The ABC of D&C

Dilatation and curettage (D&C)

 refers to the dilation (widening/opening) of the cervix and surgical removal of part of the lining(endometrium) of the uterus and/or contents of the uterus by scraping and scooping (curettage).

What are the benefits of D&C:

The purpose of D&C may be diagnostic or therapeutic…

Diagnostic:-

• To obtain endometrial samples
• to evaluate abnormal uterine bleeding
• to rule out endometrial cancer

Therapeutic:-

• 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 polycystic ovary syndrome (which cause a prolonged buildup of tissue with no natural period to remove it)
• to remove tissue in the uterus that may be causing abnormal vaginal bleeding  including postpartum retained placenta
• to remove retained tissue (also known as retained products of conception) in the case of a missed or incomplete miscarriage (in which some of the tissue remains in the uterus and the cervix stays open. This may increase a woman’s risk of infection and continued bleeding)
• and as a method of abortion. In contrast, D&C remains ‘standard care’ for missed and incomplete miscarriage in many countries despite the existence of alternatives currently used for abortions.

How is D&C Done: (Procedure)?

The woman is typically put under monitored anesthesia care (MAC) before the procedure begins.

The first step in a D&C is to dilate the 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 by pathology for abnormalities (in the case of treatment for abnormal bleeding).

Post Procedure Recovery:

Most patients should be able to resume their normal activities in a day or two. Mild abdominal cramping and spotting may persist for few hours or days.Abdominal cramps may be treated  with oral anti-inflammatory drugs.Next menstrual  period usually occurs within 4 to 6 weeks of the procedure.

Complications associated with D&C:

• introduction or spreading of infection
• cervical injury
• risk of sharp curettage 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.
• intrauterine adhesions, or Ashermans syndrome
• Infection of the uterus or fallopian tubes is also a possible complication, especially if the woman has an untreated sexually transmitted infection.