Dilation & Curettage (D&C): How it Is Done, Recovery & More

Dilation and curettage, also known as D&C, is a minor surgical procedure used to remove tissue from the uterus after a miscarriage, diagnose and treat certain gynecological conditions (such as heavy bleeding), or clean the uterus after a miscarriage. This procedure involves dilating the cervix and gently removing tissue from the uterine lining using a specialized instrument called a curette.

It's important to note that a gynecologist can perform D&C in a clinical setting, such as a doctor's office. Read on to learn about the different types of D&C procedures and their pre and post-operative care instructions.

Dilation & Curettage

What Is a Dilation and Curettage (D&C)?

A dilation and curettage procedure is a surgical procedure during which the cervix is dilated or expanded, and a thin instrument called a uterine curette is used to scrape the lining of the uterus gently. This process allows for the removal of tissue for diagnostic purposes, treatment of abnormal uterine bleeding, or management of incomplete miscarriages.

It is worth mentioning that the uterine curette is a crucial component of the comprehensive set of tools known as the dilatation and curettage (D&C) set. This set encompasses all the necessary tools required to carry out curettage surgery effectively.

What Are the Dilation and Curettage (D&C) Types and Their Applications?

There are three types of dilatation and curettage (D&C) procedures, each serving specific purposes, including:

Therapeutic D&C;

Diagnostic D&C is performed to remove the remaining tissue after a miscarriage and prevent complications such as infection or excessive bleeding.

Diagnostic D&C;

Diagnostic D&C is a procedure performed to investigate or diagnose certain gynecological conditions such as endometrial hyperplasia (abnormal thickening of the uterine lining), uterine polyps, or endometrial cancer. It involves dilating the cervix and scraping the lining of the uterus to collect tissue samples for examination (biopsy). 

In cases where abnormal Pap smear results indicate possible cervical or endometrial abnormalities, diagnostic D&C may be recommended to obtain tissue samples for further evaluation and diagnosis. 

Additionally, when a woman experiences abnormal menstrual bleeding, such as heavy or irregular periods, diagnostic D&C can help determine the underlying cause by examining the uterine lining for abnormalities.

Elective D&C.

Elective D&C may be performed for certain gynecological conditions or as part of a planned treatment strategy. During this procedure, a tissue sample is taken from the cervix and sent to the laboratory for detailed examination.

Dilation and Curettage (D and C) in Postmenopausal Women

As mentioned earlier, Dilation and Curettage (D and C) is a procedure used to diagnose and treat various gynecological conditions, including abnormal bleeding in postmenopausal women. This abnormal uterine bleeding involves spotting and bleeding in the middle of the menstrual cycle, heavy bleeding during periods, irregular menstruation, and bleeding after menopause.

Postmenopausal bleeding (PMB) can be a sign of underlying gynecological issues such as endometrial hyperplasia or endometrial cancer. A D and C can help determine the cause of the bleeding by sampling the endometrial tissue for further analysis.

D and C can be used to remove non-cancerous growths such as polyps or fibroids from the uterus in postmenopausal women experiencing symptoms such as pelvic pain or abnormal bleeding.

Postmenopausal women with a thickened endometrium on imaging studies may also undergo a D and C to evaluate the tissue for any abnormalities or signs of cancer.

Dilation and Curettage in Postmenopausal Women

What Are the Main Reasons for the D&C Procedure?

Dilation and Curettage (D and C) procedure is performed to:

  • Remove any remaining tissue from the uterus after a miscarriage to prevent infection and heavy bleeding;
  • Remove the remaining placenta in the uterus to treat excessive bleeding after delivery;
  • Remove molar pregnancy (where abnormal tissue grows in the uterus instead of a normal embryo);
  • Diagnose and treat infection, abnormal uterine bleeding, heavy menstrual bleeding, postmenopausal bleeding, and hormonal imbalance;
  • Examine conditions such as fibroids, polyps, uterine cancer (endometrial cancer), heart diseases, and lung diseases;
  • Remove infected scar tissue caused by pelvic inflammatory disease (PID);
  • Remove IUD.

What Are the Main Methods for Performing a D&C Procedure?

There are two main methods for performing a Dilation and Curettage (D&C) procedure. In both methods, the doctor administers a local anesthetic to numb the vagina and cervix. Then, a speculum is inserted into the vagina to dilate the cervix gently. 

The D&C procedure is then carried out using one of the following methods:

D&C Traditional Scraping Method

During the traditional D&C method, the doctor inserts the curette or other D&C tools through the speculum into the uterus to scrape any abnormal tissues and perform the necessary examinations.

Suction Curettage Method

During a suction D&C, a thin tube called a cannula is inserted through the cervix into the uterus. The cannula is connected to a suction device that removes the uterine lining and any other tissue present. 

The suction D&C method is less invasive than the traditional scraping method and may result in less discomfort and shorter recovery time for the patient.

Methods for Performing a D&C Procedure

How a Dilation and Curettage (D&C) is Done?

A Dilation and Curettage (D&C) procedure is typically performed in a hospital or outpatient surgical setting. Before the procedure, the patient will be asked to change into a hospital gown and lie down on an examination table while her heels rest in stirrups.

The patient will be given either general anesthesia, which puts them to sleep during the procedure, or local anesthesia, which numbs the cervix and uterus. The choice of anesthesia depends on the patient's medical history and the complexity of the procedure.

The doctor then will use a speculum to hold the vaginal walls apart and access the cervix.

D&C procedure typically includes two main steps: 

Step 1:

After the cervix has been sufficiently dilated, the doctor may insert a thin tube called a Laminaria into it or administer a medication called misoprostol to soften it. The laminaria expands by absorbing fluid from the surrounding tissue, gradually opening the cervix.

In situations where the cervix needs to be opened more than a typical dilation and curettage procedure, the doctor may opt to open the cervix a few hours or even a day before the procedure. This gradual opening process is commonly used in cases such as abortion or specific types of hysteroscopy.

Step 2:

The doctor will use a curette or a suction device to remove the contents of the uterus.

A Dilation and Curettage may be combined with another procedure called hysteroscopy, during which the doctor inserts a slim instrument with a light and camera on the end through the cervix and into your uterus.

The doctor then observes the lining of the uterus on a screen, identifying any abnormal areas. This allows for the removal of polyps or fibroids present in the uterus.

What Are the Risks and Complications of Dilation and Curettage (D&C)?

While dilation and curettage (D&C) is generally considered a safe procedure, there are some potential risks and complications associated with it. These may include:

  • Abnormal spotting or bleeding;
  • blood clotting;
  • Muscle cramping;
  • Damage to the cervix;
  • Uterine or pelvic infection;
  • Persistent (lasting longer than 48 hours) fever, pain, or cramps;
  • Foul-smelling vaginal discharge;
  • Abdominal tenderness;
  • Perforation of the uterus, bladder, or blood vessels (rare);
  • Asherman syndrome (the formation of scar tissue in the uterus).

What Are the Dilation and Curettage (D&C) Aftercare Instructions?

After undergoing a dilation and curettage (D&C) procedure, it is important to follow certain aftercare instructions to promote healing and reduce the risk of complications. Here are some common aftercare guidelines for D&C:

  • Avoid sexual intercourse or use tampons for at least one to two weeks after a D&C procedure to allow the cervix to return to its original size and reduce the risk of infection;
  • Prioritize rest to allow your body to recover after the D and C. If general anesthesia is administered during the procedure, you may experience symptoms like nausea, vomiting, and fatigue. Therefore, it is advisable to limit physical activities and ensure sufficient rest;
  • Take over-the-counter pain relievers to alleviate any cramping or discomfort following the D&C;
  • Take prescribed medicines regularly to prevent infection;
  • Avoid heavy exercises, douching, and swimming until complete recovery from the D&C;
  • Avoid cycling as it may put excessive pressure on the uterus;
  • Keep an eye out for warning symptoms such as fever, abdominal pain, dizziness, prolonged cramps, foul-smelling discharge, or persistent bleeding. Promptly contact your doctor if any of these symptoms manifest.

It is important to note that following a D&C, the uterus will regenerate its lining, potentially causing your next period to occur earlier or later than expected.

What Are the Dilation and Curettage (D&C) Aftercare Instructions

Who Are Not Good Candidates for Dilation and Curettage (D&C)?

Some factors that may make a woman unsuitable for a diagnostic D&C can include:

  • Cervical stenosis: Cervical stenosis, a condition characterized by narrowing of the cervical opening, can make it challenging to perform a D&C safely and effectively;
  • Difficulty seeing the opening of the cervix: If the doctor is unable to visualize or access the opening of the cervix during a D&C procedure, it can make the procedure technically challenging and potentially increase the risk of complications;
  • Active pelvic infection: If a person has an active pelvic infection, undergoing a D&C can potentially spread the infection further or lead to complications. It is crucial to treat the infection before considering a D&C;
  • Pregnancy: D&C is typically avoided during pregnancy unless it is necessary for specific medical reasons, such as treating a miscarriage or performing an abortion. In other cases, D&C during pregnancy can pose risks to the developing fetus;
  • Uterine perforation risk: Individuals with a high risk of uterine perforation, such as those with specific uterine abnormalities or conditions such as arthritis that make the procedure technically challenging, may not be good candidates for D&C.

Is Curettage Necessary After a Miscarriage? 

The need for a D&C procedure following an abortion depends on several factors, such as the type of abortion procedure performed, the completeness of the abortion, and the presence of any complications.

There is no need for D&C if the abortion is performed before the 10th week of pregnancy. However, if it occurs after this timeframe, there is a risk of incomplete miscarriage. In such cases, a healthcare provider might advise a D&C to remove any remaining tissue from the uterus.

It is crucial to recognize that many women who experience miscarriages may have a history of malnutrition, which can heighten the likelihood of complications during a D&C. To minimize these risks, abortions should be performed within the first trimester of pregnancy. In some cases, the curettage may be used for a faster resolution when waiting for a natural miscarriage is not feasible.

Is Dilatation and curettage (D&C) Painful? 

Patients may typically experience mild discomfort or cramping during a dilation and curettage (D&C) procedure. However, it is typically not considered painful. Most patients are given anesthesia or sedation to help minimize any discomfort during the procedure. It should be noted that muscle contractions in the abdomen and uterus during the procedure can cause some discomfort; however, many women can tolerate it well and undergo the procedure successfully.

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Final Word

Curettage serves both a therapeutic and diagnostic purpose. Typically, diagnostic D&C is a relatively quick procedure with a short recovery time, allowing the individual to resume their normal activities soon after following the doctor's instructions and post-operative care. 

It is important to note that the uterus will be at a higher risk for infection after a D&C. Therefore, failure to adhere to proper post-operative care may result in the spread of infection, potentially leading to serious health complications.

Frequently Asked Questions

1) How long does a D&C procedure take?

A D&C (dilation and curettage) procedure typically takes 5 to 10 minutes to perform. However, this process may sometimes be longer. After the procedure, you should rest for a few hours in the recovery room.

2) How long does it take to get your period after D&C?

The timing of menstruation after a curettage procedure can vary from person to person. However, it typically occurs between 2 to 6 weeks after the procedure. It is important to note that the uterus forms a new layer after D&C, which can lead to an early or delayed period. Additionally, menstrual bleeding may be more intense than usual for one or two cycles following the procedure.

3) How long will I bleed after diagnostic D&C?

Light vaginal bleeding can last for a few days to up to two weeks after a diagnostic dilatation and curettage (D&C) procedure. The amount and duration of bleeding can vary depending on individual factors such as the reason for the D&C, the person's overall health, and how the body responds to the procedure.

Patients may also experience pain similar to menstrual cramps after the procedure.

4) How many days should you rest after a D&C?

The recovery time after a D&C may last 2 to 3 days, during which it is recommended that patients rest at home to recover faster. Once fully recovered, individuals can gradually resume their usual daily activities. It is important to note that women who have undergone a D&C due to a miscarriage are advised to rest for 48 hours before resuming normal activities.

5) Can dilatation and curettage (D&C) cause female infertility?

There is a 30% risk of developing Asherman Syndrome from dilatation and curettage (D&C). This condition can result in the formation of scar tissue within the uterine cavity, which may cause changes in menstrual flow, potentially impacting female fertility in the future.

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