What is a D&C procedure. How is dilation and curettage performed. What are the risks and benefits of D&C. How long does D&C recovery take. When is a D&C necessary. What should patients expect before and after a D&C. How does a D&C affect menstrual cycles.

Understanding Dilation and Curettage: A Crucial Gynecological Procedure

Dilation and Curettage, commonly known as D&C, is a minor surgical procedure performed to remove tissue from the uterus. This gynecological intervention plays a vital role in diagnosing and treating various conditions affecting the female reproductive system. But what exactly does this procedure entail?

A D&C consists of two main steps:

1. Dilation: The cervix, which is the opening of the uterus, is gently widened.
2. Curettage: A thin instrument called a curette is used to scrape the uterine wall and remove tissue.

Typically performed by a gynecologist or obstetrician, a D&C is usually an outpatient procedure, allowing patients to return home on the same day. The procedure’s versatility makes it an essential tool in women’s healthcare, addressing a range of issues from abnormal bleeding to post-miscarriage care.

When Is a D&C Necessary? Exploring Common Indications

D&C procedures are recommended for various reasons, each tied to specific gynecological conditions or diagnostic needs. Understanding these indications can help patients grasp the importance of this procedure in maintaining reproductive health.

Common reasons for undergoing a D&C include:

• Diagnosing and treating abnormal uterine bleeding
• Removing tissue following a miscarriage or abortion
• Treating incomplete miscarriages
• Diagnosing or treating uterine polyps or fibroids
• Investigating postmenopausal bleeding
• Evaluating the uterine lining for potential cancer

In some cases, a D&C may be combined with a hysteroscopy, where a small camera is inserted into the uterus to provide visual guidance during the procedure. This combination allows for more precise diagnosis and treatment of uterine conditions.

The D&C Procedure: Step-by-Step Breakdown

Understanding the D&C process can help alleviate anxiety and prepare patients for what to expect. How is a D&C performed? Let’s break down the procedure into its key stages:

Pre-Procedure Preparation

In some cases, cervical dilation begins before the main procedure:

• A laminaria stick may be inserted into the cervix several hours before the D&C.
• This thin rod absorbs fluid, gradually opening the cervix to provide access to the uterus.
• Patients can move around normally while the laminaria stick is in place.

During the Procedure

The main D&C procedure typically follows these steps:

1. Anesthesia administration (general anesthesia or sedation)
2. Positioning the patient with feet in stirrups
3. Insertion of a speculum to open the vagina
4. Cervical stabilization using a clamp
5. Further dilation of the cervix if necessary
6. Tissue removal using a curette or suction device
7. Collection of tissue samples for laboratory analysis

The actual D&C procedure usually takes between 5 to 10 minutes, although the entire process, including preparation and recovery, may last several hours.

Weighing the Benefits and Risks of D&C

Like any medical procedure, D&C comes with both advantages and potential risks. Understanding these can help patients make informed decisions about their healthcare.

Benefits of D&C

D&C offers several important benefits:

• Diagnostic tool for abnormal uterine bleeding
• Detection of abnormal endometrial cells and potential uterine cancer
• Removal of residual tissue after miscarriage or abortion, preventing infection and heavy bleeding
• Treatment of various uterine conditions

Potential Risks and Complications

While D&C is generally safe, patients should be aware of potential risks:

• Uterine perforation (small tear in the uterus)
• Uterine infection
• Excessive bleeding
• In rare cases, development of Asherman’s syndrome (formation of scar tissue in the uterus)

Is Asherman’s syndrome a significant concern? While rare, this condition can cause infertility and changes in menstrual flow. However, it’s important to note that adhesions resulting from Asherman’s syndrome can often be treated surgically.

Navigating D&C Recovery: What to Expect

Recovery from a D&C is typically straightforward, but knowing what to expect can help patients prepare and ensure a smooth healing process.

Immediate Post-Procedure Care

Following a D&C:

• Patients need someone to drive them home
• Most can return home a few hours after the procedure
• Mild pain and light bleeding may occur for a few days
• Pads should be used instead of tampons for any bleeding

Recovery Timeline

How long does D&C recovery take? Most patients can resume regular activities within a week. A follow-up appointment is typically scheduled 1-2 weeks after the procedure to ensure proper healing.

Impact on Menstrual Cycles and Sexual Activity

D&C can temporarily affect menstrual cycles and necessitate changes in personal hygiene and sexual practices.

Key points to remember:

• The first menstrual period after D&C may be early or late
• Tampons and sexual intercourse should be avoided until the cervix fully closes
• The open cervix increases the risk of bacterial infection, necessitating these precautions

How long should patients wait before resuming sexual activity? It’s best to consult with the healthcare provider for personalized advice, as healing times can vary.

Preparing for a D&C: Patient Guidelines

Proper preparation can significantly enhance the D&C experience and recovery. What should patients do before undergoing a D&C?

Pre-Procedure Considerations

• Discuss any medications or supplements with the healthcare provider
• Arrange for transportation home after the procedure
• Follow fasting instructions if general anesthesia will be used
• Wear comfortable, loose-fitting clothing on the day of the procedure

Questions to Ask Your Healthcare Provider

To ensure a comprehensive understanding of the procedure, consider asking:

• What type of anesthesia will be used?
• How long will the recovery process take?
• Are there any specific post-procedure care instructions?
• When can regular activities, including work, be resumed?
• What symptoms should prompt immediate medical attention?

By addressing these questions, patients can feel more prepared and confident about their D&C procedure.

Advances in D&C Techniques: Improving Patient Outcomes

As medical technology evolves, so do the techniques used in D&C procedures. These advancements aim to enhance safety, reduce recovery time, and improve overall patient outcomes.

Modern D&C Innovations

Recent improvements in D&C procedures include:

• Hysteroscopy-guided D&C for more precise tissue removal
• Vacuum aspiration techniques that may reduce the risk of uterine perforation
• Improved anesthesia protocols for better pain management
• Use of ultrasound guidance during the procedure for enhanced accuracy

How do these advancements benefit patients? They often result in shorter procedure times, reduced complications, and quicker recovery periods. As research continues, we can expect further refinements in D&C techniques, making the procedure even safer and more effective.

The Role of Minimally Invasive Alternatives

In some cases, alternatives to traditional D&C may be considered:

• Hysteroscopy alone for diagnostic purposes
• Medication management for certain types of abnormal bleeding
• Endometrial ablation for treating heavy menstrual bleeding

These alternatives may be suitable depending on the specific condition and patient preferences. Discussing these options with a healthcare provider can help determine the most appropriate course of action.

As we continue to explore the nuances of D&C procedures, it’s clear that this gynecological intervention remains a cornerstone in women’s health. From its diagnostic capabilities to its therapeutic applications, D&C plays a crucial role in addressing a wide range of reproductive health issues. By understanding the procedure, its indications, and the recovery process, patients can approach D&C with confidence, knowing they’re taking an important step in managing their gynecological health.

The field of gynecology continues to evolve, with ongoing research and technological advancements promising even more refined and patient-friendly approaches to D&C and related procedures. As we look to the future, the focus remains on improving patient outcomes, minimizing risks, and ensuring that women have access to the best possible care for their reproductive health needs.

Dilation and Curettage (D&C): Treatment, Risks, Recovery

Overview

Female Pelvic Anatomy

What is dilation and curettage (D&C?)

A D&C is a minor surgical procedure to remove tissue from the uterus (womb). A gynecologist or obstetrician performs this surgery in their office or a surgery center. It’s usually an outpatient procedure, so you go home the same day.

A D&C gets its name from:

• Dilation of the cervix: The provider dilates, or opens, the cervix. The cervix is the opening of the uterus, where it meets the top of the vagina. Usually, the cervix only dilates during childbirth.
• Curette: The provider uses this thin instrument to scrape the uterine wall and remove tissue.

Who needs a dilation and curettage (D&C?)

You might need a D&C if you have or had:

Sometimes, you have a D&C and hysteroscopy. During this procedure, your provider inserts a device into the cervix to see the inside of the uterus. You may have a hysteroscopy with a D&C if your provider is trying to diagnose a problem.

Procedure Details

What happens before a dilation and curettage (D&C)?

Occasionally, before beginning the D&C, your provider may begin to dilate your cervix using a laminaria stick. They insert this thin rod into the cervix and leave it there for several hours. You can get up and walk around while the laminaria stick is inside. The laminaria stick absorbs fluid from the cervix. When that happens, the cervix opens and gives access to the uterus.

What happens during a dilation and curettage (D&C)?

Before the procedure, your provider will give you medicine to make you comfortable. You may have general anesthesia, where you’re asleep for the procedure. Or your provider may give you medication to relax and sedate you, but you remain awake for the procedure. Your provider will recommend the best anesthesia option for you.

During the procedure, you lie on a table with your feet in stirrups, like during a gynecologic exam. Your provider will:

1. Insert a speculum into your vagina. This smooth device, shaped like a duck’s bill, helps open the cervix.
2. Use a clamp to hold the cervix in place.
3. Make sure your cervix is sufficiently dilated, using a series of rods to open it slowly.
4. Use a curette, a type of suction or scraping device, to clean out tissue from the uterus.
5. Send a sample of the tissue to a laboratory for analysis.

How long does a dilation and curettage (D&C) take?

The procedure itself takes about five to 10 minutes. But the process may be longer. And you’ll need to wait in the recovery room for a few hours after the procedure before you go home.

Does a dilation and curettage (D&C) hurt?

You may feel cramps similar to menstrual cramps. Pain medication can relieve the cramps.

Risks / Benefits

What are the advantages of a dilation and curettage (D&C)?

A D&C can help your provider figure out why you have abnormal bleeding. It can also help detect abnormal endometrial cells, which may be a sign of uterine cancer. After a D&C, your provider sends the sample of cells to a laboratory where pathologists can identify if you have normal or abnormal tissue, polyps or cancer.

A D&C is also important for your health after a miscarriage or abortion. It removes any leftover tissue to prevent heavy bleeding and infection.

What are the risks of a dilation and curettage (D&C)?

A D&C is a safe, routine procedure. But like any surgery, it has some risks. D&C risks include:

• Uterine perforation (a small tear in the uterus), which may happen if the tip of the curette passes through the uterine wall.
• Uterine infection.
• Uterine bleeding.

In rare cases, if you had a D&C after a miscarriage, you may develop Asherman’s syndrome. This condition occurs when adhesions, or bands of scar tissue, form in the uterus. In Asherman’s syndrome, scar tissue builds up between the uterine walls. The walls then stick together. This condition can cause infertility and change your menstrual flow. But providers can usually treat the adhesions with surgery.

###

Recovery and Outlook

What’s the follow-up care for a dilation and curettage (D&C)?

You’ll need someone to drive you home from the procedure. You can usually go home a few hours after a D&C. You might have mild pain or light bleeding for a few days. Use pads, not tampons, for the bleeding. Within a week, you should be able to get back to your regular activities. You usually return to your provider about a week or two after the procedure.

Will a dilation and curettage (D&C) affect my menstrual cycle?

After having a D&C, your next period may be early or late. You’ll need to avoid using tampons or having sex for a while after the procedure. Until your cervix returns to its normal, closed state, you’re at higher risk of bacteria entering your vagina and causing an infection. Your provider will tell you when you can resume having sex and using tampons.

When to Call the Doctor

When should I call my healthcare provider about a dilation and curettage (D&C)?

Complications from a D&C are treatable when they’re diagnosed early. If you notice symptoms after a D&C, call your provider so they can diagnose and treat the problem. Symptoms may include:

Additional Details

If I had a miscarriage, do I need a dilation and curettage (D&C)?

About half of women who miscarry don’t need a D&C procedure. If the miscarriage occurs before 10 weeks of pregnancy, it will most likely happen on its own and not cause any problems. After the 10th week of pregnancy, there’s a higher risk of having an incomplete miscarriage. In that case, you need a D&C procedure to make sure the uterus is clean.

You may be able to decide if you want to miscarry naturally or have a D&C procedure. Talk to your provider to decide what’s right for you.

A note from Cleveland Clinic

A D&C, or dilation and curettage, is a procedure to remove tissue from your uterus. You may need a D&C procedure if you had a miscarriage or abortion. Your healthcare provider can use a D&C and hysteroscopy to diagnose unexplained bleeding. A D&C is an outpatient procedure. You may have some mild cramping and bleeding for a few days after a D&C. If you had a miscarriage or have bleeding between your periods, talk to your healthcare provider to see if you need a D&C.

Dilation and Curettage (D&C): Treatment, Risks, Recovery

Overview

Female Pelvic Anatomy

What is dilation and curettage (D&C?)

A D&C is a minor surgical procedure to remove tissue from the uterus (womb). A gynecologist or obstetrician performs this surgery in their office or a surgery center. It’s usually an outpatient procedure, so you go home the same day.

A D&C gets its name from:

• Dilation of the cervix: The provider dilates, or opens, the cervix. The cervix is the opening of the uterus, where it meets the top of the vagina. Usually, the cervix only dilates during childbirth.
• Curette: The provider uses this thin instrument to scrape the uterine wall and remove tissue.

Who needs a dilation and curettage (D&C?)

You might need a D&C if you have or had:

Sometimes, you have a D&C and hysteroscopy. During this procedure, your provider inserts a device into the cervix to see the inside of the uterus. You may have a hysteroscopy with a D&C if your provider is trying to diagnose a problem.

Procedure Details

What happens before a dilation and curettage (D&C)?

Occasionally, before beginning the D&C, your provider may begin to dilate your cervix using a laminaria stick. They insert this thin rod into the cervix and leave it there for several hours. You can get up and walk around while the laminaria stick is inside. The laminaria stick absorbs fluid from the cervix. When that happens, the cervix opens and gives access to the uterus.

What happens during a dilation and curettage (D&C)?

Before the procedure, your provider will give you medicine to make you comfortable. You may have general anesthesia, where you’re asleep for the procedure. Or your provider may give you medication to relax and sedate you, but you remain awake for the procedure. Your provider will recommend the best anesthesia option for you.

During the procedure, you lie on a table with your feet in stirrups, like during a gynecologic exam. Your provider will:

1. Insert a speculum into your vagina. This smooth device, shaped like a duck’s bill, helps open the cervix.
2. Use a clamp to hold the cervix in place.
3. Make sure your cervix is sufficiently dilated, using a series of rods to open it slowly.
4. Use a curette, a type of suction or scraping device, to clean out tissue from the uterus.
5. Send a sample of the tissue to a laboratory for analysis.

How long does a dilation and curettage (D&C) take?

The procedure itself takes about five to 10 minutes. But the process may be longer. And you’ll need to wait in the recovery room for a few hours after the procedure before you go home.

Does a dilation and curettage (D&C) hurt?

You may feel cramps similar to menstrual cramps. Pain medication can relieve the cramps.

Risks / Benefits

What are the advantages of a dilation and curettage (D&C)?

A D&C can help your provider figure out why you have abnormal bleeding. It can also help detect abnormal endometrial cells, which may be a sign of uterine cancer. After a D&C, your provider sends the sample of cells to a laboratory where pathologists can identify if you have normal or abnormal tissue, polyps or cancer.

A D&C is also important for your health after a miscarriage or abortion. It removes any leftover tissue to prevent heavy bleeding and infection.

What are the risks of a dilation and curettage (D&C)?

A D&C is a safe, routine procedure. But like any surgery, it has some risks. D&C risks include:

• Uterine perforation (a small tear in the uterus), which may happen if the tip of the curette passes through the uterine wall.
• Uterine infection.
• Uterine bleeding.

In rare cases, if you had a D&C after a miscarriage, you may develop Asherman’s syndrome. This condition occurs when adhesions, or bands of scar tissue, form in the uterus. In Asherman’s syndrome, scar tissue builds up between the uterine walls. The walls then stick together. This condition can cause infertility and change your menstrual flow. But providers can usually treat the adhesions with surgery.

###

Recovery and Outlook

What’s the follow-up care for a dilation and curettage (D&C)?

You’ll need someone to drive you home from the procedure. You can usually go home a few hours after a D&C. You might have mild pain or light bleeding for a few days. Use pads, not tampons, for the bleeding. Within a week, you should be able to get back to your regular activities. You usually return to your provider about a week or two after the procedure.

Will a dilation and curettage (D&C) affect my menstrual cycle?

After having a D&C, your next period may be early or late. You’ll need to avoid using tampons or having sex for a while after the procedure. Until your cervix returns to its normal, closed state, you’re at higher risk of bacteria entering your vagina and causing an infection. Your provider will tell you when you can resume having sex and using tampons.

When to Call the Doctor

When should I call my healthcare provider about a dilation and curettage (D&C)?

Complications from a D&C are treatable when they’re diagnosed early. If you notice symptoms after a D&C, call your provider so they can diagnose and treat the problem. Symptoms may include:

Additional Details

If I had a miscarriage, do I need a dilation and curettage (D&C)?

About half of women who miscarry don’t need a D&C procedure. If the miscarriage occurs before 10 weeks of pregnancy, it will most likely happen on its own and not cause any problems. After the 10th week of pregnancy, there’s a higher risk of having an incomplete miscarriage. In that case, you need a D&C procedure to make sure the uterus is clean.

You may be able to decide if you want to miscarry naturally or have a D&C procedure. Talk to your provider to decide what’s right for you.

A note from Cleveland Clinic

A D&C, or dilation and curettage, is a procedure to remove tissue from your uterus. You may need a D&C procedure if you had a miscarriage or abortion. Your healthcare provider can use a D&C and hysteroscopy to diagnose unexplained bleeding. A D&C is an outpatient procedure. You may have some mild cramping and bleeding for a few days after a D&C. If you had a miscarriage or have bleeding between your periods, talk to your healthcare provider to see if you need a D&C.

Dilation and Curettage (D&C) | Michigan Medicine

Surgery Overview

A dilation and curettage (D&C) is a procedure to remove tissue from the lining of the uterus (endometrium).

During a D&C, the vagina is spread open. Then the cervix is opened gently so that tissue can be removed, usually with a scraping or suction tool.

A D&C may be done in a hospital or clinic. Most women go home the same day.

You will be kept comfortable and safe by your anesthesia provider. You may get medicine that relaxes you or puts you in a light sleep. You may get pain medicine before the procedure.

What To Expect

• Most women are able to return to normal activities in a day or two.
• You may have mild pelvic cramping for a few hours.
• You may have a small amount of vaginal discharge.
• For 2 weeks after the D&C, you should not:
  • Have sexual intercourse.
  • Douche.
  • Use tampons.
• Your next period may be early or late.

Why It Is Done

Dilation and curettage (D&C) may be used to:

• Find and treat bleeding problems.
• Control sudden, heavy vaginal bleeding that is causing heavy blood loss or a low number of red blood cells (anemia).
• End a pregnancy.
• Remove tissue that remains after a miscarriage.
• Get a tissue sample for testing. For example, a postmenopausal woman who has vaginal bleeding may be tested for signs of endometrial cancer.

How Well It Works

D&C usually stops heavy menstrual bleeding. The stop in bleeding may be temporary.

Risks

A D&C has risks, but problems are rare. The risks include:

• Infection.
• Puncture of the uterine wall.
• Heavy vaginal bleeding.
• Scarring of the lining of the uterus. This can make it hard to get pregnant.

What To Think About

Right after the procedure, you will likely stay in the recovery area for 1 to 4 hours. Then you will go home. You will get information to help you during your recovery.

Credits

Current as of: October 8, 2020

Author: Healthwise Staff
Medical Review: Kathleen Romito, MD – Family Medicine
Adam Husney, MD – Family Medicine
Kirtly Jones, MD – Obstetrics and Gynecology, Reproductive Endocrinology

Current as of: October 8, 2020

Author:
Healthwise Staff

Medical Review:Kathleen Romito, MD – Family Medicine & Adam Husney, MD – Family Medicine & Kirtly Jones, MD – Obstetrics and Gynecology, Reproductive Endocrinology

Surgical Procedures: Dilation and Curettage

What is a Dilation and Curettage and how is it performed?

A dilation and curettage (D&C) is a surgical procedure in which the uterine cervix is dilated (expanded to be bigger) so that tissue can be removed from the uterus. A D&C can be done to diagnose and treat many types of uterine conditions.  

When used to diagnose an issue, a D&C can look for:

• Abnormal uterine bleeding.
• Post-menopausal bleeding.
• Changes in endometrial cells.
• Uterine polyps.
• Uterine cancer.
• Endometrial hyperplasia.

When used as a treatment, a D&C is used to treat:

• A molar pregnancy.
• Excessive (too much) post-partum bleeding.
• Benign (non-cancerous) polyps.
• Fibroids.
• Retained products of conception following a miscarriage or abortion.

At times a D&C may be done with a hysteroscopy. A hysteroscopy is a procedure where a lighted camera is inserted into the uterus to look at the lining of the uterus.

What are the risks of having a dilation and curettage?

As with any surgery, there are risks and possible side effects. These can be:

• Perforation (puncturing) the uterus.
• Damage to the cervix.
• Uterine wall scar tissue (called Asherman Syndrome).
• Infection and/or bleeding.

What is recovery like?

Recovery from a D&C may take about 1-2 days. It is normal to have cramping, spotting and light vaginal bleeding. Your next period may be late due to the need for the uterus to thicken and build a new lining.

Cramping can be relieved with over-the-counter ibuprofen, or medications recommended by your healthcare team. Always ask your provider before taking any new medications.

You will need pelvic rest until given the okay from your healthcare team. This means that you should not put anything in the vagina (tampons, vaginal intercourse, douche). Doing so can increase your risk for infection.

When should I call my provider?

Call your provider if you have:

• Heavy vaginal bleeding and/or foul-smelling vaginal discharge.
• Light vaginal bleeding lasting more than two weeks.
• Cramps that last longer than 48 hours.
• Fever. Your care team will tell you at what temperature they should be called.
• Abdominal (belly) pain.

What will I need at home?

• Sanitary pads for vaginal bleeding/discharge.
• Thermometer to check for fever, which can be a sign of infection. Your care team will tell you at what temperature they should be called.

Talk with your provider about why you may need a dilation and curettage. If you have any questions about recovery or risks, be sure to ask your care team.

Dilation and Curettage (D&C) | UAMS Health

Dilation and curettage (D&C) is sometimes necessary to remove tissue after a miscarriage within the first trimester. It is a procedure in which the cervix of the uterus is expanded (dilated) so that the uterine lining (endometrium) can be removed with a spoon-shaped instrument called a curette.

Before the Procedure

Before a D&C, the same general recommendations for other outpatient procedures apply. It is recommended that the patient take nothing by mouth (food, water, etc.) for at least 6 to 8 hours prior to the scheduled operation. Often, the doctor will see the patient the day before surgery to discuss the procedure and potential complications in detail.

Are you awake during a D&C?

Most D&Cs are done under general anesthesia. The procedure is typically very short, and general anesthetic can be quickly reversed, with the patient going home later the same day.

Some patients prefer or require spinal or epidural blocks, but these forms of anesthesia take more time for the anesthesiologist to perform and require more recovery time for the patient. Occasionally, in a very motivated patient, the procedure can be done under a local anesthetic with or without intravenous pain medication.

Overall, the choice of anesthetic is generally determined by the surgeon, the
anesthesiologist, and the patient.

What are the possible complications of a D&C?

The D&C procedure has a low risk of serious complications. It is normal to experience vaginal bleeding and/or pelvic cramping (similar to menstrual cramping) for a few days following a D&C. Typically, over-the-counter pain medications will help pain control.

The most common complication that can occur is the perforation of the uterus with either the dilators or the curette. When this happens, as long as no internal organs (intestines, bladder, or rectum) or large blood vessels are damaged, the hole will usually heal itself without further surgery. The risk for this problem is increased in patients with a narrowed opening to the cervix (cervical stenosis) or in females with distorted internal uterine anatomy. This risk is also increased if the uterus is infected or has undergone previous surgeries such as cesarean sections or myomectomies.

Injury to the cervix is another possible complication. Tears or cuts in the cervix can usually be treated by the application of pressure and application of local medications to stop bleeding. In some cases, stitches in the cervix may be required, but this is not common.

Other complications, as with any surgery, include bleeding and infection. Most bleeding is mild and resolves on its own. Infection is also rare and can normally be managed with oral antibiotics. Most D&Cs do not require the routine use of post-operative antibiotics. On occasion, in patients with certain heart defects, the surgeon may give the patient antibiotics before and after the surgery to prevent bacteria from the vagina from infecting the heart valves.

What happens after a D&C?

After the surgery, most patients can return to normal activities within a few days. Nonsteroidal anti-inflammatory medications may be recommended to relieve the mild pain and cramping that may follow. To decrease the chance of developing an infection, doctors advise that patients not use tampons or insert anything into the vagina for two weeks following the surgery, and do not have sexual intercourse for the same time period.

You will have a follow-up appointment usually around 2 weeks after the surgery.

What is a Dilation and Evacuation (D and E, D&E)?

A D&E is done during the second trimester and is pretty similar to a D&C in that it uses a vacuum aspiration, but requires more surgical instruments to remove the tissue (like forceps). Because it’s done later on in a pregnancy, it can take a little longer. A lot of the complications and instructions will be the same as a D&C.

If you have one of these procedures done, you can expect additional lab tests at your follow-up appointments.

Dilatation and curettage | healthdirect

Dilatation and curettage (‘D&C’) is an operation to scrape away tissue from the inside of the womb (uterus). It’s used to diagnose and treat many conditions, including abnormal bleeding, and after a miscarriage.

Why is the procedure performed?

D&C refers to opening of the cervix (dilatation) followed by removal of tissue from inside the uterus (curettage).

The procedure is done to diagnose why you have abnormal bleeding, bleeding after menopause, or if you have abnormal endometrial cells. A small sample of the tissue is sent to a laboratory for testing, allowing a pathologist to identify conditions such as polyps or uterine cancer.

A D&C can also be used to remove all the contents from inside your womb, for example after a miscarriage or abortion (to prevent heavy bleeding), to remove remnants of the placenta after childbirth, or to remove polyps.

How to prepare for the procedure

Your doctor will ask you a series of questions before a D&C. Make sure you tell them if you are pregnant or might be pregnant, or if you have a history of bleeding or allergies. You should follow any instructions on drinking and eating.

Sometimes your doctor may start dilating your cervix a few hours before the procedure, either with medication or with a small rod called a laminaria, which is inserted into the cervix and left in place for a while.

What happens during the procedure

A D&C is usually done under general anaesthetic, but can also be performed with an epidural, where you are relatively numb from the waist down, or with a local anaesthetic, where just the area around your cervix is numb.

Once you can’t feel anything, your doctor will insert an instrument called a speculum into your vagina so they can see your cervix. They will slowly dilate the cervix using a series of thicker and thicker rods. They will then remove the rods and insert an instrument called a curette to scrape away the lining of the uterus. This can also be done with suction.

The procedure normally takes 5 to 10 minutes, but you will need to wait in recovery for a few hours afterwards.

D&C involves 2 main steps: dilation of the cervix followed by removal of tissue from the lining of the uterus using an instrument called a curette.

What to expect after the procedure

It will take you a while to recover if you have had a general anaesthetic, and you should have someone with you when you go home. You should also not drive, operate machinery or drink alcohol for at least 24 hours after the procedure. You can get back to normal activities in a day or 2.

You might feel some cramping and discomfort after a D&C, which you can control with paracetamol and with a heat pack. You might have light bleeding for 10 to 14 days, which may become heavier when you do physical activity such as lifting. Use sanitary pads and not tampons. Your next period may also be heavier than usual.

You should see your doctor 1 to 2 weeks after the procedure, but call them earlier if you experience:

• heavy bleeding (you need to change the pad every 10 to 20 minutes)
• fever
• passing blood clots larger than a 50 cent piece
• cramps for more than 48 hours
• worsening pain that doesn’t go away after taking painkillers
• a foul-smelling discharge from the vagina

What might go wrong

Complications during or after a D&C are rare, but include:

• bleeding
• infection
• perforation of the uterus
• a reaction to the anaesthetic
• scarring of the uterus, leading to infertility or changes to your menstruation – known as Asherman syndrome, this is very rare and can often be treated with surgery

More information

Visit healthdirect’s surgical procedures pages for more general information, such as:

Dilation and Curettage (D&C) Procedures, Risks & Recovery.

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What is Dilation and Curettage?

Dilation and curettage (pronounced “dye-LAY-shun” and “KYUR-uh-tedge”) is a surgical procedure to scrape the uterine lining, either to remove tissue or take a sample for testing. The procedure involves dilating the cervix and scraping the inside of the uterus with a surgical tool. A Dilation and Curettage (D&C) can be used for several different reasons:

• Remove tissue following a miscarriage
• Extract residual pieces of the placenta following childbirth
• Terminate an early pregnancy

It also is used to diagnose and treat conditions such as:

Preparation for Dilation and Curettage

Your doctor will want to take a complete medical history before your surgery. You will want to let her know if:

• You are or may be pregnant
• You are on any blood thinners or have any known blood disorders
• You have any allergies to medication or latex

How is a D&C Performed?

Dilation and curettage can be performed in a hospital setting, but they are also routinely performed at your gynecologist’s office as an outpatient procedure. The procedure usually only takes about 10-15 minutes, but you may need to remain in recovery for a few hours before going home.

Depending on your medical history and the extent of the D&C, your doctor may choose one of three types of anesthesia for your procedure:

• Local anesthesia – Your cervix will be numbed to minimize your discomfort
• Nitrous Oxide (laughing gas) – This is often used for many in-office procedures to minimize pain
• General anesthesia – You will be asleep during the procedure and won’t feel any pain

During the procedure, you will be positioned on your back with your feet in stirrups. The doctor will place an instrument called a speculum into the vagina so that the other instruments can access the cervix and uterus.

Dilation

Next, your doctor will need to dilate the cervix. This can be done with a dilation rod or with medication.

Curettage

Once the cervix is dilated, the doctor can scrape the lining of the uterus with an instrument called a curette. The curette looks like a small spoon or loop at the end of a long, thin handle. In some cases, the doctor may need to use a suction device to remove all of the tissue.

Hysteroscopy

If your doctor needs to take a look inside your uterus, she may insert a slender instrument equipped with a lens at this time. The lens allows your doctor to view the inner walls of the uterus and may help in making a diagnosis. This is not required in all D&C procedures.

Risks of Dilation and Curettage

Dilation and curettage is a very safe procedure, but all medical interventions carry some risk. Many women experience minor side effects after a D&C, such as:

• Light vaginal bleeding
• Cramping
• Grogginess
• Nausea

You can manage these effects with a pain reliever (Tylenol) and sanitary pads. Refrain from using tampons for at least one week following a D&C.

Complications are rare, but you should call your doctor if you experience any serious symptoms, such as:

• Fever, chills
• Nausea or vomiting that lasts longer than 24 hours
• Heavy bleeding or clotting
• Severe pain
• Swelling and tenderness in the abdomen
• A change in color, texture, or odor of vaginal discharge

These symptoms may be a sign of infection or damaged tissue.

Asherman’s Syndrome

Rarely, a D&C may cause scarring. Scar tissue of the pelvic organs is known as adhesions, and they can cause pain and hinder fertility in some cases. Adhesions can be treated. Your doctor can evaluate you for adhesions at a follow-up appointment.

Recovery from Dilation and Curettage (D&C)

You will need someone to drive you home following your Dilation and Curettage (D&C) and you may need to take a day or two off work. Most women experience some light cramping and bleeding. This is normal, and you can take medication or use a heating pad to manage the pain.

To reduce the risk of infection, avoid inserting anything into your vagina for at least one week, including tampons and having sex.

If you are considering Dilation and Curettage and aren’t fully comfortable with the procedure, don’t just read what you find on the Internet, but also ask your doctor any questions you may have.

We also invite you to establish care with Dr. Aliabadi. Please click here to make an appointment or call us at (844) 863- 6700.

Highly-trained and honored by the medical community, Dr. Thais Aliabadi is certified by the American Board of Obstetrics and Gynecology and a Diplomat of the American College of Obstetrics and Gynecology. She implements the most advanced, state-of-the-art technology and treatment options. Dr. Aliabadi specializes in up-to-date, minimally invasive surgical techniques, promising her patients shorter recovery times, reduced pain, and the least interruption to their daily lives.

Supported by her warm professional team, Dr. Aliabadi treats women through all phases of life and cherishes the special one-on-one relationship between patient and doctor.

Latest posts by Dr. Thaïs Aliabadi (see all) 90,000 Abrasion.!

1.

What is abrasion and what is it for?

Abrasion, also called dilatation and curettage, is a short surgical procedure in which the cervix is ​​dilated (dilatation) and then curettage (curettage) of the uterus is performed. If you are going to do abrasion, then you should know what to do before and wait after it.Although the abrasion only takes 10-15 minutes, you may need to stay in the hospital for several hours for observation.

What is abrasion for?

Dilation and curettage are carried out in order to:

• Remove tissue from the uterus during miscarriage or for abortion, or to remove residual placenta after delivery;
• To diagnose or treat uterine bleeding.Dilation and curettage of the uterus helps in the treatment of polyps, fibroids, endometriosis, hormonal imbalances, and cancer.

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2.

How to prepare for the procedure?

Before the abrasion, the doctor learns about the past diseases and other information of interest to him.You can also ask all your questions. Tell the doctor:

• About possible or confirmed pregnancy;
• About hypersensitivity or allergy to any medicinal products, iodine and latex;
• About disorders of the circulatory system.

During the procedure, you will be under the influence of anesthesia. Ask your doctor about the type of anesthesia and recommendations for preparing for it.

Before dilation and curettage of the uterus, you should urinate and remove all clothing below the waist.

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3. How is the procedure performed and possible side effects?

During dilation and curettage, you will lie on your back, your feet will be supported by special steps. Although neither dilation nor curettage involves stitches, the doctor will treat the cervix with an antiseptic.

Dilation. For dilation, the doctor uses special instruments to dilate the cervix so that instruments can be inserted into it.

Curettage of the uterus. Curettage is the “scraping” of the uterus with a curette using a special instrument that resembles a spoon. The doctor may also use a cannula to suck out tissue debris.

After abrasion

After abrasion, the following side effects may appear:

• Spasm;
• Staining;
• Bleeding.

Call the hospital immediately if, after dilatation and curettage of the uterus, you have:

• Heat;
• Profuse vaginal bleeding;
• Feeling of weakness in the abdomen;
• Pain;
• Offensive vaginal discharge.

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4.

Rehabilitation after abrasion

After abrasion, you will need to spend a day or two at home. If the abrasion was performed under general anesthesia, then you may feel nausea, slight spasms. Be prepared that your menstrual cycle is likely to change.

90,000 Endometrial thickness is not a criterion for choosing instrumental revision of the uterine cavity after medical abortion

This section is only for specialists in the field of medicine, pharmacy and healthcare!

Ultrasonography is a routine technique used to confirm the effectiveness of medical abortion.Its main purpose is to make sure that the gestational sac is removed from the uterine cavity [1]. Measuring the thickness of the endometrium is also used to determine the amount of detritus or remnants of gestational tissues (fragments of the decidua or chorionic elements) in the uterus after expulsion of the ovum [15].

Many practitioners use this indicator as an indicator of the need to empty the uterine cavity after medical abortion, considering this condition as incomplete abortion, which leads to an increase in the frequency of unnecessary instrumental intervention [3].

In a joint study of the Ministry of Health and Social Development of the Russian Federation and WHO “Strategic Assessment of Policies, Programs and Services in the Sphere of Unplanned Pregnancy, Abortion and Contraception in the Russian Federation” (2009) [2], a group of experts made findings indicating insufficient knowledge of doctors in the technology of managing patients after medical abortion: unreasonably frequent ultrasound examination (up to 7 times in 10 days) and inadequate interpretation of the data obtained, which leads to an increase in curettage of the uterine cavity in some medical centers up to 50%.Whereas WHO experts have shown that multiple ultrasound (ultrasound) does not increase the effectiveness of medical abortion, and an early follow-up visit to the clinic is attributed to the risk factors for surgical completion of abortion [1,2,11].

Empirical observations (when consulting doctors seeking a high frequency of “ineffective cases” of termination of pregnancy, requiring curettage of the uterine cavity, and complaints of “poor quality” drugs) also indicate a significant variability in the use of ultrasonography and overdiagnosis of incomplete abortion, and ultimately discrediting the method. The most common mistakes in the management of patients are: early ultrasound control (starting from the second day after the administration of mifepristone to ascertain the death of the ovum), the use of Doppler ultrasonography (which leads to the “diagnosis” of a non-existent “placental polyp”), visualization of detritus in the uterine cavity ( the presence of which is the norm, but is regarded by doctors as incomplete abortion), inadequate assessment of the thickness of the endometrium (and the use of this indicator as a criterion for determining the indication for curettage of the uterine cavity) [3].Examination of medical records in such cases testifies in most of them to the insufficient quality of medical care for women in the post-abortion period with medical abortion.

Analysis of foreign literature on this issue showed that the thickness of the endometrium less than 15 mm indicates complete removal of the ovum and gestational tissues from the uterine cavity after spontaneous or medical abortion [15]. A small amount of blood in the uterine cavity with small clots gives a picture of the heterogeneity of the M-echo structure with the presence of echo-positive and echo-negative inclusions (Fig.13].

Thus, in one large (652 patients) prospective study, it was shown that endometrial thickness is not a criterion for performing dilatation and curettage (D&C) [16]. This study examined the state of the endometrium according to the data of ultrasonography in women after medical and surgical abortion. The mean endometrial thickness on day 14 after misoprostol was 9.0 mm and in the D&C group 6.9 mm (difference 2.1 mm, 95% confidence interval [CI] 1.0-3.2). 12 women (3.2%) after medical abortion subsequently underwent D&C and their mean endomerism was greater (difference 5.5 mm, 95% [CI] 2.3-8.8). However, endometrial thickness did not correlate with subsequent D&C. The predictive value of endometrial thickness in this study was less than 40%.

In two prospective studies, it was shown that R-hCG was significantly more important than endometrial thickness in the outcome of medical abortion [7,10].

In a study of 1870 women, D&C was required in 1.6% of cases after ultrasound-confirmed ovum expulsion [16]. The median time between taking mifepristone and D&C was 24 days (range 6 to 67 days). The average endometrial thickness in women who underwent D&C was 14.5 mm, and in women who did not need this intervention, on average 10.9 mm (a difference of 3.5 mm is not statistically significant). The researchers then categorized the women by endometrial thickness from 10 to 30 mm at 5 mm intervals and calculated the positive and negative predictive values.A positive predictive value was less than 25.0% in all subgroups, a negative predictive value was more than 98.4%. Allocation was also performed according to the time interval from misoprostol to ultrasound monitoring. It turned out that the values ​​of the thickness of the endometrium varied less than 3 mm in time intervals and showed no trend either to decrease or increase in the period from 5 to 11 days between taking misoprostol and ultrasound. The authors conclude that endometrial thickness cannot predict the choice of active surgical tactics after medical abortion.
The groundlessness of doctors’ complaints about the “low quality” of drugs indicates insufficient knowledge of the mechanism of drug action.

In the clinical characteristics of the course of medical abortion, two periods are distinguished. Period I is latent. It is characterized by the absence of clinical manifestations of abortion within 24-48 hours (28.6 ± 2.3) from the moment of taking the drug. In this case, spotting appears only in 50% of patients [13]. During this period, there is a conformational rearrangement of the progesterone receptor and blockade of transcriptional effects, which leads to the death of the embryo and detachment of the ovum from the walls of the uterus.In addition, mifepristone helps to restore the sensitivity of myometrial cells to oxytocin and interleukin 1, inhibits the effect of estrogens on the uterus, leads to relaxation of the cervix due to changes in the ratio of cAMP / cGMP, increases sensitivity to endogenous prostaglandins [4]. Due to these effects, in approximately 3-5% of women, the expulsion of the ovum can occur without the additional administration of misoprostol [13].

II period – main. It is characterized by bleeding, in intensity corresponding to or slightly higher than normal menstruation and lasting for 5-30 days.The onset of bleeding after taking misoprostol averages 1.4 hours [13]. The average duration of bleeding is 7.2 days (maximum – 12-14 days, rarely – up to 16.7-21.7 days, or even before the next menstruation in an insignificant amount, which is considered a variant of the norm). The woman should be warned that if there is no spotting after taking misoprostol for 24 hours, then she must come to the clinic for a second dose of misoprostol [6]. The volume of blood loss, determined by the number of pads used during the period of post-abortion bleeding, corresponds to an average of 30.5 pieces per 2 weeks (options from 2 to 125).The most abundant spotting is observed 3-6 hours after taking prostaglandin. The volume of blood loss indicated above does not significantly affect the level of hemoglobin, which decreases by no more than 0.5 g / dL and does not significantly differ from the initial one [8, 9].

The drug causes an expansion of the cervix and an increase in uterine contractions, which contributes to the expulsion of the ovum. In 60% of cases, the expulsion of the ovum occurs within the first 6 hours after taking misoprostol, in the rest – during the day.Only in 2.9% of patients there is a delay of the ovum in the uterus for more than a specified period, but within 7-10 days, its spontaneous expulsion without the use of additional funds is possible [13].
Therefore, if during the control ultrasound there is no ovum in the uterine cavity, or if it died and exfoliated from the walls of the uterus, we can talk about the effectiveness of mifepristone. Delay of a detached ovum in the uterine cavity or the presence of a significant amount of detritus (Fig. 2) or chorionic elements (Fig. 3) indicates insufficient contractile activity of the myometrium and / or insufficient opening of the cervical canal, and in this case, the possibility of prescribing repeated doses of misoprostol should be considered [6].

Continuing pregnancy is recorded in 1.1% (Fig. 4) [1] of cases and does not characterize the “quality” of drugs, but indicates an individual lack of sensitivity of receptors to them.

As risk factors for “unsuccessful” medical abortion in one of the studies indicated: an older age of women, previous spontaneous abortions, multiple pregnancies and an earlier follow-up visit to the clinic [11].

According to the current WHO recommendations, in order to confirm the fact of the completion of the abortion, the absence of infection or any other complications, a time should be appointed for a repeated visit to the doctor in 10-15 days [1] (in the Letter of the Ministry of Health of the Russian Federation No. 2510 / 4854-02-32 ” On the use of the drug mifegin in obstetric and gynecological practice “dated 05. 15.2002, this period is determined at 7-10 days).

At the same time, according to WHO experts, sending women to vacuum aspiration is advisable only when the process of ongoing pregnancy is confirmed on the basis of gynecological examination data, clinical symptoms or laboratory results [1,5].

You can verify that the abortion was successful based on two of the following methods [6]:
Medical examination: the woman’s message about the symptoms of abortion (information about pain and the nature of bleeding) and the results of a gynecological examination (reduction of the uterus to normal (before abortion) size).
Ultrasound: this method can be effective if the doctor knows the technique of conducting the study. It is very important to be able to differentiate blood clots and residues of products of conception from incomplete abortion and ongoing pregnancy.If a woman is clinically healthy, then there is no indication for the surgical completion of the abortion, even if the ultrasound revealed the remains of the products of conception. Moreover, even after the death of the fetus, an unviable fertilized egg may remain in the uterus, and if the woman has no signs of infection, severe bleeding and has a desire to wait for complete expulsion, then this can be done. In this case, it is advisable to prescribe additional doses of misoprostol in order to enhance the contractile activity of the uterus. Research is currently underway to determine the optimal dose of misoprostol in the event of a delayed ovum.

Serum I-hCG content: a decrease in the I-hCG content may indicate that the pregnancy has been terminated (if the level has decreased by 50% in 24 hours, provided that its content was determined before the abortion or its content is below 1000 mU / L 2 weeks after taking mifepristone).

Active surgical tactics are indicated in the following cases:
1. Continuing pregnancy, confirmed 10-14 days after taking mifepristone / misoprostol.
2. Acute blood loss after taking misoprostol (more than 2 maxi pads for 1 hour for 2 hours).
3. Abundant blood loss (exceeding the volume of menstrual blood) for 7 days or more without a tendency to decrease during treatment for conservative hemostasis; the presence of signs of anemia.
4. Signs of infection in the presence of remnants of gestational tissue in the uterine cavity.
5. The desire of a woman to complete the process with prolonged discharge.
The need for revision arises no more often than in 1.5-2.5% of cases. In order to preserve the principle of safety when completing an abortion by surgery, the method of manual vacuum aspiration should be preferred [1]. Histological examination of the removed material should be considered mandatory [6].

Literature

1. Safe Abortion: Policy and Practice Guidelines for Health Systems. – World Health Organization.Geneva, 2004 .– 138 p.
2. Dicke G.B., Yarotskaya E.L., Erofeeva L.V. Strategic assessment of policies, programs and services in the field of unplanned pregnancy, abortion and contraception in the Russian Federation. Joint study of the Ministry of Health and the SR of the Russian Federation and the WHO. // Problems of reproduction. – 2010. – No. 3. – S. 92-108.
3. Dicke G.B. Clinical aspects of the use of pencrofton for medical termination of pregnancy. A guide for doctors. M., 2008 .– 52 p.
4. Kareva EN .. Molecular mechanisms of action of female sex steroids and their antagonists: author.dis. … Dr. med. sciences. M 2003; 55.
5. Frequently asked clinical questions about medical abortion. – World Health Organization. Geneva, 2007 .– 40 p.
6. Providing medical abortion in resource-limited settings. An introductory guide. Second edition. New York, 2009 .– 63 p.
7. Chou S.Y. Chen C.Y. Chiang H.K. Chow P.K. Wang C.C. Hsu C.S. Monitoring medical abortion using mifepristone / misoprostol combination with ultrasonogram and serum human chorionic gonadotropin.Taiwan J Obstet Gynecol. 2006; 45 (1): 48-52
8. Davey A. Mifepristone and prostaglandin for termination of pregnancy contraindications for use, reasons and rationale. Contraception. 2006 Jul; 74 (1): 16-20.
9. Davis A., Westhoff C., De Nonno L. Bliding patterns after ealy abortion with mifepriston and misoprostol or manual vacuum aspiration. J. Am. Med. Assoc. 2000; 55 (3 Suppl): 141-4.
10. El-Baradie S.M., El-Said M.H. Ragab W.S, Elssery K.M, Mahmoud M. Endometrial thickness and serum beta-hCG as predictors of the effectiveness of oral misoprostol in early pregnancy failure.J Obstet Gynaecol Can. 2008; 30 (10): 877-81.
11. Haimov-Kochman R., Arbel R., Sciaky-Tamir Y., Brzezinski A., Laufer N., Yagel S. Risk factors for unsuccessful medical abortion with mifepristone and misoprostol. Acta Obstet Gynecol Scand. 2007; 86 (4): 462-6
12. Fiala C., Safar P., Bugdeman M., Gemzell-Danielsson K. Verifying the effectiveness of medical abortion; ultrasound versus hCG testing. Eur J Obstet Gynaecol Reprod Biol 2003; 109 (2): 190-5.
13. Fiala Ch.Improving medical abortion. Using mifepristone in combination with a prostaglandin analog. Stockholm, 2005.
14. Gonzalez C. H. G., Vargas F. R., Perez A. et al. Limb deficiency with or without Mobius sequence in seven Brazilian children with misoprostol use in the first trimester of pregnancy. American Journal of Medical Genetics. 1993; 47: 59-64.
15. Pymar H.C., Creinin M.D., Schwartz J.L. Mifepristone followed on the same day by vaginal misoprostol for early abortion. Contraception.2001; 64: 87-92.
16. Reeves M. F .; Fox V.C., Lohr P.A .; Creinin M.D. Endometrial thickness following medical abortion is not predictive of subsequent surgical intervention. Ultrasound Obstet Gynecol 2009; 32: 104-9.
17. Reeves M. F., Lorh P. A., Harwood B. J., Creinin M. D. Ultrasonographic endometrial thickness after medical and surgical management of early pregnancy failure. Obstet Gynecol. 2008; 111 (1): 106-12.
18. Sing K.C., Ummat S., Rajaram S., Goel N. First trimester abortion with mifepristone and sublingval misoprostol: a pilot study.Aust. N. Z. J. Obstet Gynaecol. 2005; 45 (6): 495-8.

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Dilation and curettage is … What is Dilation and curettage?

Dilation and curettage (from Lat. dilato – to expand and FR. curette – scraper), also acute curette , in everyday life “scraping” is one of the surgical technologies for abortion. In the process of dilatation and curettage, the doctor first dilates the cervical canal (dilatation), and then scrapes the walls of the uterus with a curette (curettage).

In Russia, dilatation and curettage is the most famous and widespread method of abortion. 80-90% of first trimester abortions are performed using this method ^[1] . However, the World Health Organization classifies it as a less safe method and recommends resorting to it only in extreme cases.

Procedure

Abortion by dilatation and curettage is performed only in a hospital setting. In Russia, it is used both in the first and second trimester of pregnancy.The procedure is usually performed under general anesthesia.

Dilation, or dilation of the cervical canal, is usually performed using metal dilators (bougie). WHO recommends instead, drug preparation for abortion, provoking spontaneous dilatation of the cervix with special drugs – in this case, the risk of injury to the cervix and subsequent development of cervical insufficiency is significantly reduced.

After opening the cervix, the doctor scrapes the ovum with a curette together with the placenta and uterine lining.In late pregnancy, additional surgical instruments may be required to separate and retrieve parts of the fetus.

Dilation and curettage and vacuum aspiration

In a number of cases in Russia, after an abortion by the method of vacuum aspiration, the so-called control curettage of the uterus is performed. However, according to experts and the international medical community, with manual vacuum aspiration, when a transparent syringe is used to suck the ovum, there is no need for control curettage – moreover, it negates the advantages of the atraumatic vacuum aspiration method ^[2] .

According to the WHO, the incidence of complications after dilatation and curettage is 2-3 times higher than the incidence of complications after vacuum aspiration. WHO recommends that every effort be made to replace dilation and curettage with vacuum aspiration to improve the safety and quality of care ^[3] .

In the hospital of the city of Uglegorsk, Sakhalin Region, after the introduction of manual vacuum aspiration as a replacement for the dilatation and curettage procedure, the incidence of incomplete abortion decreased from 2.1 to 0.74%, cervical injuries from 0.6 to 0.53%, continuing pregnancy – from 2.4 to 0.85%, hematomas – from 6.8 to 1.91%, inflammatory diseases of the pelvic organs – from 4.8 to 2.77%.The hospital doctors noted that manual vacuum aspiration is faster and easier for women ^[1] .

Possible complications

The likelihood of complications after dilatation and curettage surgery depends on the duration of pregnancy and the quality of the procedure. The risk of complications in surgical abortion is also associated with the timing of the operation: for example, the likelihood of perforation of the uterine wall increases by 20% every two weeks of pregnancy ^[4] .

Possible complications of abortion are divided into three groups: early, late and distant ^[5] .

Early (during abortion or after 1 week)

• perforation of the uterus – damage to the uterus with surgical instruments, the formation of a through hole in the wall of the uterus;
• hematometer – the accumulation of blood in the uterine cavity due to postoperative bleeding against the background of poor contraction of the myometrium and inadequate hemostasis;
• incomplete abortion – incomplete removal of the placenta and parts of the fetus. Clinically manifested by ongoing bleeding, painful contractions, poor uterine contraction.Requires repeated curettage of the uterine cavity (reabrasion). With the preservation of parts of the fetus or placenta in the uterus, such a distant complication as a placental polyp (gestational trophoblastic disease) is associated.
• failed abortion – a special case of incomplete abortion, when there is a complete abandonment of the rejected fetus in the uterine cavity;
• Cervical tears: There can be two degrees of severity: tears of the vaginal part and tears of the cervical wall. Without suturing at the end of the rupture of the cervix – isthmic-cervical insufficiency, ectropion, cervico-vaginal fistula.
• Acute blood loss.

Late (1 week – 1 month).

• Late complications of abortion include gynecological infection of all degrees according to the Bartels-Sazonova classification up to gynecological sepsis: metroendometritis, exacerbation of chronic adnexitis, pyosalpinx, salpingo-oophoritis, pyometra, parametritis.

Remote (later than 1 month).

Notes

See also

What is Dilation and Curettage (D&C)

Dilation and curettage, commonly called D&C, is a procedure in which the cervix is ​​dilated and the lining of the uterus is surgically scraped off.This is sometimes done after a miscarriage to further assess the condition of the uterus in the event of abnormal uterine bleeding.

This article explains why and how to do this to help you prepare for your procedure.

PeopleImages / Getty Images

Why is it done

D&C removes tissue from the lining of the uterus. It can be used to treat or prevent complications from miscarriage, or to evaluate other problems with uterine bleeding when someone is not pregnant.

Some of the more common reasons it happens after a miscarriage include:

• Diagnose and treat severe bleeding

• Remove infected tissue, such as pelvic inflammatory disease.

• Remove excess tissue or placenta during miscarriage

The procedure can also be used to collect a sample for testing fetal chromosomes. Couples can use this information to figure out if their child has any genetic abnormalities.

In some cases, tissue samples are taken during a D&C procedure to diagnose conditions such as uterine polyps and uterine cancer.

How to prepare

Your doctor will help you prepare for your procedure and provide written instructions for a reminder.

Before your procedure, your doctor will review your medical history, give you time to ask questions, and review your consent documents.

Tell your doctor if:

• You have a bleeding disorder or are taking anticoagulants

• You have a known allergy to drugs, anesthesia or latex.

The procedure can be performed in a hospital, clinic, or doctor’s office. Depending on the type of anesthesia used, you may need to fast for about 12 hours before your procedure.

You can be given:

• General anesthesia (i.e. you will not be awake during the procedure)

• Local anesthesia (i.e. you will wake up but will not feel the procedure)

Your doctor may recommend starting cervical dilatation from a few hours to one day before procedures depending on your medical needs.Starting the dilation process before the procedure allows the cervix to open more slowly than with standard dilation.

You will most likely be asked to empty your bladder before starting your procedure.

What happens during the procedure

At the beginning of the procedure, you will be given the type of anesthesia that you discussed with your doctor. With any form of anesthesia, you will not feel pain or discomfort during the D&C procedure.

Steps D&C

• You will lie on the examination table with your feet resting on the stirrups, as in a pelvic exam or Pap test.

• Your doctor inserts a dilator into your vagina so you can see your cervix.

• To help dilate your cervix, your doctor may have prescribed medication or inserted a thin rod and then a thicker one. They will continue this process with thicker rods until the cervix is ​​open enough for the procedure.

• Your doctor will remove the dilator rods and insert a spoon-shaped instrument with sharp edges to remove uterine tissue.Your doctor may also use a suction device to remove tissue.

• The collected tissue is usually sent to a laboratory for testing.

After procedure

Upon completion, you will remain in the same room or be taken to a recovery room to rest. The time before you can leave after the procedure will depend on the type of anesthesia.

With general anesthesia, you will have more time to wake up. Your blood pressure, heart rate, and breathing will be closely monitored.When you are on your guard, you may be discharged home. Schedule someone to drive you home in case you feel sleepy from the medication.

If you were given local anesthesia, you could probably go away faster than with general anesthesia.

You can put on a sanitary pad after your procedure in case you experience spotting or bleeding.

Your doctor may recommend avoiding for a few days:

• Strenuous activity

Recovery

For several days after the D&C, you may experience some fatigue, light bleeding, and mild cramps.Your doctor may recommend pain relievers if you have cramping.

Bleeding

Bleeding after D&C is common and you can wear a sanitary towel for several days. The use of a tampon is not recommended as it may increase the risk of infection.

If you have a menstrual cycle, the length of your cycle is likely to change due to the procedure. It could have started earlier or later than expected.

You will most likely be able to resume your normal daily activities within a few days after your D&C procedure, but follow your doctor’s recommendations for any restrictions.

Your doctor will most likely ask you to schedule a follow-up visit and review tissue test results if you had a procedure to make a diagnosis.

Complications

D&C is considered a low risk procedure and complications are rare.However, with any procedure, there may be some complications such as: 1

• Reaction to anesthesia

• Infectious disease

• Perforation or injury of the uterus or cervix

• Development of scar tissue on the uterine wall

• Blood vessel injury

Complications are rare, but if you experience If you have any of the following symptoms after D&C, contact your doctor: 1

• Seizures lasting more than 48 hours

• Increasing pain

• Foul-smelling discharge

• Heavy bleeding

Summary

Dilation and curettage, commonly referred to as D&C, is a procedure in which the cervix is ​​dilated and the lining of the uterus is removed.