Intact dilation and extraction

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Intact dilation and extraction (IDX) is a surgical abortion wherein an intact fetus is removed from the uterus via the cervix. It is also known as intact dilation and evacuation, dilation and extraction (D&X, or DNX), intrauterine cranial decompression and, vernacularly in the United States, as partial birth abortion. The procedure may also be used to remove a deceased fetus that is developed enough to require dilation of the cervix for its extraction.[1]

Though the procedure has had a low rate of use, representing 0.17% (2,232 of 1,313,000) of all abortions in the United States in the year 2000, according to voluntary responses to an Alan Guttmacher Institute survey,[2] it has developed into a focal point of the abortion debate. In the United States, intact dilation and extraction was made illegal in most circumstances by the Partial-Birth Abortion Ban Act, which the U.S. Supreme Court upheld in the case of Gonzales v. Carhart.

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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.[3] First, the cervix is dilated. Second, the fetus is positioned for a footling breech. Third, the fetus is partially pulled out, starting with the feet, as far as the neck. Fourth, the brain and material inside the skull is evacuated, so that a dead but otherwise intact fetus can be delivered via the vagina.

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,[4] 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.[5]

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