Dilation and curettage (D&C)

Dilation and curettage (D&C): Before and After Procedure

The removal of a tissue from a uterus is a process that is referred to by the name Dilation and curettage. It is a diagnostic procedure that is sort of similar to biopsy in certain ways and this method is used to treat and diagnose conditions like the ones below:

  • Heavy bleeding

  • Clearing the uterine inner lining after there had either been an abortion or a miscarriage.

To explain this process succinctly, it involves the dilatation or curettage of the uterus. That basically means small instruments along with some medications are used in order to dilate or open your cervix, and then, once the cervix is opened up enough, use the instrument called the curette in order to remove the uterine tissue. As far as the matter of what is curettage, it can either be suction or a very sharp blade. 

Whats the purpose of dilation and curettage?

As we have already explained, the reasons for this procedure are both for the purpose of diagnostics and for the purpose of both diagnostics and treatment.

When it comes to diagnostics, the procedure is used when the following symptoms are there:

  • If you have a kind of uterine bleeding, then this procedure is recommended by the gynaecologists. 

  • If you are experiencing post-menopausal bleeding. 

  • If there are abnormal endometrial cells present during a routine test for the presence of cervical cancer.

The tissue sample of the uterus is collected during this test and once it is done, the sample is sent to the lab for testing (similar to biopsy). The reason or this diagnostic is to check for the following conditions: 

  • Endometrial hyperplasia: a condition where the inner lining of the uterus becomes a bit too thick. 

  • Uterine cancer

  • Uterine polyps

When it comes to treatments, the procedure is used as the following

In case the procedure is meant for treatment, the doctors are not here to take just a small sample, but to remember the entire contents that are present in your uterus. The reasons to do this are as follows: 

  • After the abortion or a miscarriage, there are several extra tissues present inside the uterus that are needed to be cleaned out. Failure to do so can lead to further issues.

  • This treatment is also there for the removal of molar pregnancy. A molar pregnancy is a condition where instead of a child; a tumour is developed in the uterus. 

  • There is also a case where there is a need to treat excessive bleeding after the delivery. This is done in order to clear out the part of the placenta that is still remaining inside the uterus.  

  • Removing the uterine and cervical polyps that are mostly benign and to that end, non-cancerous.  

What are the risks that are associated with this procedure?

Dilation and curettage is a very safe process. However, just like any other procedure, it involves some rare occurrences of the following risks:

  • The uterus might be perforated: A uterus can perforate i.e. some instruments have mistakenly poked into the uterus. The common occurrence happens because the uterus muscles are weak. To that end, this sort of risk is with the women who have hit menopause or who had been pregnant recently.

  • Cervical Damage: There can be a case where the cervix is damaged during the procedure. 

  • Asherman’s syndrome: Asherman’s syndrome refers to the development of scar tissue inside the inner wall of the uterus during the D&C procedure. This particular risk can be prevalent in the women who have recently gone through either miscarriage or abortion. 

  • Infection: There is also a possibility of infection after D & C. However, this possibility is sort of rare.

D&C: Before after and during

The procedure is performed in the hospital itself on an outpatient basis. To that end, once the procedure is over with, you will be allowed to leave the hospital on that very day. 

Before the procedure:

  • You will have to every instruction of the doctor regarding your food and drink.

  • You also need to make sure that you can go back home after the procedure as you will feel a bit drowsy.

  • You will need to clear your schedule for the day when you are going to get the procedure. Once the procedure is over with, you will need to consider rest. To that end, make sure that if you are working, you have the day off. 

During the procedure:

  • You will be told to lie on our back on the examination table. Once you are laid back, your heels will be supported on the stirrups. 

  • A speculum will be inserted into your vagina.

  • Thicker rods will be inserted into the cervix in order to dilate the vaginal region.

  • Once enough dilation has been done, the rods will be removed and curettage is inserted. This can either be a sharp instrument or suction in order to remove the uterine tissue.

During the entire procedure, you will be kept sedated. To that end, you won’t feel any sort of discomfort throughout the procedure. 

After the procedure:

  • You will be monitored for a while to see if there are complications after the procedure. 

  • You might want to vomit after coming out of general anaesthesia as you will be nauseated. 

  • There will be some normal side effects after the procedure like the following: 

  • a. Spotting or light bleeding

  • b. Cramping of a mild nature

These side effects can be dealt with the aid of medications and the doctors will provide you with the same. 

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Dr. Madhu Goel is a well renowned senior gynaecologist and a senior consultant at Fortis La femme, New Delhi. She runs a private consultation in Goel’s surgery and Gynea centre and prior to being associated with Fortis; she was a consultant a Rockland Hospital.