Dilatation and curettage

Definition

Dilatation and curettage (D & C) is a gynecological procedure in which the cervix is dilated (expanded) and the lining of the uterus (endometrium) is scraped away.

Purpose

D & C is used to diagnose and treat heavy or irregular bleeding from the uterus. Possible reasons for abnormal uterine bleeding include:

Hormonal imbalance. Often women with abnormal bleeding are first treated with hormones in an attempt to normalize bleeding. D & C may be used to determine the cause of bleeding if hormone treatment is ineffective.
Endometrial polyps. Polyps are benign growths that may protrude from the uterus by a stem or stalk, usually to the endometrium or cervix. D & C may be used to diagnose polyps or to remove them.
Uterine fibroids. Also called leiomyomas, fibroids are benign growths in the smooth muscle of the uterus. Abnormal bleeding is often the only symptom of fibroids. D & C is often used to diagnose fibroids and may be used to scrape away small tumors; additional surgery may be needed to remove more extensive growths.
Endometrial hyperplasia (EH). EH is a condition where the endometrium grows excessively, becoming too thick and causing abnormal bleeding. Tissue samples procured during D & C can be assessed for early signs of cancer.
Cancer. D & C may be used to obtain tissue for microscopic evaluation to rule out cancer. Women over the age of 40 are at an increased risk of developing endometrial cancer.
Miscarriage, incomplete abortion, or childbirth. Abnormal bleeding may result if some of the products of pregnancy remain in the uterus after a miscarriage or induced abortion, or if parts of the placenta are not expelled naturally after childbirth. These retained products can be scraped out by D & C.

Description

D & C is usually performed under general anesthesia, although local or epidural anesthesia can also be used.

For a D & C, the patient lies on her back, and a weighted retractor is placed in the vagina (A). A dilator is used to open the cervix (B), and a curette is used to scrape the inside of the uterus (C). (

Illustration by GGS Inc.

)

Local anesthesia lessens risk and costs, but the woman will feel cramping during the procedure. The type of anesthesia used often depends upon the reason for the D & C.

During the procedure (which takes only minutes to perform), the doctor inserts an instrument called a speculum to hold open the vaginal walls, and then stretches the opening of the uterus (the cervix) by inserting a series of tapering rods, each thicker than the previous one, or by using other specialized instruments. This process of opening the cervix is called dilation.

Once the cervix is dilated, the physician inserts a spoon-shaped surgical device called a curette into the uterus. The curette is used to scrape away the uterine lining. One or more small tissue samples from the lining of the uterus or the cervical canal are sent for analysis by microscope to check for abnormal cells.

Although simpler, less expensive techniques such as a vacuum aspiration are quickly replacing the D & C as a diagnostic method, it is still often used to diagnose and treat a number of conditions.

Diagnosis/Preparation

If general anesthesia will be used, the patient will be instructed to refrain from eating and drinking for at least eight hours before the procedure. The doctor may order blood and/or urine tests to scan for certain abnormalities. Because opening the cervix can be painful, sedatives may be given before the procedure begins. Deep breathing and other relaxation techniques may help ease cramping during cervical dilation.

Aftercare

A woman who has had a D & C performed in a hospital can usually go home the same day or the next day. Many women experience backache and mild cramps after the procedure, and may pass small blood clots for a day or so. Vaginal staining or bleeding may continue for several weeks.

Most women can resume normal activities almost immediately. Patients should avoid sexual intercourse, douching, and tampon use for at least two weeks to prevent infection while the cervix is closing and to allow the endometrium to heal completely.

Risks

The primary risk after the procedure is infection. If a woman experiences any of the following symptoms, she should report them immediately to her doctor, who can treat the infection with antibiotics:

fever
heavy bleeding
severe cramps
foul-smelling vaginal discharge

D & C is a surgical operation that has certain risks associated with general anesthesia such as pulmonary aspiration and failed intubation. Rare complications include perforation of the uterus (which usually heals on its own) or puncture of the bowel or bladder (which requires further surgery to repair).

Extensive scarring of the uterus may occur after over-aggressive scraping during D & C, leading to a condition called Asherman's syndrome. The major symptoms of Asherman's syndrome are light or absent menstrual periods, infertility, and recurrent miscarriages. Scar tissue can be removed with surgery in most women, although approximately 20–30% of women will remain infertile after treatment.

Normal results

Removal of the uterine lining will normally cause no side effects, and may be beneficial if the lining has thickened so much that it causes heavy periods. The uterine lining soon grows again normally, as part of the menstrual cycle.

Morbidity and mortality rates

D & C has been associated with a 4–10% rate of postoperative complications.

Alternatives

There are a number of alternatives to D & C, depending on the reason for doing the procedure. The following are some examples of procedures that allow doctors alternative ways of evaluating, sampling, or treating disorders of the inner lining of the uterus:

Expectant management of spontaneous abortion. D & C is the most commonly used method of treatment for incomplete abortion; one study showed that over 90% of women who visited hospital emergency rooms for incomplete spontaneous abortion were treated by D & C. Recent studies, however, have shown that expectant management (i.e., no active intervention) is a viable option for women who do not wish to undergo surgery and who are in otherwise good health. Up to 72% of women indicated that that expectant management of incomplete abortion was preferable to medical or surgical intervention.
Endometrial biopsy. This procedure is similar to D & C in that a curette is used to obtain a sample of endometrial tissue. Little or no cervical dilation is necessary, however, because the curette used in endometrial biopsy is narrower. The cervix is numbed with a local anesthetic but the patient will still experience cramping.
Vacuum scraping. A thin plastic tube attached to a suction machine is passed through the cervix and scraped along the endometrium. Vacuum scraping has been shown to have similar success in diagnosing uterine cancer as D & C. Local anesthesia is also used for this procedure.
Hysteroscopy. A thin telescope called a hysteroscope is inserted through the cervix and used to view the inside of the uterus after it has been expanded with a liquid or gas. The view afforded by the hysteroscope can help to diagnose abnormal growths, accumulation of scar tissue, or other conditions.
Hysterectomy . A total hysterectomy permanently removes the uterus and cervix. This procedure is generally recommended only if a woman no longer desires to have children and no other forms of treatment have been successful. Most hysterectomies are done to treat uterine fibroids and endometriosis (a condition in which the endometrium grows outside of the uterus).

Resources

periodicals

Geyman, John, Lynn Oliver, and Sean Sullivan. "Expectant, Medical, or Surgical Treatment of Spontaneous Abortion in First Trimester of Pregnancy?" Journal of the American Board of Family Practice 12, no. 1 (1999): 55–64.

Molnar, Alexandra, Lynn Oliver, and John Geyman. "Patient Preferences for Management of First-Trimester Incomplete Spontaneous Abortion." Journal of the American Board of Family Practice 13, no. 5 (2000): 333–337.

organizations

American College of Obstetricians and Gynecologists. 409 12th St., SW, PO Box 96920, Washington, DC 20090-6920. http://www.acog.org

other

"Asherman's Syndrome." International Adhesions Society . April 24, 2002 [cited February 24, 2003]. http://www.adhesions.org/relatedconditions/asherman.htm .

"Dilatation and Curettage." eTenet . 2001 [cited February 24, 2003]. http://www.etenet.com/Apps/Library/Corporate.asp?ID=713 .

"Dilatation and Curettage." Patient Education Institute . December 21, 2001 [cited February 24, 2003]. http://www.nlm.nih.gov/medlineplus/tutorials/dilationandcurettage/og059101.html .

"Dysfunctional Uterine Bleeding." WomenOne.org . 2001 [cited February 24, 2003. http://www.womenone.org/health04.htm .

"Endometrial Hyperplasia." American College of Obstetricians and Gynecologists . 2001 [cited February 24, 2003]. <http://www.medem.com/MedLB/article_detaillb.cfm? article_ID=ZZZ7Z2GWQMC&sub_cat=9> .

"Hysterectomy." American College of Obstetricians and Gynecologists . 2001 [cited February 24, 2003]. http://www.medem.com/search/article_display.cfm?path=n:&mstr=/ZZZ MULQGSWC.html&soc=ACS&srch_typ=NAV_SERCH .

"Hysteroscopy." American College of Obstetricians and Gynecologists . 2001 [cited February 24, 2003]. <http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZ AXX8MA7C&sub_cat=8> .

Williams, Carmine. "Dilation and Curettage." eMedicine . April 26, 2001 [cited February 24, 2003]. http://www.e medicine.com/aaem/topic156.htm .

Carol A. Turkington Stephanie Dionne Sherk

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

D & C is generally performed by an obstetrician/gynecologist, a medical doctor who has completed specialized training in the areas of women's general health, pregnancy, labor and childbirth, prenatal testing, and genetics. Samples of the uterine lining may be sent to a pathologist for analysis. A pathologist is a medical doctor who has completed specialized training in the diagnosis of diseases from microscopic analysis of cells and tissues.

The health of the patient and the type of anesthesia used determines where a D & C is performed. The procedure is generally done in a hospital on an outpatient setting.

QUESTIONS TO ASK THE DOCTOR

Why is D & C recommended for my condition?
Where will the procedure be performed?
What alternative therapies are available to me?
What are my options in terms of anesthesia during the procedure?
What risks are involved with the procedure?

User Contributions:

carmen tamayo

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Do you have any magazine or book about incomplete dilatation and curettage?
Could you tell me the reference please? Thanks you very much

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I'm really terrified to get a D&C with a hysteroscopy done,I'm 45 and a half and in March a possible polyp was found on a transvaginal ultrasound and my mother died at the age of 49 in just four months of a less common more aggressive type of endometrial cancer at stage 4.She had put off going to the doctor for many months after she wasn't feeling well.So I really don't know what to do,another gynecologist I saw for the first and only time in June said you have a uterine polyp,and she said your 45 and this is the age when we start to worry about endometrial cancer and she also recommended a D&C. I told her that an oncology gynecologist who she worked with for a short time,was going to do a biopsy (but she surprised me with this and I wasn't prepared with any pain medicine and even a few months later she wouldn't prescribe anything stronger than Ibuprofen and so many women say the uterine biopsy is horribly painful and that you need strong prescription pain medication not just Motrin) but this other gynecologist said she wouldn't do a biopsy because it could miss the polyp and it could be cancer and that would be horrible.

I went to my regular gynecologist today to make an appointment for him to do a D&C with a hysterscopy. I had been at his office September 14 or so the day I got my September 1 transvaginal ultrasound report. He told me about risks with the D&C such as bleeding,and that he could puncture my uterus or intestines etc. He said in his 20 years of doing D&C's it's never happened.He had asked me to sign consent forms but I got really scared then and he said OK you think about it.Well I had an appointment with him a few weeks ago but I had to cancel it because I got a very bad cold.

So he actually said when I came there to agree to go through with this procedure,when I said that I want an epidural and don't want to be put to sleep,he said it was fine but he said they may have to sedate you. I said why,he said if you start kicking and screaming,I said why would I kick and scream,he said you are a very anxious person,he said you don't consider yourself a very anxious person? He said I never had anyone have to come back four times to make a decision about getting something like this. I said it wasn't four times,the last time I came here was when I had just got back my recent transvaginal ultrasound and I was more concerned because this time it was four days after my period was over and my lining was too thick when it shouldn't have been.And I said my mother died as I told you of uterine cancer at age 49,and I have never had a procedure like this before.

At one point he said do you want someone else to do this? I said no,but I really wish I knew of another good and a nice doctor to do it! I had discussed this or getting a biopsy(he only uses the TruTest Tao brush biopsy which he gave me two years ago because endometrial cells had turned up on my pap test only two days after my period had ended but he said he would use the regular uterine biopsy if I wanted to and he would prescribe prescription pain medicine for it,but he said he could go in there with a brush or the other biopsy and miss the polyp)) done with him on the phone 2 times over months.

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He also didn't even write on the forms about me getting an epidural,after he took me to his secretary's office to schedule the D&C she noticed he hadn't written that on there,and I went back to his office and asked him to and he did,but he at first said that I could ask the anesthesiologist for it when I got there,but they would have just put me to sleep because that is what they usually do! And I'm too petrified to be put to sleep! I have talked to two different anesthesiologists at two different hospitals to find out if they will do it with an epidural and the first one said they would never do a D and C with a spinal or epidural,and the second one said a spinal could be done but he doesn't recommend it.So what am I supposed to do?

The gyneocologist said that he's not going to remove that much uterine lining,just a part of it and remove the polyp.

Also,In this recent report the radiologist said that the differential diagnoses is endometrial hyperplasia, a polyp or endometrial cancer my lining was 14mm just four days after my period ended.

Anyway, I was just hoping that you could offer any alternative suggestions if you have any.

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This message is in reply to C.

Having had a D&C myself, I can say that general anesthesia is the way to go. And it's really not bad. They give you a light sedative by IV and then put a mask over your mouth and nose and ask you to breath deeply and then you're out. The next second (or so it feels!), you wake up in the recovery room, all fixed up. I've had two general anesthetics in my life and both experiences were like that. If I had to choose that route over experiencing any of the tugging and cramping sensations of a procedure, I'd choose the GA right away - it's much less scary! (The other nice think about GA is that you actually become alert quite quickly in recovery unlike when they just sedate you). Don't let yourself get too worked up about the procedure. It's low risk and very routine for gynecologists. All of this is a small price to pay for early treatment of a possible problem.

Wishing you courage, strength, and confidence to get this procedure done!

ireneFV

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I had a miscarriage issue and the operation/procedure of Dilatation and curettege was done last oct5, 2010. My question is how long will back my menstruation period? Please reply. Many thanks in advance.

Regards,
Irene

Nilesh

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Oh, this all is very helpfull to me thanx.this site is OSAM again thank u very much

donna

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I am going to undergo hysterocopy and laparocoscopy on tomorrow, but the problem is I just had my period 2 days ago, My dilemma is i dont know if the procedure will go ahead as I have got my menstrual cycle. They have had previously cancelled it as before I had my period again and it was my second day which was heavy. please need to know if it will be likely to go ahead. As im so scared that they will have to cancel it again.

ayishatu

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hi,

its up to a month now that i had D&C is getting to 1 month and 1 week i still have seen my mestral cycle, what is wrong with me pls...should i still be excepting it or wat...pls i need ur advise. thanks. hoping to here from u.

Amy

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I had a miscarriage and had to have three d&c's for it. I have never heard of anyone needing to have three d&c's. on the third one my doctor told me that I had a placental site tumor. After reading about it and questioning it to him, he then says well you had something like a placental site tumor. But all is over now and I need to put this behind me and move on. Everything on the internet says its cancer and a hystorectomy is needed. Anyone know anything about this. I am so scared. Please respond.

Lesa

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I had a D&C done Dec 6 due to irregular heavy bleeding. I found out I had a fibroid and a polyp. I was so nervous about the D&C. They said they have to thin out my inside of uterus to help with the bleeding and to check for other issues such as cancer. This was the easiest surgery I've had. It was better than having my tubes tied 12 years ago. My mother had this done after a miscarriage years ago and they didnt use anything no pain killers nothing. She said it was so painful. Nowadays, its condisered surgery. Of course there are risks but it rarely happens and if it does they repair it while you're still under. I would do it over and over again if I had to. I am going to have my hysterectomy Jan 13 and that is alot more invasive not necessary. My medical team is awesome. Its better to get this done at 42 then to wait years down the road. After my D&C, I have more energy now that ever. I feel like myself now. I am so glad I did it. I'm healthier because of it :)

Mary

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Could you asvise, how to distinguish cervical & virginal dilater,
and before using these dilater, how do the user know which size is determined, is there any other device to use before dilater(like fitting set).

Which positions are for cervical & virginal dilater.

Thanks in advance for your reply!

mamee

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hi just wanted to say that i recently had this procedure done and the dr who did it fixed me. im very greatful. thank god for all medical personal. you ROCK

naveed

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my wife after delivery not d and c test so that time some germs remainining in her utres after 16 days she go to abnormal posation she dont know any family member and her baby now doc start her treatment d and c but she remamber family member but not speach good only yes r no and shethinkinkg few seconds and shee feel so much pain her head pls tel me how can and how many time she recover her like before posation and wat she do care pls m wate your suggestion

nel

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I am 26yrs old mom, Ive been to C-section..Is it ok to undergo d&c? pls rply,...tnx

Elisa

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One of two things has oucerrcd:1. Endometrial cancer had metastasized to other areas of the body outside of the uterus before the uterus was removed.2. She had endometriosis before the cancer was diagnosed. Endometriosis is the tissue that lines the uterus that overgrows and often migrates up the fallopian tubes and escapes onto the outer walls of the intestines, bladder,kidney and other internal organs. It is not about sloughing it off and going the wrong way. The endometrial tissue over-listens to the hormone estrogen telling it to grow. That's what causes it to migrate up and out of the uterus. This is why one of the major treatments for endometriosis involves taking an anti-estrogen to reduce growth. They also try to surgically laser patches they find with a laperoscope. These cells may have the same defect as the ones in the uterus and developed cancer on their own at a later time.The Decadron (dexamethasone) is a long acting hydrocortisone type steroid. It helps to keep down inflammation and helps to reduce reproduction of cells. This is why it is used in treating metastatic cancers, lymphomas, and leukemias. They will do their best to help retard the growth in outlaying areas with the use of the decadron and chemo. P.S. There is a drug that they use to help reduce the nausea from the chemo. Zofran (ONDANSETRON HCL) helps to significantly reduce the nausea associated with the treatments. It is relatively inexpensive as a generic so it should be used. Make sure it is taken before chemo appointment. It works much better to prevent nausea than it does to catch up to stop it.

rebelrose76

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I am 36 and I just had an emergency D&C and hysteroscopy done Thursday, after going to my obgyn to see why I had been bleeding for the past 17 days. I assume the surgery went okay-I mean I at least woke up. My doctor never came in to see me after the surgery. I was only told that he took samples and they had to be sent off for testing. Should I be worried? I go back in this coming Thursday, but am scared. I stopped bleeding late Friday and didn't bleed at all Saturday, but started again today. There is a family history of female cancers in my line, having an aunt that died from ovarian cancer, another aunt and my mother both had hysterectomies at a very young age. I think my mom was like 26. They both had then due to symptoms and not just because.I have had a number of miscarriages and only one successful birth(and she is 5 today :)). Please give me some insight on this matter. I am a sinngle mother who is terrified right now :/

Ajay

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My wife underwent D&C last week (Day 7th today). Till today she has bleeding. Today she notice blood clot(marble sized). Is this normal? Please reply.

Agy

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Hi,
Pls i need ur advice,dis is my second time of having d & c operatn as an abortion.A day after d act, my breast grew bigger and harder,i went back 2 d hospital where i had it,d doctr tld me not to wory dat within a week it wil return 2 normal.Pls im worried.

suzie

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I had a D&C done on 2 march 2014 due to irregular heavy bleeding and thick lining. My doctor (male) never came in to see me after the surgery and i was not given any pain killers or antibiotics after d&c.Till today i am bleeding and have a lot of pain notice chunks of blood clot,went to my doctor 2 weeks after d&c and he told me it's normal to get the pain and bleeding,he gave me ponstan forte for the pain and provera to stop the bleeding.the bleeding never stop and as soon as the ponstan forte wears out it's back to pain,i went and saw my doctor again and he repeat the same medication,i was disappointed.i also had to beg for my result which i got on the 19 may.the result is (cancer negative).i went to another gynecologist and she gave me some antibiotics,birth control and pain killers,well it is not working still so she recommend a viginal scan which i have to do next week if the bleeding stop,hoping a miracle work and the bleeding stop because it is very heavy right now,at this point i don't know what is causing the pain and bleeding hoping to know soon.13 june 2014.

Ally Cipolli

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Hi, I had a d&c in april... I was 21 weeks pregnant with my baby girl. Her heart stopped, so I went and had a d&c done. Its been almost 3months since the surgery, and my breast haven't gone down (34b to a 32d ) and my stomach is still a little flubby. Will my body ever go back to normal... I hate having big breasts now and not being able to fit into half of my clothes. To me, having this weight is a constant reminder that I lost my baby.

JEAN

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HAD a DNC and hysterscopy for abnormal heavy bleeding The entire thing took less that twenty minutes but had to stay about two hours post op. Went in for pre-op abut two hours ahead of time, was given an iv and then met with doctor of anasthesia before procedure. Doctor was kind and wrote me a note as I was given sedation during the surgery and couldn't remember what she said right after. Had very little bleeding after the procedure, equivalent to a heavy period day but nothing concerning. Felt groggy and out of it from the sedation and a little light headed but bounced back to normal in the few days after. Felt no pain during the procedure except for the first few minutes the doctor put the clamps in while i was in the stirrups and then I was out by the time that was over. Was nervous going in but it was not bad at all, wouldn't stress about it now that i know.

yetty

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When someone see a light blood for two days after D&C what does it mean and in how many weeks will you see your normal menstration.

tobi

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How can someone know that the pregnancy has been removed?

tosin

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I'm about to go for a d and c in the next three days. Considering what I've read so far,I will go for a GA. Thanks for all info...you helped reduced my anxiety

Dammy

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I had a d nd c last month august 18 nd i had unprotected s*x bt i took postenor2 nw im having pains on my Nipples nd my flow is late also pls what should i do???

Can i also do another d nd c this month or is there any trusted drugs that will put an end to it if it is pregnancy?

Jane

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I have never had any gynae problems and am over menopause. I am 64 and have not had any bleeding, but after a pelvic ultrasound the gynae wants to do a D and C . Perhaps a polyp or thickening of endometrial lining. Do I really need this procedure?

omo

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i had two D&C in the past.first was 2010 and the other last year.Now can i still go for D&C this year because,i discover that am pregnant using pt strip and my last preiod stop on 30th of Nov./1 Dec.pls i need your advice because i am scared and i don't want to be a mother now.

omo

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pls enlighten me.i went for d&c and i saw blood that same day but after that day i did see it.Does that means the abortion is successful or not?

Laarni Carreon

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Please help me know is it normal to have spotting or mens after d&c its been two weeks since i had a d&c and still have spotting, i was d&c because i had thickened endometrium. Please anyone help me answer my question. Thanks

Ajibola Naomi

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I did an abortion on the 11th of March nd I started feeling fever on the 14th and I have been vomiting and feeling dizzy since that 14th till as at when I send this mail.although am on drugs (Flagyl, tetracycline, paracetamol nd ampliclox) pls what can I do pls

jenna

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does anyone know if patients without insurance have to pay for the follow up appointment of the dilation and curettage? if so, approximately how much

Maimz

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I had 2 D&Cs for the purpose of abortion, after a year n a half i had another abortion with 3 tablets sublingual misoprostol, now i want to be pregnant for the past 6months but nothing

Pomala

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1/22/17 Ultrasound shows lining to be .07cm I also have very light bleeding. Gyn wants to do endometrial biospy. Ok What do you do for pain. Doctor said, no pain meds are given, no iv sedation. The only way to get pain medication is to have a d&c performed. But that's only usually done after a biospy if needed.

I have a very low tolerance for pain. Even at dentist..they always end up administrating more than that they thougt I would need. How to I go about finding a gyn or surgeon that is willing to accomadate me. My friend had procedure 6 mos ago. Doctor didn't inform her as to what he was doing. She said she screamed, then cried. Never felt pain like that before. She asked, why would doctors put women throught that without giving them something for pain. It was cruel.

My question is how to find a gyn or surgeon that will help me using some type of sedation for the biospy?

ESL

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Reading about D & C studies says it significantly lowers your fertility, I had D & C for polyp, anesthesiologist used way too many drugs, even though I told them I'm very sensitive, 6 weeks later I'm still feeling drugged, asked for epidural or twilight, they said not up to me. They used twice as many drugs for an hour surgery than another place used for my two hour foot surgery.
Don't feel comfortable going back to this hospital, feeling a bit traumatized, also wish I had asked for more details from Dr. Still having cramps.

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