What is it?

Dilation and curettage (D&C) is a procedure that is used to diagnose and treat many conditions that affect the uterus. Dilation means to open the cervix to 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 done to find out the cause of abnormal bleeding. It provides a sample of the tissue that lines the uterus. Allowing for the cells to be viewed under a microscope to tell whether they are abnormal. A D&C may also be done after a miscarriage or abortion to remove the tissue that has remained in the uterus. It may also be done with other procedures, such as a hysteroscopy in which a slender device is used to view the inside of the uterus.

The procedure

A D&C can be done in a health care provider’s office, surgery center or a hospital. Your health care provider may want to start dilating your cervix before surgery using laminaria. This is a slender rod that is inserted into the cervix. It is left in place for several hours. The rod absorbs fluid from the cervix and expands. This 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 not be awake during the procedure. With regional anesthesia, you will be awake. Often you will have medication to make you drowsy.

During the procedure, you will lie on your back with legs placed in stirups. A speculum will be inserted into your vagina. The cervix will be held in place with a special instrument.

The cervix will then be slowly opened (dilated). This is done by placing a series of rods that become progressively larger through the cervical opening. Usually only a small amount of dilation is needed.

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

Risks

Complications with this procedure are rare. When they do occur, they 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 has been performed following a miscarriage, bands of scar tissue or adhesions may form inside the uterus. This is called Asherman syndrome. These adhesions may cause infertility and changes in menstrual flow. In most women, Asherman syndrome may be treated with surgery. Contact your health care 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 in a few hours. You will need someone to take you home. You should be able to resume most of your normal activities in one to two days.

If you had general anesthesia you may have some nausea and vomiting when you wake up. You may feel groggy and weak for a short while. Pain after a D&C is usually mild. You may have light bleeding or spotting. Contact your health care provider if you have any of the following:

• Heavy bleeding from the vagina
• Fever
• Pain in the abdomen
• Foul-smelling discharge from the vagina

After a D&C a new lining will build up in 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 health care provider when you can have sex or use tampons again.

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