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DILATATION AND CURETTAGE

Dilation (or dilatation) and curettage (D&C) refers to the dilation (widening/opening)
of the cervix and surgical removal of part of the lining of the uterus and/or contents
of the uterus by scraping and scooping (curettage). It is a therapeutic gynecological
procedure as well as a rarely used method of first trimester abortion.

D&C normally is referred to a procedure involving a curette, also called sharp


curettage. However, some sources use the term D&C to refer more generally to any
procedure that involves the processes of dilation and removal of uterine contents,
which includes the more common suction curettage procedures of manual and
electric vacuum aspiration.

A D&C is seldom done as a lone procedure anymore. It is most frequently done as


an adjunct procedure to a hysteroscopy and/or polypectomy. A D&C is often used
for the following conditions:

o Irregular bleeding: You may experience irregular bleeding from


time to time, including spotting between periods. If the spotting develops into
continuous midcycle bleeding, your health care provider may perform a D&C to
investigate the cause of bleeding.
o Too much bleeding: Bleeding with long, heavy periods, or bleeding
after menopause, can signal a number of problems. These symptoms may not
need immediate investigation. You may observe and record them. At some
point, though, your doctor may look for a cause that is best detected with a
hysteroscopy.

 Fibroids and polyps: These conditions are very common. In fact,


they are thought to occur in about 20% of all women. Fibroid tumors are
noncancerous growths appearing in and on the uterus. Some even grow out
from the uterine wall on a stalk. Fibroids can cause chronic pain and heavy
bleeding. Polyps, like fibroids, are noncancerous growths and are a common
cause of irregular bleeding. Polyps and fibroids can have symptoms that
resemble other more serious causes of bleeding. Your doctor may still want
to perform a hysteroscopy.
 Endometrial cancer: Cancer is a scary word, especially when it is
said about you. A D&C and hysteroscopy are often performed to make
certain your symptoms are not caused by uterine cancer. It is, of course,
important to detect cancer in its earliest, most curable stages.
 Therapeutic D&C: A D&C is often planned as treatment when the
source of the problem is already known. One situation is an incomplete
miscarriage or even full-term delivery when, for some reason, the uterus
has not pushed out all the fetal or placental tissue inside of it. If tissue is left
behind, excess bleeding can result, perhaps even life-threatening bleeding.
This is an important reason why your doctor will want to remove any
remaining tissue with a D&C.

What happens before surgery? (PRE OP)

• Before a D&C, the same general recommendations as for other outpatient


procedures apply. It is recommended that the patient take nothing by mouth
(food, water, etc.) for at least 7 hours before the scheduled operation. Often,
the doctor will see the patient the day before surgery to discuss the
procedure and the potential complications in greater detail.

What happens after a D&C? (POST OP)

• After the surgery, the patient is cared for in a post-anesthesia care unit
during recovery from the anesthesia. Most patients can return to normal
activities within a few days. Nonsteroidal anti-inflammatory medications may
be recommended to relieve the mild pain and cramping that may follow. To
decrease the chance of developing an infection, doctors advise that patients
not use tampons or insert anything into the vagina for two weeks following
the surgery, and to abstain from sexual intercourse for the same time period.
• The follow-up office care depends on the surgeon. Most doctors have the
patient return to the office to make sure that all is well and to discuss the
results of the tissue samples that were removed. Usually, this is done 2 to 6
weeks post-operatively. Sometimes, the patient will simply be notified by a
phone call with the results, and no direct contact with a health professional is
necessary.

What are possible complications of a D&C?

• The D&C procedure has a low risk of serious complications. It is normal to


experience vaginal bleeding and/or pelvic cramping (similar to menstrual
cramping) for a few days after a D&C. Over-the-counter pain medications are
usually sufficient for pain control.
• The most common complication that can occur is perforation of the uterus
with either the dilators or the curette. When this happens, as long as no
internal organs (intestines, bladder, or rectum) or large blood vessels are
damaged, the hole will almost always heal itself without further surgery. The
risk for this problem is increased in patients with a narrowed opening to the
cervix (cervical stenosis) or in patients with distorted internal uterine
anatomy. This risk is also increased if the uterus is infected or has undergone
previous surgeries such as cesarean sections or myomectomies.
• Injury to the cervix is another possible complication. Tears or cuts in the
cervix can usually be treated by application of pressure and application of
local medications to stop bleeding. In some cases, stitches in the cervix may
be required, but this is not common.
• Other complications, as with any surgery, include bleeding and infection.
Most bleeding is mild and resolves on its own. Infection is also rare and can
normally be managed with oral antibiotics. Most D&Cs do not require the
routine use of post-operative antibiotics. On occasion, in patients with certain
heart defects, the surgeon may give the patient antibiotics before and after
the surgery to prevent bacteria from the vagina from infecting the heart
valves.
How is a D&C performed?

• The actual procedure is done in an operating room, either in a hospital,


surgery center, or a specially designated room in a physician's office. After
adequate anesthesia has been administered, and with the patient in position
(similar to that for a Pap smear), the vagina and cervix are cleansed with an
antibacterial scrub (usually Betadine). An instrument is used to grasp the
upper portion of the cervix, and then the opening to the uterus is gradually
widened with metal dilators to about the size of a large pencil.
• Once the dilation has been completed, the curette, which is an instrument
with a flat metal loop at the end, is inserted into the uterine cavity and is
used to gently scrape the lining of the uterus. When the surgeon feels the
gritty layer of cells just above the muscle of the uterus, then he/she knows
that the scraping has gone deep enough to sample the tissue adequately.
This scraping is done throughout the uterus, and the tissue that is removed is
then sent to a pathologist for microscopic examination.
• After the surgeon feels that enough tissue has been obtained, that the entire
uterine cavity has been sampled, or that any abnormal growths that were
seen on ultrasound were removed, then the procedure is stopped. Often, the
doctor uses a viewing instrument to examine the uterus visually
(hysteroscopy) prior to the D&C to make the procedure more complete. This
is not, however, always necessary