Intact dilation and extraction
| Background | |
| Abortion type | Surgical |
| First use | 1983 |
| Gestation | >16 weeks |
| Usage | |
| United States | 0.17% (2000) |
Intact dilation and extraction (Intact D&E) is a surgical procedure that removes an intact fetus from the uterus. The procedure is used both after late-term miscarriages and in late-term abortions.
It is also known as intact dilation and evacuation, dilation and extraction (D&X, or DNX, disfavored term), and, in United States federal law, as partial-birth abortion.
In 2000, although only 0.17% (2,232 of 1,313,000) of all abortions in the United States were performed using this procedure, it has developed into a focal point of the abortion debate. It was outlawed in most cases by the 2003 Partial-Birth Abortion Ban Act, which was upheld in the case of Gonzales v. Carhart.
Patients who are experiencing a miscarriage or who have fetuses diagnosed with severe congenital anomalies may prefer an intact procedure to allow for viewing of the remains, grieving, and achieving closure. In cases where an autopsy is requested, an intact procedure allows for a more complete examination of the remains. An intact D&E is also used in abortions to minimize instruments introduced into the uterus, therefore reducing the risk of trauma. It also reduces the risk of cervical lacerations that may be caused by the removal of bony parts from the uterus, or retention of any fetal parts in the uterus.
There is no difference in postoperative blood loss, future pregnancy outcomes, or major complications in intact D&E when compared to non-intact dilation and extraction. The risks of intact D&X are similar to the risks of non-intact D&E and include postoperative infection, hemorrhage, or uterine injury. In cases where the parent is Rh-negative and the fetus is Rh-positive, subsequent pregnancies have a risk of erythroblastosis fetalis (hemolytic disease of the newborn) if Rho(D) immunoglobulin (RhoGam) is not administered. Overall, the complication rate is low, with rates of serious complications (those requiring blood transfusion, surgery, or hospital treatment) ranging from 0 per 1,000 cases to 2.94 per 1,000 cases. The rate of minor complications is approximately 50 in 1,000 (5%), the same as the minor complication rate for non-intact D&E; the rate of serious complications is higher in non-intact D&E.
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