D and C (Dilation and Curettage)
Published on Feb 12, 2019 and last reviewed on Nov 15, 2022 - 4 min read
Abstract
Dilation and curettage is a minor surgical procedure where the cervix is widened (dilation) and the tissue lining the uterus is scraped out (curettage).
Dilation and Curettage (D & C) Overview
Dilation and curettage, or otherwise called D and C, is a minor surgical procedure where the cervix is widened (dilation) and the tissue lining the uterus is scraped or suctioned out (curettage). This procedure is usually done to treat conditions like heavy menstrual bleeding or to remove tissues left in the womb after a miscarriage. Here, the opening of the uterus (cervix) is widened using medicine or small instruments, and the uterine lining is removed using a spoon-shaped instrument called a curette, which can be either sharp or with a suction.
Why is D and C Done?
There are many indications for this procedure. The following are some of the reasons your doctor might suggest you undergo a D and C.
- To treat and know the cause of heavy menstrual bleeding.
- To find out the reason for bleeding between menstrual periods.
- After a miscarriage, to remove the tissue left behind.
- To collect tissue samples to check for endometrial hyperplasia (precancerous thickening of the uterine wall), uterine polyp, and uterine cancer.
- To clear out remaining placenta after delivery, to reduce excessive bleeding.
- To remove uterine or cervical polyps and fibroids.
- To remove a molar pregnancy (instead of a healthy pregnancy, a tumor forms).
- In case of bleeding after menopause.
- Surgical abortion.
How to Prepare for a D&C?
The doctor will explain in detail about the things you need to do and avoid before the surgery. You need to follow them properly. A few things you might need to do are:
- Get all the tests and physical examinations told by your doctor done before the surgery.
- Avoid eating and drinking anything on the day of the surgery.
- The doctor might ask you to visit the day before the surgery, so he or she can apply the gel or tablet (Misoprostol) that starts the process of opening your cervix.
- Take a couple of days off from work.
- Look to it that you have someone to drive you to the hospital before and after the procedure.
What to Expect During a D and C?
Anesthesia:
Your doctor will decide the type of anesthesia depending on your medical history and the reason for getting a D and C. It can be general anesthesia, where you are unconscious and cannot feel pain, or the doctor might give you spinal anesthesia (spinal block) or just numb your cervix (local anesthesia). In both local and spinal anesthesia, you will be awake during the procedure and will not feel any pain, but you might experience some cramping in the uterus during curettage.
Steps:
- You will be told to lie back on the examination table, and your heels will rest on supports called stirrups. It is the same position while having a Pap smear.
- You will be hooked up to monitors that measure your breathing, heartbeat, and breathing.
- The doctor inserts a speculum, which is an instrument used to spread the vagina so that the cervix can be visualized.
- Then your cervix is dilated by inserting a series of rods that increase in size until the cervix is opened sufficiently.
- After this, the doctor inserts a spoon-shaped instrument called a curette inside the uterus and scraps the wall of the uterus.
- Along with the curette, the doctor uses suction to loosen the uterine lining.
- After sufficient tissue is collected, all the instruments are removed, and the tissue is sent for analysis.
What to Expect After a D and C?
It will take a few hours for you to recover from the effects of anesthesia. With general anesthesia, you might feel nauseous and might have a sore throat from the pipe placed in your throat to help you breathe.
- You might have mild cramping and light bleeding for a few days after the procedure, which is normal.
- Your doctor might give you painkillers for the cramping and discomfort.
- You can resume your normal daily activities after a couple of days.
- After the procedure, walk around as much as possible, as this will keep your muscles strong and prevent blood clots from forming in your legs.
- Your doctor might tell you to avoid sexual intercourse or the use of tampons for at least a week or longer.
- It might take a while for the uterine lining to form again after this procedure, so your next period might be delayed.
- If the biopsy reports show noncancerous tissue, then you need no further treatment. If it shows cancerous tissue, then you need to consult a cancer specialist to plan further treatment.
What are the Complications of D&C?
As it is a minimally invasive procedure, it usually does not cause any serious complications. Some of the potential complications are:
- Heart and lungs problems, which are related to the use of anesthesia.
- Due to restricted bed rest, blood clots can form.
- Uterus and cervix might get damaged.
- Postsurgical infection.
- Heavy bleeding.
- Uterine and bowel puncture.
- Asherman syndrome - scar tissue formation in the uterus.
- Cervical insufficiency - weakening of the cervical muscles.
How Long Can the Bleeding Last After a D and C?
It is normal to bleed after a D and C. You can use sanitary pads for this and avoid using tampons. This bleeding might last for a few weeks. But, if you are bleeding heavily, which requires you to change pads every 10 to 20 minutes, then get medical attention immediately.
Things to Look out for After a D and C
You should seek immediate medical advice if you experience any of the following symptoms:
- Heavy bleeding.
- If you pass large blood clots frequently.
- Fever and chills.
- Abdominal pain that does not get better after taking painkillers.
During the follow-up visit, your doctor will check and let you know if any further treatment is needed. Depending on the symptoms you have and the biopsy result, your doctor will suggest appropriate treatment.
Frequently Asked Questions
1.
How Long Does It Take to Recover From D&C?
The recovery duration is different in different women. The average recovery period is 2 to 3 days. Some women who have extended pain and discomfort may take a week to recover from D& C. You should consult your doctor and ask their help to heal faster.
2.
Is Dilation and Curettage Painful?
The procedure is usually done under local anesthesia. Thus, the procedure is not painful. But, once the effect of local anesthesia is gone post-surgery, the woman will get her pain, which can be treated with painkillers. The common side effects of D&C are cramping of the uterus and mild spotting for at least ten days post-procedure.
3.
Is Dilation and Curettage Necessary?
D&C is a procedure that is needed only when a woman has a miscarriage or has leftover tissues in her uterine cavity, or when a woman is tested using a hysteroscopy procedure. Other than these instances, D&C is not mostly indicated.
4.
Can Dilation and Curettage Cause Infertility?
In rare circumstances, dilation and curettage cause a condition known as Asherman’s syndrome. This medical condition involves the formation of unusual bands of tissues in the uterine cavity. Those bands are known as adhesions. Those adhesions might cause infertility after the procedure.
5.
Can D&C Damage Cervix?
D&C procedure is usually an easy and low-risk procedure. But rarely cervical tissues get torn during the procedure. It causes temporary damage that can be rectified by stopping the bleed and administering pain medicines. It does not produce scar tissue. In rare cases, scar tissue is produced, and complications such as Asherman's syndrome are seen.
6.
What Should Be Avoided After D&C?
Strenuous physical exercise, usage of tampons, and sexual intercourse should be avoided for a period ranging from 3 to 10 days after the D&C procedure. Failure to do so will result in prolongation of healing or further damage to the cervical region.
7.
What Are the Side Effects of Dilation and Curettage?
The most commonly presented symptoms after D&C are uterine cramps, spotting, and mild bleeding. However, other symptoms such as fever, abdominal pain, pelvic pain, prolonged bleeding, discharge of clots, and foul-smelling vaginal discharge that indicates infection can also be seen. When you see these symptoms after a D&C procedure, it is necessary to contact the doctor immediately.
8.
How Long Should One Stay in the Hospital After a D&C?
D&C is a simple gynecological procedure done under mild anesthesia. The recovery usually takes three days to a week. Unless there are any severe comorbidities to be addressed, a hospital stay of 5 hours to a half-day is enough after the procedure. The procedure is also too short, ranging from 15 minutes to 30 minutes only.
9.
Is D&C an Abortion Procedure?
Yes, D&C is a minor gynecological surgical procedure done in elective abortion cases. However, it is also used in removing remaining tissues in case of a spontaneous miscarriage also. It can also be used to remove placental remnants after a normal delivery, remove an intrauterine device, and remove cancerous tumors and infected tissue bits in sexually transmitted diseases.
10.
What Are the Signs of an Incomplete Abortion?
Heavy bleeding is the most commonly presented sign where the woman needs immediate medical help if you are soaking through a pad in an hour. Continuous bleeding can also be seen as passing blood clots from the vagina. The other symptoms are increasing abdominal pain over time, which the woman may feel like cramps or contractions. The last warning symptom of an incomplete abortion is a raised body temperature above 37.8 degrees Celsius and flu-like symptoms.
11.
Is Bleeding for Three Weeks After D&C Normal?
After the D&C procedure, the woman is likely to experience backache or abdominal cramps similar to menstrual cramps. The woman should be advised to expect to pass small clots of blood from her vagina for the first few days. She might have light vaginal bleeding for several weeks after the D&C. It is normal to have mild bleeding after three weeks. However, a sudden gush of blood with associated symptoms such as fever and foul smell from the vagina is an emergency.
12.
How Can I Clean My Uterus After Abortion?
No, you do not need to do anything by yourself to evacuate the remains after an abortion. In the case of abortion induced through pills, the uterus is capable of self-cleaning through vaginal discharge and bleeding. When you take abortion pills, the bleeding and cramping are how the fetal tissue leaves your body. If the abortion was a spontaneous miscarriage, immediate medical care is needed to remove the remnants through the D&C procedure. Failure to treat immediately might lead to life-threatening conditions.
13.
Do They Put You to Sleep for a D&C?
Yes, the D&C procedure is done under anesthesia always.
The type of anesthesia used will depend on the specificity of the procedure being performed. Sometimes D&C procedures may be done while the woman is asleep under general anesthesia. Sometimes it is done while the woman is awake under spinal or epidural anesthesia. If spinal or epidural anesthesia is used in the procedure, the woman will have no pain from her waist down to her toes.
14.
What to Do When There Is Heavy Bleeding With Clots After D&C?
The passage of mild to moderate-sized clots is normal and expected after the D&C procedure. However, the woman should seek urgent medical care from her gynecologist or emergency department doctor if she experiences symptoms such as heavy bleeding that requires changing her sanitary napkin every 10 to 20 minutes. Passing large blood clots through the vagina, or pieces of pregnancy tissue is harmful and requires immediate care.
15.
Is It Normal to Have Blood Clots After D&C?
As said above, during the first few days to two weeks passage of mild to moderate-sized clots is normal after the D&C procedure.
16.
How Long Will the Bleeding Last After D&C?
Mild to moderate bleeding up-to two weeks after the D&C procedure is quite normal. The main reason for bleeding is the curette which used to perform the procedure damages the uterine endometrium. The endometrium takes time to heal and bleeds until it is completely healed.
17.
What Is Your First Period Like After a D&C?
Most women who went through the d and c procedure for varied reasons get their monthly menses within 4 to 6 weeks after a D&C. The first menstrual cycle after a miscarriage is noted to be heavier, longer, and more painful than the usual menses in many women. That might be because the female's body did not undergo ovulation during this cycle, which imposes the endometrial lining to become thicker. It will result in a heavier or longer period.
18.
Can You Get an Infection From a D&C?
Infections do occur after a D&C procedure in some women. If the woman is not pregnant during her D&C, this complication is infrequent. But when D&C was done due to elective abortion or a miscarriage, the risk of developing an infection is quite high. Heavy and prolonged bleeding or blood clots, pain, fever, pain, abdominal tenderness, and foul-smelling discharge from the vagina are signs of an infection after the procedure. These symptoms require immediate medical attention.
19.
How Much Pain Is Normal After D&C?
The woman can go back to her normal activities after 1 to 2 days. Pain is usually high on the first two days after the procedure. It is normal for the woman to experience some cramps or mild abdominal discomfort after a D&C. It is controlled with intake Paracetamol or other medications. Proper medical advice from a gynecologist is required. But if pain presents with prolonged bleeding or signs of infection, it is a medical emergency.
20.
Is D&C the Same as Biopsy?
Though biopsy and the D&C procedure looks similar in approach, the purpose differs widely. In a biopsy, it is done to remove a sample tissue where the presence of cancer is suspected, and in the D&C procedure, it is done to remove the remaining tissues of a miscarriage.
21.
When Can I Take a Bath After a D&C?
The woman who went through the D&C procedure should be able to continue most of her routine activities within a day or two after the procedure. However, the gynecologist will ask her to refrain from activities like taking a bath, douching, or having intercourse for at least three days and in some women longer if needed.
22.
When is D&C Recommended?
Dilation and curettage procedure is most frequently done to remove the remaining tissues of a spontaneous miscarriage or an elective abortion. However, it might also be used to remove placental bits that remain after delivery or to remove intrauterine tumors.
23.
Is D&C Safe?
The D&C procedure is a very routine, safe procedure done in clinical settings by a gynecologist. However, like other surgical procedures, there is a rare risk of complications such as uterine perforation and infection and in rare cases, Asherman's syndrome.
24.
What Happens to Baby After D&C?
Since the baby dies before 24 weeks of pregnancy are only aborted by the D&C procedure, there is no legal requirement to have a baby's burial remains. However, most hospitals have good disposal policies, and the aborted baby products might be cremated or buried, along with the remains of other miscarried babies.
25.
Does D&C Increase Fertility?
Yes, D&C can increase fertility. D&C is a well affordable and simple surgical technique used to scratch the lining of the uterine endometrium that is found to double the fertility rate in women by many studies.
26.
How Long Should One Rest After D&C?
The woman might experience cramping for the first few days after a D&C. Since it is a minor procedure, a rest period of three days to a week is more than enough in most women. Exceptions occur in those who have comorbidities.
Last reviewed at:
15 Nov 2022 - 4 min read
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