Dilation and Curettage

(D & C)
 Definition:

• is a brief surgical procedure in which

the cervix is dilated and a special
instrument is used to scrape the
uterine lining.
• It is performed by a gynecologist or
obstetrician.
 Definition:

• It is usually an outpatient surgery

that can be done in a doctor’s office
or surgery center.
 Dilation/Dilatation

• involves widening the opening of

the lower part of the uterus (the
cervix) to allow insertion of an
instrument.
 Curettage
• involves scraping the lining and
removing uterine contents with a long,
spoon-shaped instrument (a curette).
• The doctor may also use a cannula to
suction any remaining contents from the
uterus.
Dilatation and Curettage
 INDICATIONS for diagnostic d & C

1. Abnormal or heavy bleeding

2. Severe menstrual pain
3. Difficulty to become pregnant
4. Abnormal cervical cells
INDICATIONS for therapeutic d & C

5. Excessive bleeding after birth

6. Cervical or uterine polyps
7. Fibroid tumors
8. Incomplete miscarriage or abortion
• A D&C may also be done along with a
procedure called a hysteroscopy. In
this procedure, a device is inserted to
view the inside of the uterus for
diagnostic purposes.
What to Expect When Having a D&C

1. You can have a D&C in your doctor's office, an

outpatient clinic, or the hospital.
2. It usually takes only 10 to 15 minutes, but you
may stay in the office, clinic, or hospital for up to
five hours, depending on the anesthesia used.
3. Sign a consent form, & be sure to tell the doctor
if:
-You suspect you are pregnant
 What to Expect When Having a D&C

-You are sensitive or allergic to any

medications, iodine, or latex.
-You have a history of bleeding disorders or are
taking any blood-thinning drugs.
4. You will receive anesthesia.
 WHAT TO EXPECT
1. Patient will be able to go home within a few hours
after a D&C.
2. Mild pain or light bleeding is normal for a few
days.
3. Within a few days, you should be able to resume
most of your regular activities.
4. After a D&C, your next menstrual period may not
start at usual time it may be early or late.
 WHAT TO EXPECT

5. Must not use tampons or have intercourse for 2

weeks after the procedure.
6. Until your cervix returns to normal, you will be at
higher risk of bacteria entering the vagina and
causing infection.
Risks of dilation and curettage (D&C)
• Cramping
• Spotting or light bleeding
• Uterine perforation and infection
• Adhesions may form in the uterus called Asherman’s
Syndrome, the scar tissue can cause infertility and
changes in menstrual flow, but can usually be
treated successfully with surgery.
Risks of dilation and curettage (D&C)
• Most complications from a D&C are treatable,
especially infection, if diagnosed early. If you notice
any of the following after a D&C, you should contact
your doctor immediately:
-Heavy or prolonged bleeding
-Excessive cramping
-Fever
-Abdominal pain or tenderness
-Unusual or foul-smelling discharge
 PROCEDURE
• Prerequisites….
1. Provide emotional support and
encouragement.
2. Perform a bimanual pelvic examination to
assess the size and position of the uterus
and the condition of the fornices
• Prerequisites….
3. Apply antiseptic solution to the vagina and cervix
(especially the os).

4. Check the cervix for tears or protruding products

of conception.

5. If products of conception are present in the vagina

or cervix, remove them using ring (or sponge
forcep).
• Prerequisites….
6. Gently grasp the anterior lip of the cervix
with vulsellum or single-toothed tenaculum.

Note: With incomplete abortion, a ring (sponge) forceps is

preferable as it is less likely than the tenaculum to tear the
cervix with traction
• Prerequisites….
7. In case of pregnancy, dilatation is needed
only in cases of missed abortion or when
some retained products of conception have
remained in the uterus for several days:
8. Gently introduce the widest gauge
cannula or curette;
9. Use graduated dilators only if the cannula
or curette will not pass. Begin with the
smallest dilator and end with the largest
dilator that ensures adequate dilatation
(usually 10–12 mm)
Graduated Cervical Dilators
• Prerequisites….
10. Take care not to tear the cervix or to
create a false opening.
11. Gently pass a uterine sound through the
cervix to assess the length and direction of
the uterus.
****The uterus is very soft in pregnancy and can be
easily injured during this procedure
12. Evacuate the contents of the uterus with
ring forceps of large curette. Gently curette
the walls of the uterus until a grating
sensation is felt.
12. Evacuate the contents of the uterus with ring forceps of large
curette. Gently curette the walls of the uterus until a grating sensation
is felt.
• 13. Perform bimanual pelvic examination to
check the size and firmness of the uterus.

• 14. Examine the evacuated material. Send

material for histopathological examination, if
required.
• Post procedure care..
– Give pain medication as needed.
– Encourage the woman to eat, drink and walk
about as she wishes.
– Advise woman to watch for symptoms and sign
requiring immediate attention:
• Prolonged cramping (more than a few days)
• Prolonged bleeding (more than 2 weeks)
• Bleeding more than normal menstrual bleeding
• Severe or increased pain
• Fever, chills or malaise
• fainting
• Risks..
– The primary risk after the procedure is infection. Signs of
infection include:
• Fever
• Heavy bleeding
• Severe cramps
• Foul-smelling vaginal discharge
• A woman should report any of these
symptoms to her doctor, who can treat the
infection with antibiotics before it
becomes serious.

• Rare complications include puncture of the uterus (which

usually heals on its own) or puncture of the bowel or bladder
(which require further surgery to repair).