Intact dilation and extraction abortion (IDX, intact D&E) is a surgical procedure to remove an intact fetus from the uterus to terminated a late-term pregnancy. It is also known as partial-birth abortion, intact dilation and evacuation or dilation and extraction
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
The surgery is preceded by cervical preparation which may take several days. Laminaria sticks, natural or synthetic rods that absorb moisture from the cervix, mechanically dilate the cervix. Misoprostol can be used to soften the cervix further; an intact D&E can only be performed with 2-5 centimeters of cervical dilation.
Feticidal injection of digoxin or potassium chloride may be administered at the beginning of the procedure to allow for softening of the fetal bones or to comply with relevant laws in the physician's jurisdiction and the federal Partial-Birth Abortion Ban Act
During the surgery, the fetus is removed from the uterus in the breech position, with mechanical collapse (crushing) of the fetal skull if it is too large to fit through the cervical canal. Decompression of the skull can be accomplished by incision and suction of the contents, or by using forceps.
If the fetus is in a vertex presentation, forceps can be used to turn it to a breech presentation while in the uterus. Recovery from an intact dilation and evacuation procedure is similar to recovery from a non-intact dilation and extraction. Prophylactic antibiotics (usually doxycycline) are given to prevent infection of the Fallopian tubes (salpingitis) or endometrium (endometritis). Postoperative pain is usually minimal and managed with NSAIDs