Dilation and Evacuation (D&E) Gestational Age Limits
Dilation and evacuation (D&E) can be safely performed through 24 weeks of gestation, with most procedures performed between 14-24 weeks. 1, 2
Gestational Age Range for D&E
D&E is the preferred and safest method for second-trimester pregnancy termination from approximately 14 weeks through 24 weeks of gestation 1, 2, 3
The procedure is most commonly performed after 14 weeks, as roughly 11% of induced abortions in the United States occur after this gestational age 3
Less than 2% of abortions occur after 20 weeks, but D&E remains the standard surgical approach through 24 weeks 4
Beyond 24 weeks of gestation, pregnancy termination is typically considered only for maternal indications (such as placenta previa or uterine rupture) or in the context of periviable birth management 5
Safety Profile Across Gestational Ages
D&E demonstrates superior safety compared to medical methods throughout the second trimester, with significantly lower complication rates: 1
- Hemorrhage risk: 9.1% with D&E vs 28.3% with medical methods
- Infection risk: 1.3% vs 23.9% with medical methods
- Retained tissue requiring additional procedures: 1.3% vs 17.4% with medical methods
Procedures performed at more advanced gestations (20-24 weeks) are associated with increased morbidity and mortality compared to earlier second-trimester procedures, making adequate cervical preparation critical 2, 4
Technical Requirements by Gestational Age
Before 20 weeks (14-19 weeks):
- A single set of osmotic dilators is usually adequate for cervical preparation 3
- Same-day procedures may be safe and reasonable in the early second trimester 6
- Preoperative cervical preparation is recommended to decrease complication risk 3
At 20-24 weeks:
- At least one day of cervical preparation with osmotic dilators is mandatory before D&E 2, 4
- Overnight osmotic dilators alone are sufficient for most procedures in this range 2
- Dilapan-S® dilators may be more effective than laminaria and increase likelihood of success on the first attempt 2
- Adjunctive mifepristone administered one day preoperatively should be considered, as it makes D&E subjectively easier without increasing side effects 2
Critical Practice Points
The procedure must be performed in a hospital setting by experienced providers, particularly at advanced gestational ages 1
Adequate cervical preparation is essential to reduce risks of cervical laceration and uterine perforation 3, 4
Two-day cervical preparation provides greater dilation than one day but may not impact procedure time below 19 weeks 6
After 19 weeks gestation, addition of prostaglandins to osmotic dilators may increase cervical dilation 6
Common Pitfalls to Avoid
Do not attempt D&E beyond 24 weeks of gestation without specific maternal indications 5
Avoid using mifepristone plus misoprostol alone without osmotic dilators at 20-24 weeks, as this lengthens procedure time and increases immediate complications, especially among less experienced providers 2
Do not use same-day cervical preparation at 20-24 weeks unless the provider has significant experience with these regimens 2
Ensure proper cervical preparation time—inadequate preparation increases complication risk substantially at advanced gestational ages 4