D and C (Dilation and Curettage)

Creator: Dr. Sneha Kannan
Published: 2019-02-12T16:11:09

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Dilation and curettage is a minor surgical procedure where the cervix is widened (dilation) and the tissue lining the uterus is scraped out (curettage).

Written by

Dr. Sneha Kannan

Medically reviewed by

Dr. Megha Tuli

February 12, 2019

April 13, 2024

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Contents

Why Is D and C Done?
How to Prepare for a D&C?
What to Expect During a D and C?
What to Expect After a D and C?
What are the Complications of D and C?
How Long Can the Bleeding Last After a D and C?
What Are the Things to Look Out for After a D and C?

Introduction

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 a doctor might suggest one 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 and C?

The doctor will explain in detail about the things one needs to do and avoid before the surgery. It is importnat to follow them properly. A few things one might need to do are:

Get all the tests and physical examinations told by a doctor done before the surgery.

Avoid eating and drinking anything on the day of the surgery.

The doctor might ask one to visit the day before the surgery, so he or she can apply the gel or tablet Misoprostol that starts the process of opening the cervix.

Take a couple of days off from work.

Look to it that the patient has someone to drive to the hospital before and after the procedure.

What to Expect During a D and C?

Anesthesia:

The doctor will decide the type of anesthesia depending on the medical history and the reason for getting a D and C. It can be general anesthesia, where one is unconscious and cannot feel pain, or the doctor might give a spinal anesthesia (spinal block) or just numb the cervix (local anesthesia). In both local and spinal anesthesia, the patient will be awake during the procedure and will not feel any pain, but may experience some cramping in the uterus during curettage.

Steps:

The patient will be told to lie back on the examination table, and the heels will rest on supports called stirrups. It is the same position while having a Pap smear.

The patient will be hooked up to monitors that measure 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 the 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 scrapes 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 one to recover from the effects of anesthesia. With general anesthesia, the patient might feel nauseous and might have a sore throat from the pipe placed in the throat to help breathe.

The patient might have mild cramping and light bleeding for a few days after the procedure, which is normal.

The doctor might give painkillers for the cramping and discomfort.

One can resume normal daily activities after a couple of days.

After the procedure, walk around as much as possible, as this will keep the muscles strong and prevent blood clots from forming in the legs.

The doctor might tell patients 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 the next period might be delayed.

If the biopsy reports show noncancerous tissue, then one might need no further treatment. If it shows cancerous tissue, then the patient needs to consult a cancer specialist to plan further treatment.

What are the Complications of D and 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. Purchasing overnight pads with wings can help to manage heavy bleeding.

Uterine and bowel puncture.

Asherman syndrome, a 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. One can use sanitary pads for this and avoid using tampons. This bleeding might last for a few weeks. But, if one is bleeding heavily, which requires the patient to change pads every 10 to 20 minutes, then get medical attention immediately.

What Are the Things to Look Out for After a D and C?

One should seek immediate medical advice if they experience any of the following symptoms:

Heavy bleeding.

If one passes large blood clots frequently.

Fever and chills.

Abdominal pain that does not get better after taking painkillers.

Foul smelling vaginal discharge.

During the follow-up visit, the doctor will check and let the patient know if any further treatment is needed. Depending on the symptoms one has and the biopsy result, the doctor will suggest appropriate treatment.

Conclusion

Performing a D and C (dilation and curettage) involves an invasive process carrying both evident advantages and disadvantages for both pregnant and nonpregnant individuals. It is crucial for these pros and cons to be fully disclosed during an informed consent procedure, allowing patients the opportunity to enquire about alternate options and related matters. Gaining an understanding of these potential hazards does not necessarily reduce the likelihood of complications, but rather enables both the patient and the doctor to involve in joint decision-making. Elective abortion remains a disputable topic. Therefore, healthcare providers need to consider potential legal consequences and openly address any ethics they might need to confront. This discussion should take place well before any patient treatment, and no one should be compelled to participate in a patient interaction if they find the care provided uncomfortable.

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.

Sources

Dr. Megha Tuli

Obstetrics and Gynecology

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