Dilatation And Curettage

Usually D&C is done for one of the following reasons:

• to diagnose and possibly treat abnormal vaginal bleeding
• to perform an abortion
• to treat an incomplete miscarriage or abortion
• to diagnose and possibly treat vaginal bleeding after childbirth
• to help detect cancer of the uterus
• to help evaluate some cases or infertility, or inability to have children

In some cases, a sample of the uterine lining is taken before D&C is done. This is called an endometrial biopsy. Or a tiny telescope, called a hysteroscope, may be used before D&C. This allows a doctor to look at the lining of the cervix and uterus before doing the D&C.

Dilatation and curettage is usually done in a surgical center, hospital or office setting. It is often done as an outpatient, meaning that a woman can go home on the same day as the procedure.

A sedative medicine or even general anesthesia may be given before D&C. General anesthesia is when a person is put completely to sleep with medications.

After a woman has a pelvic exam to check the size and position of her uterus, a tool called a speculum is placed inside her vagina. This tool, which is also used during a Pap smear, allows the cervix to be seen. A special tool straightens the cervix and instills local numbing medicine if general anesthesia is not used. Special rods of increasing size are passed through the opening of the cervix so as to dilate the cervix.

Once the opening is wide enough, the healthcare professional can put other tools into the uterus.

In a D&C, the main tool put into the uterus is known as a curette, or scraper. This tool is used to scrape off the inner lining of the uterus. Scraping off the lining of the uterus may stop some types of vaginal bleeding and will terminate a pregnancy.

This tissue that was scraped off (curettaged) is sent to the lab. This tissue can then be examined with a microscope if needed. For example, the tissue scraped off may contain cancer of the uterus, which can be seen in the scrapings under the microscope.

In most cases, a woman is observed for an hour or two in a recovery area. This allows time for the anesthesia medicine to wear off and make sure a woman is stable. If there is no reason to stay in the hospital, most women can then go home. Some mild cramping pain is common right after the procedure, but often quickly goes away.

A D&C is considered minor surgery. No cutting or stitches are needed.

After a D&C a woman usually:

• may go back to normal activities the next day. If only local numbing medicine was used and no sedatives were given, a woman can return to regular activities within a few hours.
• may be sleepy for several hours if she had general anesthesia. People should not drive or use heavy machinery for 24 hours after having general or total anesthesia.
• may have cramps and vaginal bleeding or spotting. This is considered normal after the procedure.
• may take pain relievers such as acetaminophen or ibuprofen for discomfort.
• should not put anything into her vagina for about 1 to 2 weeks. This includes tampons, douches, and having sexual intercourse. Avoiding these will help to prevent infections.

Though uncommon, the complications of D&C may include:

• reactions to medicines, such as anesthesia, pain relievers and antibiotics
• problems with the anesthetic, such as allergies or other reactions and difficulty waking up or breathing
• heavy vaginal bleeding or passage of clots
• infection of the uterine lining, pelvic organs or the surrounding area
• developing a hole in the uterus
• scarring of the uterus from too much scraping
• damage to the cervix