.
Evidence-Based Recommendation
The recommendation for D&E at 17 weeks is based on the increased size of fetal tissue at this gestational age, which makes D&E more appropriate than medical methods or D&C, which are designed for earlier pregnancies and may be incomplete or cause complications at this advanced gestational age 1. Additionally, the risk of major abortion complications, such as prolonged fever, hemorrhage necessitating blood transfusion, and injury to pelvic organs, increases with advancing gestational age 1. Therefore, it is crucial to prioritize the safest and most effective method for pregnancy termination at 17 weeks, which is D&E.
From the Research
Indications for 17-week Pregnancy Termination via Dilation and Curettage (D&C)
- The provided studies do not specifically address the indications for a 17-week pregnancy termination via dilation and curettage (D&C) 2, 3, 4, 5, 6.
- However, the studies suggest that medical and surgical methods can be recommended for second-trimester abortion, and dilation and evacuation (D&E) is the procedure of choice for surgical abortions 2.
- Cervical preparation is recommended for D&C after 12 weeks gestation and is standard practice for D&E beyond 14 weeks gestation 4.
- The studies evaluate cervical preparation methods for second-trimester surgical abortion, including osmotic dilators, prostaglandins, and Foley balloon catheters 4.
- The addition of mifepristone to misoprostol has been found to improve cervical dilation and make surgery easier and shorter in second-trimester abortions 6.
- However, the addition of mifepristone to vaginal misoprostol did not provide a significant increase in cervical dilation compared to misoprostol alone as cervical preparation 4-6h prior to D&E at 14-19 weeks 5.
Cervical Preparation Methods
- Osmotic dilators were found to be superior to prostaglandins with respect to cervical dilation throughout the second trimester and with respect to procedure time within the early second trimester 4.
- The use of adjunctive mifepristone administered one-day pre-operatively at the time of osmotic dilator placement should be considered because evidence demonstrates that it makes D&E subjectively easier at 20-24 weeks without increasing side effects 3.
- Same-day procedures appear to be a safe and reasonable option in the early second trimester, however, more research is needed to assess the effectiveness and safety of same-day procedures in the later second trimester 4, 5.