Once you're asleep a speculum is placed inside the vagina to keep the vaginal walls apart. The doctor will determine if there has been sufficient dilation. The doctor will hold the cervix, the opening to the uterus, with an instrument called a tenaculum. The physician will then insert several narrow metal rods, called dilators, into the cervix to further open it. The physician uses a slender suction cannula and other specialized instruments to remove the pregnancy form the uterus. The entire process can take 10-20 minutes.

Laminaria Insertion
The purpose of laminaria insertion is to dilate the cervix so that the pregnancy can be removed. Laminaria are made from various materials whose purpose is to absorb water from the cervix and slowly expand - thereby gently dilating the cervix. It takes a few minutes for the physician to insert one or several laminaria and they may require a few hours or overnight to effectively dilate the cervix. They are removed prior to the surgical procedure when the patient is under general anesthesia.

D&E (Dilatation & Extraction)
This procedure is used for later 2nd trimester terminations of pregnancy. The cervix has been dilated with laminaria and/or cytotec over the course of 1 to 2 days depending on the necessary dilation. Under general anesthesia, once adequate dilation is achieved, all products of conception are removed from the uterine cavity. This is done as gently as possible. The procedure takes 5 - 10 minutes and is followed by an ultrasound inspection to assure that the cavity is empty. The patient is taken to the recovery room for approximately 1 - 1 ½ hours.