Dilation and curettage (D&C) is a surgical procedure performed to remove tissue from inside the uterus. Healthcare professionals utilize D&C for both diagnostic and therapeutic purposes, addressing various uterine conditions like heavy bleeding or clearing the uterine lining after a miscarriage or abortion.
During a D&C, small instruments or medication are used to open (dilate) the cervix. Following dilation, a surgical instrument called a curette, which can be either a sharp instrument or a suction device, is employed to remove uterine tissue.
Alt: Illustration of the female reproductive system highlighting the ovaries, fallopian tubes, uterus, cervix, and vagina.
Why is a D&C Performed?
Dilation and curettage serves dual purposes: diagnosis and treatment of uterine conditions.
Diagnostic Applications
Before proceeding with a D&C, a healthcare team may suggest an endometrial biopsy or endometrial sampling. This preliminary step aids in diagnosing the underlying condition. Endometrial sampling is typically recommended in scenarios such as:
- Unusual uterine bleeding.
- Bleeding following menopause.
- Detection of atypical endometrial cells during routine cervical cancer screening.
During an endometrial biopsy, a healthcare professional collects a tissue sample from the endometrium (uterine lining) and sends it to a laboratory for analysis. This analysis can identify:
- Endometrial intraepithelial hyperplasia: a precancerous condition characterized by excessive thickening of the uterine lining.
- Uterine polyps.
- Uterine cancer.
If the information obtained from an endometrial biopsy is insufficient, a D&C, typically performed in an operating room, may be necessary for a more comprehensive evaluation.
Therapeutic Applications
When a D&C is performed for therapeutic reasons, the objective is to remove the contents of the uterus, rather than just a small tissue sample. This might be necessary to:
- Prevent infection or excessive bleeding by removing residual tissue from the uterus after a miscarriage or abortion.
- Remove a molar pregnancy: a tumor that develops instead of a normal pregnancy.
- Manage excessive bleeding after childbirth by removing any remaining placental tissue.
- Remove cervical or uterine polyps, which are typically benign.
A D&C can also be performed in conjunction with hysteroscopy. During hysteroscopy, a slender instrument equipped with a light and camera is inserted through the vagina, past the cervix, and into the uterus.
The doctor then uses a screen to visualize the uterine lining, looking for any abnormalities. Polyps can be removed and tissue samples can be taken during hysteroscopy. In some instances, hysteroscopy may be combined with an endometrial biopsy before a complete D&C procedure.
Alt: Placement of a hysteroscope for visualization during a hysteroscopy examination.
Potential Risks Associated with D&C
While complications from dilation and curettage are infrequent, it is crucial to acknowledge the potential risks, including:
- Uterine Perforation: This occurs when a surgical instrument creates a hole in the uterus. It’s more common in women who have recently been pregnant or who are postmenopausal. Most perforations resolve spontaneously. However, damage to a blood vessel or other organ may necessitate a second procedure for repair.
- Cervical Damage: Tearing of the cervix during a D&C can be addressed by applying pressure or medication to control bleeding, or by closing the wound with sutures. Pre-softening the cervix with medication may help prevent this.
- Scar Tissue Formation (Asherman’s Syndrome): In rare instances, a D&C can lead to the development of scar tissue within the uterus, a condition known as Asherman’s syndrome. This is more often seen when the D&C is performed after a miscarriage or delivery. Asherman’s syndrome can cause unusual, absent, or painful menstrual cycles, recurrent miscarriages, and infertility. Surgical intervention is often effective in treating this condition.
- Infection: Infection following a D&C is uncommon.
Seek medical attention if you experience any of the following after a D&C:
- Heavy bleeding requiring hourly pad changes.
- Persistent dizziness or lightheadedness.
- Fever.
- Cramps lasting longer than 48 hours.
- Worsening pain.
- Foul-smelling vaginal discharge.
Preparing for the Procedure
Dilation and curettage is typically performed as an outpatient procedure in a hospital, clinic, or healthcare professional’s office.
Prior to the procedure:
- Adhere to your healthcare team’s instructions regarding food and drink restrictions.
- Arrange for transportation home, as you may experience drowsiness after the anesthesia wears off.
- Allow sufficient time for the procedure and a few hours of post-operative recovery.
In some cases, cervical dilation may be initiated several hours or even a day before the procedure. This gradual dilation is generally performed when more extensive dilation is required, such as during pregnancy terminations or specific types of hysteroscopy.
To facilitate dilation, your doctor may administer misoprostol (Cytotec), an oral or vaginal medication, to soften the cervix. Alternatively, a slender rod made of laminaria may be inserted into the cervix. Laminaria gradually expands by absorbing fluid within the cervix, thereby promoting dilation.
What to Expect During the D&C Procedure
Alt: Illustration of the dilation and curettage (D&C) procedure showing the use of a vaginal speculum and curette.
Anesthesia is administered during dilation and curettage. The specific type of anesthesia depends on the reason for the D&C and your medical history.
During the procedure:
- You will lie on your back on an examination table with your heels supported in stirrups.
- Your doctor will insert a speculum into your vagina, similar to a Pap test, to visualize your cervix.
- A series of progressively thicker rods are inserted into your cervix to gradually dilate it.
- The dilation rods are removed, and a spoon-shaped instrument with a sharp edge or a suction device is used to remove uterine tissue.
You should not experience any discomfort during the D&C procedure, as you will be either unconscious or sedated.
After the Procedure
Following the D&C, you will likely spend a few hours in a recovery room to monitor for heavy bleeding or other complications. This also provides time for you to recover from the effects of anesthesia.
Common side effects of a D&C can persist for a few days and may include:
- Mild cramping
- Spotting or light bleeding
For cramping discomfort, your healthcare team may recommend over-the-counter pain relievers such as ibuprofen (Advil, Motrin IB, others).
You should be able to resume your normal activities within a day or two.
To prevent infection, refrain from inserting anything into your vagina until cleared by your healthcare team. Consult with them regarding when it is safe to use tampons and resume sexual activity.
Following a D&C, your uterus needs to rebuild its lining, which may cause your next menstrual period to be early or late. If you underwent a D&C due to a miscarriage and desire to become pregnant, discuss with your healthcare team when it is safe to start trying again.
Understanding the Results
Your healthcare team will discuss the results of the procedure with you either immediately after the D&C or during a follow-up appointment.
