Dilation and Curettage (D&C)

Definition

Dilation and Curettage (D&C) is a common procedure performed in the United States. Dilatation is performed to open and widen the cervix (entrance to the uterus); curettage is used to sample the endometrium (the lining of the uterus).

Parts of the Body Involved

Vagina
Cervix
Uterus

Dilation and Curettage

dilation and curretage

Reasons for Procedure

Indications/Contraindications

A D&C is indicated to determine conditions that cause abnormal bleeding:
- Miscarriage [2]
- Irregularities in menstrual bleeding
- Postmenopausal bleeding
- Endometrial polyps
- Endometrial hyperplasia
- Endometrial cancer [3]
A D&C is contraindicated (ie, not advised) in:
- Infection of the uterus
- Infection of the fallopian tubes

Risk Factors for Complications During the Procedure

Pre-existing infection
Pre-existing heart [4] or other medical [5] condition

What to Expect

Prior to Procedure

D&C is a procedure performed for diagnostic and therapeutic purposes. It provides a sample of the tissue in the uterus. This sample can be viewed under a microscope to tell whether cells are abnormal.

In the days leading up to the procedure, arrange for a ride to and from the procedure.

During Procedure

IV fluids, anesthesia, possibly a sedative

Anesthesia

General [6] or local

Description of the Procedure

A gentle pelvic examination is performed to determine the size and location of the uterus.The vagina and cervix is cleaned with an antiseptic solution. A speculum is placed in the vagina and the top portion of the cervix is gently grasped with a straight instrument. An instrument called a cervical dilator is placed into the cervical canal. After the smallest dilator is used, successively larger ones are used to dilate the cervix. A scoop-shaped instrument, called a curette, is inserted and used to scrape the uterine lining and remove tissue through the vagina. After sampling the endometrium, the instrument is removed from the cervix, making sure no active bleeding occurs.

After Procedure

The tissue taken during the curettage is then evaluated under the microscope by a pathologist.

How Long Will It Take?

About 10 minutes

Will It Hurt?

General anesthesia prevents pain [7] during surgery. Among women who receive a local anesthetic, most report feeling some cramping and back pain [7] during the procedure, which may last for a day after the procedure. Over-the-counter pain [7] medications or a mild prescription drug are all that is usually needed to relieve this minor discomfort.

Possible Complications

There is no surgical procedure that is without the possibility of complications.

Complications related to the anesthetic
Injury to the cervix with cervical laceration
Scarring of endometrial lining
Infection of the uterus or fallopian tubes
Uterine perforation (hole in the uterus) leading to possible bowel perforation or significant amount of bleeding into the uterus
Hemorrhage that may require a blood transfusion [8]
Damage to bowel omentum, mesentery, ureter, bladder, and fallopian tube
Puncture of the uterus
In case of significant injury or bleeding, possible need to open the abdomen and have the uterine wound sutured
Possible need to remove the uterus ( hysterectomy [9] )

Average Hospital Stay

None

Postoperative Care

After the procedure, you will be taken to the recovery area for a short period of time before leaving for home.

Plan on having an escort for transport.
There may be some nausea from the anesthesia.
Mild uterine cramping may be experienced. The surgeon may prescribe pain [7] medication for this discomfort.
It is not uncommon to experience vaginal bleeding and discharge for some time.
Most commonly, normal activity may be started after a few days.
Refrain from placing anything inside the vagina until instructed by the doctor because the cervix has been opened and this may allow bacteria to pass up into the uterus.
The endometrium will build up within the next month. The next menstrual cycle may not be regular. It may be late or early.

Outcome

It generally takes a couple of days for your doctor to receive the lab report showing the analysis of the removed tissue. At your follow-up visit, your doctor will make recommendations for any additional treatment based on the results of the D&C. Patients can usually return to nonstrenuous work [10] after two or three days.

Call Your Doctor If Any of the Following Occurs

Fever
Increasing abdominal pain [7]
Heavy vaginal bleeding (greater than a pad per hour)
Foul smelling vaginal discharge

RESOURCES:

The American Academy of Family Physicians
http://www.aafp.org [11]

The American College of Obstetricians and Gynecologists
http://www.acog.org [12]

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada
medical [13].org/">http://sogc.medical [5].org/

Women's Health Matters
http://www.womenshealthmatters.ca/index.cfm [14]

References:

American College of Emergency Physicians website. Available at: http://www.acep.org/webportal [15] . Accessed October 14, 2005.

American College of Surgeons website. Available at: http://www.facs.org/ [16] . Accessed October 14, 2005.

Last reviewed January 2008 by Jeff Andrews, MD [17]

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical [5] advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health [18] provider prior to starting any new treatment or with any questions you may have regarding a medical [5] condition.