In the case of abnormal pregnancy healthcare, it is sometimes necessary to remove the tissue from the uterus. The surgical procedure to remove tissue is called suction dilation and curettage, or D&C for short.
Dilation and curettage is a minor surgical procedure in which your OB-GYN will dilate your cervix, either with drugs or with a surgical instrument. Then, they can clear out the tissue with a special instrument called a curette. It is used to diagnose or treat abnormal uterine bleeding. A D&C may help diagnose or treat growths such as fibroids, polyps, hormonal imbalances, or uterine cancer. Dilation and curettage may be performed in a hospital, clinic or your doctor’s office, and it’s usually done as an outpatient procedure.
You may need this procedure if you have unexplained or abnormal bleeding, or if you have delivered a baby and placental tissue remains in your womb.
D&C is sometimes used to treat:
- Molar pregnancy, when a fertilized egg develops into a tumor instead of a fetus
- Hemorrhage after birth, caused by the placenta
- Uterine fibroids
- Uterine polyps
- Remaining tissue after a miscarriage or abortion
Sometimes, a D&C is performed along with a hysteroscopy. This is when your doctor inserts a very thin light and camera through your vagina and cervix to look into your uterus. Your uterine lining will be visible on a screen, where the doctor can assess the health of your uterus by taking samples and checking for any uterine abnormalities.
Depending on your case, your doctor may start the dilation process a day early. A drug called Cytotec may be prescribed that you can take orally or vaginally, or they may insert a slim, absorbent implement into your cervix, which will slowly expand and open your cervix over the course of the day.
What to Expect on the Day of the Procedure
You will receive some form of anesthesia to combat the pain of the procedure. The type of anesthesia administered depends on your medical history and the circumstances for your surgery. Local anesthesia numbs a small area of the body while regional anesthesia numbs a larger area.
Light sedation usually puts you to sleep, while general anesthesia renders you completely unconscious for the duration of the procedure. Overall, the procedure is performed in a short amount of time.
During D&C Procedure
For dilation and curettage, you’ll receive anesthesia. The choice of anesthesia depends on the reason for the D&C and your medical history.
General anesthesia makes you unconscious and unable to feel pain. Other forms of anesthesia provide light sedation or use injections to numb only a small area (local anesthesia) or a larger region (regional anesthesia) of your body.
During the procedure:
- You lie on your back on an exam table while your heels rest in supports called stirrups.
- Your doctor inserts an instrument called a speculum into your vagina, as during a Pap test, in order to see your cervix.
- Your doctor inserts a series of thicker and thicker rods into your cervix to slowly dilate your cervix until it’s adequately opened.
- Your doctor removes the dilation rods and inserts a spoon-shaped instrument with a sharp edge or a suction device inside of the uterus.
- The curette is used to gently scrape the lining of the uterus and remove or collect tissue samples from the uterine wall.
Because you’re either unconscious or sedated during a D&C, you shouldn’t feel any discomfort.
Dilation and Curettage Recovery
After the procedure, your doctor may want you to spend a couple of hours in the recovery room to monitor for complications. You may feel drowsy from the effects of sedation or anesthesia, and you may not be able to drive. Make sure you have a partner, close friend, or relative available to take you home.
It’s normal to experience some mild cramps and spotting or light vaginal bleeding for a few days after the procedure. You may take ibuprofen to relieve the pain, a common side effect, as instructed by your physician. Avoid putting anything in your vagina (no intercourse or tampons) for at least 2 weeks after a D&C to prevent infection. Using sanitary pads is recommended for light vaginal bleeding during your recovery.
Your menstrual period may be late this month since your uterus will have to build up a new lining after a D&C. Most women can return to normal activities within a few days, and some feel good enough to return to normal non-strenuous activity within 24 hours.
Risks of Dilation and Curettage
A D&C procedure is very safe, but no surgical procedure is without its risks. Some complications that may arise during a D&C include:
This may be treated by applying pressure to the cervix or administering stitches to stop the bleeding.
If the surgeon accidentally punctures a hole in the uterus with a surgical instrument, the wound will usually heal on its own. However, severe perforations that damage a blood vessel or another organ may need to be surgically treated.
Surgical instruments are carefully sterilized, but there is always the risk of infection. Call your doctor if you have heavy bleeding, light bleeding that lasts three weeks or more, cramps that last for three days or more, worsening pain, vaginal odor, or a fever.
Very rarely, a D&C procedure could scar the uterine lining. This is called Asherman’s syndrome and is more common when the D&C is performed after childbirth or miscarriage. Scar tissue on the uterus can sometimes lead to abnormal or painful periods, miscarriages, or trouble getting pregnant in the future.
Your health care provider will discuss the results of the procedure and provide medical advice after the D&C or at a follow-up appointment.