DIALTATION AND

CURETTAGE
DONE BY
DR.P.UMA DEVI
Definition..

Dilatation and curettage (D & C)

is a gynecological procedure in
which the lining of the uterus
(endometrium) is scraped away.
Purpose..
D & C is commonly used to obtain tissue for microscopic
evaluation to rule out cancer.

D & C may also be used to diagnose and treat heavy

menstrual bleeding, and to diagnose endometrial polyps
and uterine fibroids.

A D & C can be used as a treatment as well, to remove

pregnancy tissue after a miscarriage, incomplete
abortion, or childbirth.

D & C can also be used as an early abortion technique

up to 16 weeks.

Removal of the uterine lining causes no side effects, and

may be beneficial if the lining has thickened so much that
it causes heavy periods.
 Procedure
Prerequisites..
Provide emotional support and encouragement
and give pethidine IM or IV before the
procedure. If necessary, use a paracervical
block.

Administer oxytocin 10 units IM or ergometrine

0.2 mg IM before the procedure to make the
myometrium firmer and reduce the risk of
perforation.

Perform a bimanual pelvic examination to

assess the size and position of the uterus and
the condition of the fornices.

Apply antiseptic solution to the vagina and

cervix (especially the os).
 Procedure..
Check the cervix for tears or protruding products of
conception.

If products of conception are present in the vagina or

cervix, remove them using ring (or sponge) forceps.

Gently grasp the anterior lip of the cervix with a vulsellum

or single-toothed tenaculum.

Note: With incomplete abortion, a ring (sponge) forceps

is preferable as it is less likely than the tenaculum to tear
the cervix with traction and does not require the use of
lignocaine for placement.

If using a tenaculum to grasp the cervix, first inject 1

mL of 0.5% lignocaine solution into the anterior or
posterior lip of the cervix which has been exposed by the
speculum (the 10 o’clock or 12 o’clock position is usually
used).
:
In case of pregnancy,dilatation is needed
only in cases of missed abortion or when
some retained products of conception have
remained in the uterus for several days:

- Gently introduce the widest gauge

cannula or curette;

- Use graduated dilators only if the cannula

or curette will not pass. Begin with the
smallest dilator and end with the largest
dilator that ensures adequate dilatation
(usually 10–12 mm)

- Take care not to tear the cervix or to

create a false opening.
Gently pass a uterine sound through
the cervix to assess the length and
direction of the uterus.

The uterus is very soft in

pregnancy and can be easily
injured during this procedure.

Evacuate the contents of the uterus

with ring forceps or a large curette.
Gently curette the walls of the uterus
until a grating sensation is felt.
Inserting a retractor and holding
the anterior lip of the cervix
Dilating the cervix and
curetting the uterus..
Perform a bimanual pelvic
examination to check the size
and firmness of the uterus.

Examine the evacuated

material. Send material for
histopathological examination, if
required.
Post procedure care..
Give paracetamol 500 mg by mouth as
needed.

Encourage the woman to eat, drink and

walk about as she wishes.

Offer other health services, if possible,

including tetanus prophylaxis, counselling
or a family planning method.

Discharge uncomplicated cases in 1–2

hours.
 Advise the woman to watch for symptoms and
signs requiring immediate attention:

- prolonged cramping (more than a few days);

- prolonged bleeding (more than 2 weeks);

- bleeding more than normal menstrual

bleeding;
- severe or increased pain;

- fever, chills or malaise;

- fainting.
Risks..
The primary risk after the procedure is
infection. Signs of infection include:
fever
heavy bleeding
severe cramps
foul-smelling vaginal discharge
 A woman should report any of these
symptoms to her doctor, who can treat the
infection with antibiotics before it
becomes serious.

D & C is a surgical operation, which

carries certain risks associated with
general anesthesia. Rare complications
include puncture of the uterus (which
usually heals on its own) or puncture of
the bowel or bladder (which require
further surgery to repair).
References..

Shaw’s Textbook of gynaecology

Dutta Textbook of gynaecology
www.google.com –search notes
on D&C