Women's Health

D and C (Dilation and Curettage)

Written by Dr. K Sneha and medically reviewed by Megha Tuli Gupta

 
Image: D and C (Dilation and Curettage)

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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 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 all 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.

Last reviewed at: 12.Feb.2019

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