A miscarriage, the spontaneous loss of a pregnancy before the 20th week, is a common experience. While some miscarriages resolve naturally, others may require procedures like Aspiration D&C or D&C. These interventions help clear remaining tissue, supporting recovery and preventing complications.
Understanding Aspiration D&C and D&C
Aspiration D&C, also known as vacuum aspiration, uses a vacuum source to remove tissue from the uterus. This involves inserting a thin plastic tube (cannula) after the cervix is opened, with suction drawing out uterine contents.
Conversely, D&C (Dilation and Curettage) involves widening the cervix and using a curette to scrape the uterine lining. While D&C often refers to this scraping, it sometimes broadly includes procedures involving dilation and tissue removal, like suction curettage. Both procedures begin with cervical dilation to allow instrument passage.
When These Procedures Are Necessary
These procedures are often recommended following a miscarriage, particularly in cases of an incomplete miscarriage where some pregnancy tissue remains in the uterus. They are also indicated for a missed miscarriage, which occurs when the embryo or fetus has stopped developing but has not been expelled from the uterus.
Medical professionals recommend these interventions primarily to prevent complications such as heavy bleeding or infection. If tissue remains in the uterus after a miscarriage, it can lead to excessive blood loss or create an environment conducive to bacterial growth. About half of individuals who experience a miscarriage do not require a D&C, especially if the miscarriage occurs before 10 weeks of pregnancy, as the body may naturally expel the tissue. However, after 10 weeks, there is a higher likelihood of an incomplete miscarriage, making these procedures more frequently necessary.
The Procedure and What to Expect
Before an Aspiration D&C or D&C, you will typically receive instructions regarding fasting, especially if general anesthesia is planned. A medical history review and physical examination are common preliminary steps. You will be positioned on an examination table with your feet in stirrups.
Anesthesia options vary and will be discussed with your healthcare provider. These can include local anesthesia to numb the cervix, regional anesthesia like a spinal or epidural that numbs the body from the waist down while you remain awake, or general anesthesia, which induces a sleep-like state. The cervix is then gently dilated using a series of progressively larger rods or sometimes with medication administered beforehand to soften it. Once dilated, the chosen instrument, either a suction cannula or a curette, is inserted to remove the uterine tissue.
The procedure itself typically takes a short time, often five to fifteen minutes, though the entire process, including preparation and recovery, can take a few hours. During the procedure, you should not feel pain if adequate anesthesia is used, but some individuals may experience cramping sensations. Immediately afterward, you will be monitored in a recovery area for a few hours as you awaken from anesthesia. Mild cramping and light vaginal bleeding or spotting are common immediate post-procedure symptoms.
Recovery and Follow-up Care
After an A&D or D&C, physical recovery involves mild cramping and light vaginal bleeding for a few days to two weeks. Over-the-counter pain relievers like ibuprofen can help manage discomfort. Use sanitary pads instead of tampons to monitor bleeding and reduce infection risk.
To aid healing and prevent infection, activity restrictions are usually advised. This includes avoiding tampons, douching, and sexual intercourse for at least two weeks or as directed by your healthcare provider. Strenuous activity or heavy lifting should also be avoided for a day or two following the procedure. Your next menstrual period may occur earlier or later than usual, typically within three to six weeks, as the uterine lining rebuilds.
It is important to be aware of signs that may indicate a complication and warrant immediate medical attention. These include heavy bleeding (soaking more than one sanitary pad per hour for several hours), severe abdominal pain that worsens or is not relieved by medication, fever (above 100.4°F or 38°C), chills, or foul-smelling vaginal discharge. Emotional recovery is also an important aspect of healing after a miscarriage, and support resources are available. Follow-up appointments with your healthcare provider are typically scheduled to ensure proper healing and address any concerns.