Dilatation and Curettage

Dilation (dilatation) and curettage literally refers to the dilation (opening) of the cervix and surgical removal of the contents of the uterus. It is a therapeutic gynecological procedure as well as a rarely used method of first trimester abortion. It is commonly referred to as a D&C. D&C normally refers to a procedure involving a curette, also called sharp curettage. However, some sources use the term D&C to refer more generally to any procedure that involves the processes of dilation and removal of uterine contents, which includes the more common suction curettage procedures of manual and electric vacuum aspiration. Procedure The first step in a D&C is to dilate the cervix, usually done a few hours before the surgery. The woman is usually put under general anesthesia before the procedure begins. A curette, a metal rod with a handle on one end and a sharp loop on the other, is inserted into the uterus through the dilated cervix. The curette is used to gently scrape the lining of the uterus and remove the tissue in the uterus. This tissue is examined for completeness (in the case of abortion or miscarriage treatment) or pathologically for abnormalities (in the case of treatment for abnormal bleeding). Clinical uses D&Cs are commonly performed to resolve abnormal uterine bleeding (too much, too often or too heavy a menstrual flow); to remove the excess uterine lining in women who have conditions such as PCOS (which cause a prolonged buildup of tissue with no natural period to remove it);[citation needed] to remove tissue in the uterus that may be causing abnormal vaginal bleeding; to remove retained tissue (also known as retained POC or retained products of conception) in the case of an incomplete miscarriage; and historically, as a method of abortion that is now uncommon. Abortion Because medical and non-invasive methods of abortion now exist, and because D&C requires heavy sedation or general anesthesia and has higher risks of complication, the procedure has been declining as a method of abortion. The World Health Organization recommends D&C as a method of abortion only when manual vacuum aspiration is unavailable. According to the Centers for Disease Control and Prevention, D&C only accounted for 2.4% of abortions in the United States in the year 2002, down from 23.4% in 1972.

Complications If the procedure is performed too roughly, scar tissue may form and seal the uterus shut (Asherman's syndrome), resulting in infertility. Another consequence of excessively forceful technique is uterine perforation. Although normally no treatment is required for uterine perforation, a laparoscopy may be done to verify that bleeding has stopped on its own. Infection of the uterus or fallopian tubes is also a possible complication, especially if the woman has an untreated sexually transmitted infection. Having two or more sharp curettage procedures may increase the risk of complications in future pregnancies, such as ectopic pregnancy, miscarriage, and placenta previa.

Normal Anatomy - Dilation and Curettage (D&C)

The uterus is located inside of the abdomen, and is the site of fetal development during pregnancy. The lower and narrow end of the uterus forms the cervix. The cervix opens into the vagina.

Indications - Dilation and Curettage (D&C)

A D&C or dilatation and curettage is a procedure to scrape and collect the tissue (endometrium) from inside the uterus. D&C or uterine scraping may be done to: diagnose conditions using the tissue samples collected (biopsies) treat irregular bleeding remove fetal or placental tissue ( used for some elective or therapeutic abortions and to remove any remaining tissue after a spontaneous abortion (miscarriage)) D&C or uterine scraping may be recommended for: bleeding between periods heavy menstrual bleeding bleeding after intercourse investigation of infertility uterine fibroids endometrial polyps uterine cancer (early diagnosis) cervical cancer (early diagnosis) thickening of the uterus (endometrial hyperplasia ) an embedded IUD (intrauterine device) therapeutic or elective abortion miscarriage

Procedure - Dilation and Curettage (D&C)

The procedure may be performed in the hospital or in a clinic using general or local anesthesia. The vaginal canal is held open by a speculum and the opening to the uterus (cervix) is anesthetized (not always). The cervical canal is widened (dilated) using a metal rod and a curette (a metal loop on the end of a long thin handle) is then passed through the canal into the uterine cavity. The inner layer of the uterus (endometrium) is scraped away and the tissue is collected for examination.

Aftercare - Dilation and Curettage (D&C)

Uterine scraping (D&C) has relatively few risks, can provide relief from bleeding, and can help diagnose problems including infection, cancer, infertility and other disease. Normal activities may be resumed as soon as the patient feels well, even the same day. There may be vaginal bleeding, as well as pelvic cramps and back pain for a few days after the procedure. Pain can usually be managed well with medications. Tampon use is not recommended for a few weeks and sexual intercourse is not recommended for a few days.