Definition and Overview
Also known as D&C, dilation and curettage is a surgical procedure performed on women that involves the opening of the cervix (dilation) and scraping the tissues around the uterus (curettage) to investigate or treat an underlying condition. It is performed by a gynaecologist.
In the female reproductive system, the uterus or womb is a strong muscular organ that holds the fetus. It is connected to the fallopian tube (where the fertilized egg comes from) that provides nourishment to the baby until childbirth. The uterus, on the other hand, is connected to the cervix, a tissue that is shaped like a cylinder or a canal, which is also attached to the vagina, where the baby comes out during childbirth.
Problems in any part of the female reproductive system can be diagnosed through an ultrasound, which is less invasive than D&C. However, there are cases where dilation and curettage is the better or the only option to diagnose the problem and eventually treat it.
Who should undergo and expected results
D&C may be performed on women:
- Who had a miscarriage – When a woman experiences a miscarriage or spontaneous abortion, her womb is expected to naturally get rid of the remaining tissue within ten weeks. However, there are cases where this does not take place. D&C is performed to remove any remaining tissue to avoid uterine infection and excessive bleeding.
- Who choose an elective abortion – Women who opt for an elective or induced abortion can undergo dilation and curettage, which is ideal when the fetus hasn't reached 16 weeks and when mini suction, which doesn't require dilation of the cervix, is no longer applicable.
Dilation and curettage is also recommended when there are conditions affecting the uterus. These include the presence of abnormal growths like polyps or formation of fibroids. It can also be performed to investigate symptoms such as the thickening of the endometrium and vaginal bleeding or discharge.
D&C may not be carried out if the patient:
- Cannot open up her legs
- Is believed to be pregnant
- Is pregnant and doesn't want an induced abortion
- Prefers other options
How the procedure works
D&C can be performed in a hospital, clinic, or a doctor's office under local or general anesthesia or an epidural block, depending on the preference of the patient and the doctor's recommendation.
Prior to the procedure, the patient will undergo a thorough physical exam to ascertain that she's in good health.
D&C is often a scheduled surgery. Upon arrival in a hospital or clinic, a staff and nurse will help the patient prepare by changing her clothing to a hospital gown. Anesthesia is then provided. If it's general anesthesia, the vital signs are closely monitored. Sedatives may also be provided if the patient experiences a high level of anxiety.
The patient then lies on a doctor's table with both of her feet firmly secured on a stirrup and legs wide apart. A blanket or a large sheet is placed on the knees to cover the legs. A speculum is then placed on the vagina to open it and see the cervix clearly. A clamp is then used on the cervix to gain access to the uterus.
A curette, a device that looks like a spoon, is then inserted into the cervix. The sides of the curette will be used to remove the remaining tissues or abnormal growths on the uterine lining. If there are parts that cannot be removed by a curette, suction will be used.
The procedure is normally completed within 15 minutes. Other tests like hysteroscopy, or the visual examination of the uterus, can be performed alongside D&C.
As a day surgery, the patient can go home a few hours after the procedure. She may also be able to return to light activities within 24 hours.
Possible risks and complications
There may be discomfort and cramping right after the procedure, especially if the patient is given only local anesthesia. There may also be bleeding and foul-smelling vaginal discharge. In some cases, the patient will develop infection, which may be indicated by chills, fever, and inflammation of the vagina or the cervix. Although rare, D&C may cause uterine puncture or perforation, cervical laceration and uterine scarring (adhesion). Overall, however, dilation and curettage has very minimal risks and complications. Patients are typically provided with medications like antibiotics to avoid or reduce these problems.
Bulun SE. The physiology and pathology of the female reproductive axis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 17.
Lobo RA. Abnormal uterine bleeding: ovulatory and anovulatory dysfunctional uterine bleeding, management of acute and chronic excessive bleeding. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 37.