Dilation And Curettage

1 What are Dilation and Curettage (D&C)?

Dilation and curettage (D&C) are procedure devised to remove tissue from the lining of your uterus.

Doctors perform this procedure to make a diagnosis or provide treatment for certain uterine conditions, such as heavy bleeding or to clear the uterine lining after a miscarriage or an abortion.

In dilation and curettage (sometimes spelled dilatation and curettage) your doctor uses small instruments or a medication to open (dilate) your cervix.

Your doctor will then use a surgical instrument called a curette to remove the uterine tissue. Curettes used in a D&C can be sharp or use suction.

2 Reasons for Procedure

The main reason for dilation and curettage is to diagnosis or treat a uterine infection. In order to diagnose a condition.

Your doctor might recommend a D&C to diagnose a condition for the following reasons:

  • You have abnormal uterine bleeding.
  • You experience bleeding after menopause.

Your doctor recovers abnormal endometrial cells during a routine test for cervical cancer. In order to perform the test, your doctor will collect a tissue sample from the lining of your uterus (endometrium) and sends the sample to a lab for testing.

The test usually checks for:

  • Uterine cancer.
  • Uterine polyps.
  • Endometrial hypoplasia, which is a precancerous condition in which the uterine lining becomes thicker than normal.

To treat a condition. When performing a therapeutic D&C, your doctor removes all the contents of your uterus, not just a small tissue sample.

Your doctor can do this too:

  • Remove a molar pregnancy, in which a tumor forms instead of a normal pregnancy
  • Treat excessive bleeding after delivery by clearing out any placenta that remains in the uterus
  • Remove cervical or uterine polyps, which are usually benign
  • Remove fibroid tumors, which are benign tumors formed on the uterine wall that sometimes bulge into the uterine cavity
  • Clear out any tissue that remains in the uterus after a miscarriage or abortion to prevent infection or heavy bleeding

Your doctor may perform the D&C along with another procedure called a hysteroscopy. During a hysteroscopy, your doctor inserts a slim instrument with a light and camera on the end into your vagina, through your cervix and up into your uterus.

Your doctor then views the lining of your uterus on a screen, noting any areas that look abnormal, making sure there aren't any polyps, and taking tissue samples as needed. During hysteroscopy, your doctor can also remove uterine polyps and fibroid tumors.

3 Potential Risks

Dilation and curettage are usually very safe, however, there is risk, which includes:

Perforation of the uterus. This occurs when a surgical instrument pokes a hole in the wall of the uterus. This is more common in women who were recently pregnant and women who have gone through menopause.

Most perforations heal on their own. However, if a blood vessel or another organ is damaged, a second procedure may be necessary to repair it.

Damage to the cervix. If the cervix is torn during the D&C, your doctor can apply pressure or medicine to stop the bleeding, or can stitch up the wound.

Scar tissue on the uterine wall. In a rare situation, a D&C results in the development of scar tissue in the uterus, a condition known as Asherman's syndrome.

This syndrome often happens when D&C is done after a miscarriage or delivery. This result in abnormal, absent or painful menstrual cycles, future miscarriages, and infertility.

Infection. D&G is possible after but rare after an infection.

Contact your doctor if you experience any of the following after a D&C:

  • Bleeding heavy enough to make you change pads every hour.
  • Light bleeding that lasts longer than two weeks.
  • Fever.
  • Cramps lasting more than 48 hours.
  • Pain that intensifies.
  • Foul-smelling discharge from the vagina.

4 Preparing for your Procedure

Dilation and curettage can be performed in a hospital, clinic or in your doctor's office. It is usually an outpatient procedure.

To prepare for the procedure:

Follow your doctor's instructions on limiting food and drink. Arrange for someone to help you get home because you may be drowsy after the medication wears off.

Clear your schedule to create enough time for your procedure and recovery afterward.

You will likely spend a few hours in recovery after the procedure, you should be able to go to your normal daily routine within a day or two.

In certain cases, the doctor may start dilating your cervix a few hours or even a day after the procedure.

This helps the cervix gradually open and is usually performed when our cervix needs to mere dilated more than in a standard D&C, such as during abortions or with certain types of hysterectomy.

Your doctor will give you medication known as misoprostol (Cytotec) to promote dilation.

This medication is given orally or vaginally to soften the cervix or inserts a slender rod made of laminaria into your cervix.

Your cervix will expand due to the gradual expansion of the laminaria when it absorbs the fluid in your cervix.

5 What to Expect

Read on to learn more about what to expect before, during, and after your dilation and curettage.

For dilation and curettage, you will be given anesthesia. General anesthesia makes you unconscious and unable to feel pain.

Other forms of anesthesia provide light sedation or use injections to numb only a small area (local anesthesia) or a larger region (regional anesthesia) of your body.

The choice of anesthesia depends on the reason for the D&C and your medical history.

During the procedure:

You lie on your back on an exam table while your heels rest in supports called stirrups.

Your doctor inserts an instrument called a speculum into your vagina, as during a Pap test, in order to see your cervix.

Your doctor inserts a series of thicker and thicker rods into your cervix to slowly dilate your cervix until it's adequately opened.

Your doctor removes the dilation rods and inserts a spoon-shaped instrument with a sharp edge or a suction device and removes uterine tissue.

Because you're either unconscious or sedated during D&C, you shouldn't feel any discomfort. The procedure usually takes about 15 to 30 minutes.

After the procedure:

You may spend a few hours in a recovery room after the D&C so that your doctor can monitor you for heavy bleeding or other complications. This also gives you time to recover from the effects of anesthesia.

If you had general anesthesia, you may become nauseated or vomit, or you might have a sore throat if a tube was placed in your windpipe to help you breathe. With general anesthesia or light sedation, you may also feel drowsy for several hours.

Normal side effects of a D&C may last a few days and include:

  • Mild cramping
  • Spotting or light bleeding

For discomfort from cramping, your doctor may suggest taking ibuprofen (Advil, Motrin IB, others) or another medication.

Wait to put anything in your vagina until your cervix returns to normal to prevent bacteria from entering your uterus, possibly causing an infection.

Ask your doctor when you can use tampons and resume sexual activity. Your uterus must build a new lining after a D&C, so your next period may not come on time.

If you had a D&C because of a miscarriage, and you want to become pregnant, talk with your doctor about when it's safe to start trying again.

6 Procedure Results

Your doctor will discuss the results of any lab test or the procedure itself soon after the dilation and curettage or at a follow-up appointment.