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.
D & C is used to diagnose and treat heavy or irregular bleeding from the uterus. Possible reasons for abnormal uterine bleeding include:
D & C is usually performed under general anesthesia, although local or epidural anesthesia can also be used.
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.
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.
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.
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:
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.
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.
D & C has been associated with a 4–10% rate of postoperative complications.
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:
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American College of Obstetricians and Gynecologists. 409 12th St., SW, PO Box 96920, Washington, DC 20090-6920. http://www.acog.org
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Carol A. Turkington Stephanie Dionne Sherk
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.