Intact Dilation and Extraction - Intact D&X Surgery

Intact D&X Surgery

Under the Intact D&X method, the largest part of the fetus (the head) is reduced in diameter to allow vaginal passage. According to the American Medical Association, this procedure has four main elements. Usually, preliminary procedures are performed over a period of two to three days, to gradually dilate the cervix using laminaria tents (sticks of seaweed which absorb fluid and swell). Sometimes drugs such as pitocin, a synthetic form of oxytocin, are used to induce labor. Once the cervix is sufficiently dilated, the doctor uses an ultrasound and forceps to grasp the fetus's leg. The fetus is turned to a breech position, if necessary, and the doctor pulls one or both legs out of the cervix, which some refer to as 'partial birth' of the fetus. The doctor subsequently extracts the rest of the fetus, leaving only the head still inside the uterus. An incision is made at the base of the skull, a blunt dissector (such as a Kelly clamp) is inserted into the incision and opened to widen the opening, and then a suction catheter is inserted into the opening. The brain is suctioned out, which causes the skull to collapse and allows the fetus to pass more easily through the cervix. The placenta is removed and the uterine wall is vacuum aspirated using a cannula.