Dilation and Curettage (D & C)

Overview

A Dilation and Curettage (D&C) is a procedure used to remove tissue from the uterus. This surgery is performed by a gynecologist or obstetrician in their office, a hospital, or a surgical center. Typically, it is an outpatient procedure, allowing you to return home the same day. The term “D&C” is derived from:

• Cervical dilation: Your doctor widens, or dilates, your cervix. The cervix is the opening of your uterus where it meets the top of your vagina. Normally, cervical dilation occurs primarily during childbirth.
• Curette: Your provider employs a slender instrument known as a curette to gently scrape the lining of your uterus and extract tissue.

Reasons for undergoing the procedure

A D&C may be performed by doctors for a number of reasons, including:

• Removing tissue from your uterus: This procedure is necessary following a miscarriage, abortion, or when remnants of the placenta remain in your uterus after childbirth. Ensuring the uterus is completely cleared is crucial to mitigate the risk of infection and excessive bleeding.
• Diagnosing or treating irregular uterine bleeding: A D&C can remove abnormal tissue causing conditions such as infection, fibroids, or uterine cancer. It is also effective in removing cysts, polyps, or tumors. Your doctor may send a sample of uterine tissue to a laboratory for biopsy analysis.

In some cases, a hysteroscopy is performed alongside a D&C. A video-like device is inserted through the cervix to examine the interior of the uterus during the process. This combined procedure may be used for diagnostic purposes when investigating potential medical conditions.

Risks

A D&C is a standard, safe process. But there are risks associated with every procedure. D&C risks consist of:

• Infection.
• Bleeding.
• A tiny tear in your uterus called a uterine perforation could occur if a surgical device penetrates your uterine wall.

In rare instances, Asherman’s syndrome may arise if you underwent a D&C following a miscarriage. Adhesions, or bands of scar tissue, form in your uterus and cause this problem. Menstrual flow changes and infertility may result from this disorder. A surgical procedure to remove the adhesions can be used to treat this issue.

Before the procedure

Before undergoing a D&C, your doctor will conduct a thorough medical history review. It’s important to inform them about your current medications, any allergies you have, and if you suspect you might be pregnant. They may advise you to refrain from eating and drinking starting the evening before the procedure.

To facilitate cervical dilation and softening prior to the D&C procedure, doctors may recommend using a laminaria stick or administering a medication like misoprostol.

During the procedure

Prior to the procedure, your healthcare provider will discuss anesthesia choices with you. They will recommend the most suitable anesthesia based on your medical background and the reason for undergoing the procedure.

There are various anesthesia options available for a D&C:

• General anesthesia involves being unconscious throughout the procedure.
• Regional anesthesia, such as an epidural, results in numbness from the waist down while allowing you to remain fully conscious.
• Local anesthesia specifically numbs only the cervix, allowing you to be awake with sensation in all other parts of your body except the genital area.

Your doctor will start the procedure after administering anesthesia to you. A D&C typically follows these steps:

• You will be positioned on a table with your feet in stirrups, similar to a gynecological examination.
• Your healthcare provider will insert a speculum into your vagina to assist in opening your cervix. A clamp will be used to stabilize your cervix.
• Dilators, which are slender metal rods starting small and gradually increasing in size, will be used. These dilators gently widen your cervix until it is sufficiently open to accommodate the necessary instruments for the procedure.
• Your provider will employ a curette, a spoon-shaped scraping device, to remove tissue from your uterus. In some cases, a thin suction device may be used to clear any remaining tissue.
• They may collect a sample of the removed tissue for laboratory analysis.

The actual process takes five to ten minutes. However, the whole procedure takes longer because of the anesthesia and other setup. Before you leave the recovery area following the treatment, you’ll also need to wait a few hours.

After the procedure

• You will need someone to drive you home after the procedure. It’s common to experience mild cramping and light bleeding (spotting) for several days following a D&C.
• Use pads instead of tampons for the bleeding. Refrain from sexual activity until your doctor confirms it is safe to do so, typically about one week after the procedure. During the initial recovery period, when your cervix is still closing and returning to its normal size, there is a higher risk of bacterial infection entering the vagina.
• Your doctor will advise you on when you can resume sexual activity and use tampons.
• You should be able to return to your usual activities within a few days.
• If your provider sent tissue samples for analysis, you can expect results within a week. Consult your doctor regarding the timing and method of receiving biopsy results.
• Typically, you will have a follow-up appointment with your doctor within two weeks.

Outcome

The recovery time after a D&C varies, but most individuals can resume their normal activities within five days or less. Emotional recovery may take much longer depending on the reason for the procedure. For instance, coping with the emotional aftermath of a miscarriage may require an extended period for healing.

Following a D&C, your menstrual cycle may be irregular, with your next period potentially arriving earlier or later than expected due to uncertainty about how quickly your uterine lining will regenerate.

If your D&C was performed following a miscarriage, discuss with your doctor when it is safe to start trying to conceive again. In some cases, it may be recommended to wait through two or three menstrual cycles before attempting pregnancy again.