Dilation and Curettage (D & C): All You Need To Know

Dilation and curettage, commonly known as D&C, is a minimally-invasive, minor surgical procedure to remove the tissue from the uterus after a miscarriage. The surgery is performed by a gynaecologist or obstetrician in their respective surgery centre. It is usually an outpatient procedure, where you are discharged and allowed to go home the same day. 

D&C derives its name from: 

• Dilation of the cervix: The gynaecologist dilates (opens) the cervix, which is the lower, narrower opening of the uterus where it meets the top of the vagina. The cervix usually dilates only during childbirth. 
• Curette: The gynaecologist uses a thin instrument known as a curette to scrape the wall of the uterus and remove tissue. 

1] Who needs Dilation and Curettage? 

An individual might need to undergo a D and C procedure if they have or had: 

• Miscarriage: D&C after miscarriage is common, especially for the loss of pregnancy before the 20th week. 
• Tissue residue in the uterus after an abortion: If the leftover tissue isn’t removed, it can cause heavy bleeding or infection.
• To diagnose unexplained bleeding between menstrual cycles: Abnormal or unexplained bleeding between periods is known as spotting or intermenstrual bleeding. Here, sample tissues are removed and send for analysis.

One may also have a D&C and hysteroscopy, wherein the gynaecologist inserts a device into the cervix to observe and check inside the uterus. A Hysteroscopy test is needed either for diagnosis or to treat intrauterine pathology.

2] Why is Dilation and Curettage Performed? 

• To diagnose a condition: Before D&C, the gynaecologist may recommend a procedure known as endometrial sampling. Endometrial sampling is done for unusual uterine bleeding, bleeding post-menopause, or unusual endometrial cells, which are discovered during the test for cervical cancer. D&C is performed in cases where more information is required after endometrial sampling.
• To treat a condition: D&C is used to remove the tissues from the uterus in case of miscarriage or abortion. This helps prevent heavy bleeding and infection. Additionally, it is performed to remove cervical or uterine polyps (usually non-cancerous) or treat heavy bleeding after delivery by clearing the placenta remains in the uterus.

3] D&C Procedure: What Happens Before and During the Procedure

3.1. What happens before the dilation and curettage procedure?

• Before the procedure, the gynaecologist dilates the cervix with the help of a laminaria stick. It is recommended for non-traumatic cervix dilation.
• They insert the thin laminaria stick into the cervix and leave it there for several hours.
• The laminaria stick absorbs the fluid from the cervix and dilates it to provide better access to the uterus.

The gynaecologist may prescribe medication before the procedure. Local or general anaesthesia may also be used during the procedure.

3.2. What happens during a dilation and curettage procedure?

During the D&C procedure, you lie on a table with your feet in stirrups, just like a routine gynaecology exam. Here is a step-by-step D&C procedure to help you understand this procedure better.

• The gynaecologist will insert a speculum into your vagina to open the cervix. The speculum is a smooth device shaped like a duck’s bill.
• A clamp is used to hold the cervix in place. 
• Next, a curette – a type of suction or scraping device – is used to clean out the tissues from the uterus.

If needed, a tissue sample may be sent to the laboratory for analysis. The procedure takes about five to ten minutes. However, the overall process may be longer when you factor in the before-procedure, and the waiting period after.

4] Benefits and Risks of Dilation and Curettage (D&C)

It is important to weigh the benefits and risks of a D&C before you choose to undergo the same. 

4.1. Benefits of Dilation and Curettage 

• It shortens the physical process: A D&C is a scheduled procedure that helps reduce the symptoms of bleeding and cramping during a miscarriage. In certain cases, a D&C is chosen to help people overcome the immediate trauma of a miscarriage. 
• Minimal Pain: Is D and C painful? This is the most commonly asked question. However, as mentioned earlier, D&C is a minimally-invasive procedure performed by administering anaesthesia or other sedatives, including medication which ensures that it is pain-free. Women can return to their normal routine within a day or two of the procedure. 
• Low in risk: An incomplete miscarriage is a highly risky affair wherein remnants of pregnancy can result in prolonged bleeding and infection. Here, D&C is generally a safe, low-risk option.
• Complete removal of pregnancy remains: Pregnancy remains (during miscarriage) include the remnants of the gestational sac as well as potential recognizable remains of the fetus. With a D&C procedure, the gynaecologist can completely remove these remains (tissues).
• Unlikely to affect pregnancies in the future: Another common question is, will D&C risk future pregnancies? The answer is no. It is a completely safe procedure.

4.2. Risks of Dilation and Curettage 

While a D&C is a safe, routine procedure, just like any other surgery, it also has some risks. The risks of D&C include:

• Uterine infection
• Uterine bleeding 
• Uterine perforation – It is a small tear in the uterus, which may be the result of the tip of the curette passing through the uterine wall. 

Consult a doctor at the first sign of infection after D&C. 

Further Reading: Difference Between Hysteroscopy and D&C

In rare cases, if you had a D&C after a miscarriage, you might develop Asherman’s syndrome. Asherman’s syndrome is a condition that occurs when bands of scar tissue or adhesions form in the uterus. The scar tissue builds up between the uterine wall and the walls then sticks together. This condition can result in infertility as well as a change in menstrual flow. However, the adhesions can be treated with surgery. 

Other possible side effects of D&C, which are a common occurrence, include cramping and light bleeding or spotting.

While severe complications such as a perforated uterus or bladder and damaged cervix are rare, make sure to contact the doctor if you experience any of these symptoms after a D&C procedure: 

• Prolonged or heavy bleeding or blood clots
• Fever
• Prolonged pain
• Abdominal tenderness 
• Foul-smelling vaginal discharge

5] Recovery After Dilation and Curettage

Before we get into the particulars of recovery, it is important to be well-informed about what to expect after a D&C procedure. After the D&C surgery, patients might experience mild discomfort, including:

• Mild abdominal discomfort or cramping; in cases where it becomes severe, please contact the doctor. 
• Spotting or light bleeding: It is advisable that you use sanitary pads instead of tampons. 
• Heavy bleeding: Post the procedure, heavy bleeding may indicate complications, which need immediate attention.

5.1. D and C Recovery Time

• The recovery post the dilation and curettage procedure depends on the type of anaesthesia or sedative administered. 
• After the surgery, you will be made to rest for about 2-5 hours and shall be discharged on the same day.
• Generally, complete recovery after a D&C procedure may take 2-3 days. 
• One can commence their normal routine within a day or two after D&C. 

5.2. After D&C Care: Things to Know

• After the dilation and curettage procedure, you’ll need someone to drive you home. 
• You can go home within a few hours after the procedure. 
• You might experience mild pain and light bleeding for a few days. Irregular periods after D&C are also common. Here, use sanitary pads instead of tampons. 
• Get in touch with the doctor after a week or two for a follow-up. 

Conclusion

D&C is a procedure that you may need to undergo after a miscarriage or during abortion. Both miscarriage and abortion are emotionally draining experiences. As such, making the right medical choice is highly imperative during such times. 

If you are unsure about the right choice, consult with an experienced gynaecologist in London. He/she will guide you through the medical process and particulars of a D&C, helping you make a well-informed decision while ensuring your physical and emotional needs are taken into consideration. 

Most women do not need a D&C procedure after a miscarriage if it occurs before 10 weeks of pregnancy. However, to avoid the risk of an incomplete miscarriage, opt for the D&C procedure. This will ensure that the uterus is clean and free from any pregnancy remains. 

D&C doesn’t involve high risks and allows you to get back to your normal routine within a short span of time. Moreover, it doesn’t affect future pregnancies and is a pain-free procedure. It is also known to have a high success rate and doesn’t put you or your health in any form of danger. 

Further Reading: Diagnosis of Heavy Bleeding: How D&C With Hysteroscopy Can Help

Neha Goel

Neha Goel, a Psychology alumna and MBA graduate from CASS Business School, London, brings together her expertise as a Reiki Practitioner and Practice Manager. She integrates psychology and business strategies to foster holistic well-being and personal development.