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By Dr Geeta Vandana R
Consultant Gynecologist & Obstetrician
Overview Procedure Benefits Risks Care at Medicover Frequently Asked Questions

Overview

Dilation and curettage is one of the most common procedures performed by gynecologists. Dilation and curettage (D&C) is a procedure in which material from the inside of the uterus is removed. The "dilation" refers to opening of the cervix present at the lower part of the uterus that opens into the vagina. "Curettage" refers to the scraping or removal of tissue lining the uterine cavity (endometrium) with a surgical instrument called a curette.

Indications:

Dilation and curettage can be indicated as a diagnostic test or therapeutic for a variety of conditions as the following:

Diagnostic D&C

  • The main reason for a diagnostic D&C is to obtain and examine samples of the endometrium (lining of the uterus). This may be done because of abnormal uterine bleeding (heavy bleeding, bleeding between periods or bleeding after menopause); following abnormal results from a previous endometrial biopsy, test, or imaging study; or, in rare cases, to look for evidence of pregnancy tissue in a person with early abnormal pregnancy.
  • Diagnostic D&C is sometimes done in combination with another procedure called hysteroscopy; this involves dilating the cervix and inserting a narrow camera to examine and photograph the inside of the uterus. The images are displayed on a monitor, allowing the physician to directly see the endometrium. This helps the physician to avoid missing any structural findings (eg, polyps or fibroids) that may be inside the uterus and to take a sample of the most visibly abnormal areas.
  • Investigations of female infertility
  • Investigation of uterine infection

Therapeutic D&C

  • Miscarriage: In some miscarriages, the tissues from a pregnancy are passed completely. In other cases, a D&C is needed to remove this tissue or to ensure that all of it has been passed.
  • Abortion or pregnancy termination for the first trimester: A D&C is one method that can be used when a person chooses to terminate (end) a pregnancy.
  • Treatment of molar pregnancy: A molar pregnancy is an abnormal pregnancy in which a tumor forms in place of normal placenta. D&C is the standard treatment for molar pregnancy.
  • Retained pregnancy tissue: A D&C may be recommended for management of bleeding or to identify and remove retained (unpassed) pregnancy or placental tissue following miscarriage, abortion, or delivery.
  • Prolonged or excessive vaginal bleeding: A D&C may be done as a treatment in some cases of prolonged or excessive uterine bleeding that do not respond to medical treatment.

Procedure

Before the procedure

  • Your doctor will explain the procedure.
  • You may be asked to sign a consent form for granting permission to perform the procedure.
  • Your doctor will take the complete medical history followed by physical examination to ensure you are in good health to undergo the procedure.
  • If you are pregnant or suspecting that you are pregnant, you should notify your doctor. then they may recommend a pregnancy test prior to the procedure.
  • You may be subjected to blood tests or other diagnostic procedures.
  • Inform your doctor if you are allergic or sensitive to any medications, iodine, latex, tape, or anesthetic agents (local and general).
  • Inform all the medications(prescribed and over-the-counter) and herbal supplements that you are taking.
  • If you have any history of bleeding disorders or are taking any anticoagulant or blood-thinning medications, such as aspirin, or other medications that affect blood clotting, tell your doctor. You may need to stop taking these medications before the procedure.
  • If spinal, epidural, or general anesthesia is required for your procedure, you will be asked to fast for eight hours, usually after midnight the night before. If your procedure will be performed under local anesthesia, your doctor will give you fasting instructions.
  • You may need to bring a sanitary napkin to wear home after the procedure.
  • On the day of the procedure, an intravenous (IV) catheter (a thin, flexible tube) will be inserted into a vein, usually in your arm or hand. The IV line will initially be used to administer fluids, but it will later be used to administer anesthesia (medication to make you sleep during your procedure). You will also be attached to equipment to monitor your heart rate, breathing, and blood pressure.
  • Once you’re asleep, your doctor will start your procedure.

During the procedure

  • You will lie on your back (lithotomy position) with your legs supported by stirrups.
  • Your doctor will insert a speculum into the vagina to see your cervix similar to a pap test.
  • Your doctor inserts a series of increasingly thick rods into the cervix to dilate it slowly until it's open wide enough to perform the procedure.
  • The dilation rods are removed, and then the doctor inserts a spoon-shaped instrument to remove uterine tissue.

After the procedure

  • After the D&C, you'll be shifted to the recovery room and monitored for heavy bleeding or other complications for a few hours. This also allows you to recuperate from the effects of anesthesia.
  • Mild cramping, spotting, or light bleeding are common D&C side effects that can last a few days.
  • For discomfort from cramping, your doctor might suggest taking ibuprofen or paracetomol or another medication.
  • You may be able to resume your activities within a day or two.
  • You should not place anything in your vagina to prevent infection. Ask your doctor, when you can use tampons and resume sexual activity.
  • After dilation and curettage, your uterus must regenerate a new lining, so your next period could be early or late. If you had a dilation and curettage after a miscarriage and want to become pregnant again, consult your doctor about when it is safe to begin trying again.

Benefits

The benefits of D & C are

  • A D&C can help you to know the cause of abnormal bleeding. It can also help to detect polyps, fibroids and signs of cancer.
  • A D&C may also be significant for your health after a miscarriage or abortion. It removes any leftover tissue to prevent infection and heavy bleeding.

Risks

Dilation and curettage is a commonly performed procedure that is usually very safe. As with any operation, complications can occur. Potential complications of D&C include:

Uterine perforation —

A uterine perforation occurs when one of the surgical instruments punctures the uterus. As the pregnancy softens the uterine wall, it is more common to perform the procedure during or shortly after pregnancy.
Most uterine perforations heal on their own and do not require any treatment. Two potential problems caused by perforation are bleeding from injury to a blood vessel and injury to other internal organs. A second procedure or surgery may be needed to look for and potentially repair these types of injuries.

Cervical injury

Cervical injuries can occur during dilation or from the curette. Lacerations to the cervix can be treated with pressure application, medications to stop bleeding, or stitches or a balloon to keep pressure on the cervix.

Bleeding

It is uncommon to have excessive bleeding or require a transfusion following a D&C. Visit your doctor right away if you fully soak through two or more pads or tampons in two hours and are still bleeding.

Infection

Infection from a D&C is rare. If you have a fever, pain that is getting worse instead of better, or foul-smelling vaginal discharge after a D&C, contact your doctor's office.

Intrauterine adhesions

Adhesions are areas of scar tissue that can form in the uterus following D&C in rare cases. Adhesions occur most commonly when there is also a uterine infection and the D&C is performed during or after pregnancy. It can lead to abnormalities in the menstrual cycle or problems with future pregnancies.

Care at Medicover

At Medicover Hospitals, we have the most experienced team of gynecologists and obstetricians providing care to the patients by procedures such as dilation and curettage. Our gynecologists at Medicover use a multidisciplinary approach to diagnose and treat conditions with utmost precision. We provide a wide variety of diagnostic and treatment procedures using the most advanced technologies and world-class equipment, bringing out sucessful outcomes.

Citations

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dilatation-and-curettage-dc
https://www.healthdirect.gov.au/dilatation-and-curettage
https://www.mountsinai.org/health-library/surgery/d-and-c
https://www.mskcc.org/cancer-care/patient-education/dilation-and-curettage-d-c
https://www.uptodate.com/contents/dilation-and-curettage-d-c-beyond-the-basics/print

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Frequently Asked Questions

1. What is dilation and curettage(D&C)?

Dilation and curettage is a procedure that involves opening the cervix and inserting a thin instrument into the uterus to remove tissue from the inside of the uterus.

2. Who performs D&C?

Dilation and curettage is performed by gynecologists and obstetrician.

3. How long will a patient need to stay in the hospital after D&C?

D&C is a day care procedure and patients can be discharged the same day after the procedure.

4. What can I do to deal with cramps after d and c?

D&C procedure is followed by some cramping or mild abdominal discomfort. Take paracetamol or other medication as directed by your doctor and make use of heat pack to help relieve this discomfort.

5. Is the procedure painful?

There can be mild discomfort following the procedure. The pain disappears after 24-48 hours. Pain medication are prescribed to ease any pain or cramps.