Dilation & Curettage

Dilation and Curettage (D&C)

Dilation and curettage (D&C) is a procedure used to diagnose and treat various conditions affecting the uterus. Dilation refers to opening the cervix so that a thin instrument can be introduced into the uterus for the procedure. Curettage involves removing tissue from inside the uterus.

Reasons for a D&C

A D&C may be performed to determine the cause of abnormal bleeding. It provides a sample of the tissue that lines the uterus, allowing the cells to be viewed under a microscope to check for abnormalities. A D&C may also be performed after a miscarriage or abortion to remove any remaining tissue from the uterus. It may also be done in conjunction with other procedures, such as a hysteroscopy, where a slender device is used to view the inside of the uterus.

The Procedure

A D&C can be performed in a healthcare provider’s office, surgery center, or hospital. Your healthcare provider may begin dilating your cervix before surgery using laminaria, a slender rod inserted into the cervix. It is left in place for several hours, absorbing fluid from the cervix and expanding, which causes the cervix to open. Medication may also be used to soften the cervix.

Before or during the procedure, you may receive some type of anesthesia. With general anesthesia, you will be unconscious during the procedure. With regional anesthesia, you will be awake but often given medication to make you drowsy.

During the procedure, you will lie on your back with your legs placed in stirrups. A speculum will be inserted into your vagina, and the cervix will be held in place with a special instrument. The cervix will then be slowly dilated using a series of progressively larger rods. Usually, only a small amount of dilation is needed.

Tissue lining the uterus will be removed using either an instrument called a curette or with suction. In most cases, the tissue will then be sent to a laboratory for examination.

Risks

Complications from this procedure are rare but may include bleeding, infection, or perforation of the uterus. If perforation occurs, nearby organs may be damaged, and further surgery may be required. Problems related to anesthesia used may also occur.

In rare cases, after a D&C performed following a miscarriage, bands of scar tissue or adhesions may form inside the uterus, known as Asherman syndrome. These adhesions can cause infertility and changes in menstrual flow. Most women with Asherman syndrome can be treated with surgery. Contact your healthcare provider if you notice changes in your menstrual periods after a D&C.

Recovery

Following the procedure, you should be able to go home within a few hours. You will need someone to take you home. Most normal activities can be resumed in one to two days.

If you had general anesthesia, you might experience nausea and vomiting upon waking. You may feel groggy and weak for a short period. Pain after a D&C is usually mild, and you may have light bleeding or spotting. Contact your healthcare provider if you experience any of the following:

• Heavy vaginal bleeding
• Fever
• Abdominal pain
• Foul-smelling vaginal discharge

After a D&C, a new lining will build up in the uterus. Your next menstrual period may not occur at the regular time.

Until your cervix returns to its normal size, bacteria from the vagina can enter the uterus and cause infection. It is important not to place anything in your vagina following the procedure. Discuss with your healthcare provider when you can resume sexual activity or use tampons.

A follow-up exam with your healthcare provider will be scheduled to discuss your results and determine if further treatment is needed.