Dilation and curettage, commonly known as D&C, is a gynecological procedure involving the widening of the cervix, which is the lower, narrow part of the uterus. This widening allows for the surgical removal of tissue from the uterine lining, also called the endometrium. The procedure can be performed for both diagnostic and therapeutic purposes, addressing various uterine conditions.
Reasons for Dilation and Curettage
Healthcare providers perform a D&C for several medical indications. For diagnostic purposes, a D&C helps investigate abnormal uterine bleeding, such as heavy periods, bleeding between menstrual cycles, or postmenopausal bleeding. Collected tissue samples are then examined under a microscope to identify conditions like endometrial hyperplasia, polyps, fibroids, or to screen for uterine cancer.
Therapeutically, a D&C is often performed to clear the uterine lining after a miscarriage or abortion, especially if tissue remains, to prevent infection and excessive bleeding. It can also be used to remove small pieces of the placenta that might remain in the uterus after childbirth. The procedure also helps manage abnormal uterine bleeding that does not respond to other medical treatments, or to remove growths such as polyps or fibroids from the uterus.
Preparing for the Procedure
Before a D&C, patients receive specific instructions from their healthcare provider. This often includes restrictions on eating and drinking for several hours, especially if general anesthesia will be used. Patients should inform their doctor about all medications, including over-the-counter drugs and herbal supplements, as some may need to be stopped before the procedure, particularly blood-thinning medications.
A medical evaluation helps confirm overall health and suitability for the procedure. Anesthesia options, such as local, regional (spinal or epidural), or general anesthesia, are discussed based on the patient’s medical history and the nature of the D&C. In some instances, medication may be given orally or vaginally beforehand to help soften and gradually widen the cervix.
The Dilation and Curettage Process
The D&C procedure begins with the patient positioned on an examination table, similar to a routine gynecological exam, with feet in stirrups. A speculum is then inserted into the vagina to hold the walls apart and allow a clear view of the cervix. The cervix may be cleansed with an antiseptic solution.
Next, the dilation phase involves gradually widening the cervical opening. This is achieved by inserting a series of thin rods, called dilators, each slightly larger than the last, until the cervix is sufficiently open. In some cases, medication or a slender rod that expands by absorbing fluid may be used to aid this dilation.
Once the cervix is dilated, a long, thin instrument called a curette, which can be spoon-shaped or a suction device, is carefully inserted through the cervix into the uterus. The curette is then used to gently scrape or suction tissue from the uterine lining.
Any collected tissue is sent to a laboratory for examination. The procedure is relatively quick, often taking about 5 to 10 minutes.
Post-Procedure Care and Recovery
Following a D&C, patients spend a few hours in a recovery area as the effects of anesthesia wear off. It is common to experience mild cramping and light bleeding or spotting for a few days to two weeks after the procedure. Over-the-counter pain relievers, such as ibuprofen, are recommended to manage any discomfort.
Patients are advised to avoid inserting anything into the vagina, including tampons, douches, or engaging in sexual intercourse, for a period recommended by their healthcare provider to minimize the risk of infection. Most individuals can resume light activities within a day or two, but strenuous activities or heavy lifting should be avoided for a short time. Contacting a doctor is advisable if there is heavy bleeding (requiring pad changes every hour), fever, severe abdominal pain, or foul-smelling vaginal discharge, as these could indicate complications.