Intact dilation and extraction (D&X, IDX, or intact D&E) is a surgical procedure that removes an intact fetus from the uterus. The procedure is used both after miscarriages and for abortions in the second and third trimesters of pregnancy. In United States federal law, it is known as a partial-birth abortion, although this latter term is not an accepted medical term and is not used by abortion practitioners or the medical community at large. 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 developed into a focal point of the abortion debate. Intact D&E of a fetus with a heartbeat was outlawed in most cases by the 2003 federal Partial-Birth Abortion Ban Act, which was upheld by the United States Supreme Court in the case of Gonzales v. Carhart. Indications As with non-intact D&E or labor induction in the second trimester, the purpose of D&E is to end a pregnancy by removing the fetus and placenta. Patients who are experiencing a miscarriage or who have a fetus 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 body. An intact D&E is also used in abortions to minimize the passage of instruments into the uterus, 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 and the risk of retention of fetal parts in the uterus such as brain matter and tissue. Procedure As with non-intact D&E, intact D&E may be safely performed in freestanding clinics, ambulatory surgical centers, and in hospitals. Intra-operative pain control is usually dependent on the setting and patient characteristics but commonly involves local analgesia with either IV sedation or general anesthesia. Preoperative antibiotics are administered to reduce the risk of infection. In cases where the woman is Rh-negative, Rho(D) immunoglobulin (RhoGam) is administered to prevent the risk of developing erythroblastosis fetalis (hemolytic disease of the newborn) in subsequent pregnancies. Intact D&E is more feasible among women with higher parity, at higher gestational ages, and when cervical dilation is greater. There are no absolute contraindications. Cervical preparation The surgery is preceded by cervical preparation which may take several days.