What is dilation and curettage (D&C)?

Dilation and curettage (D&C) is a procedure in which the cervix of the uterus is expanded (dilated) so that the uterine
lining (endometrium) can be removed with a spoon-shaped instrument called a curet or curette. The procedure is
performed for a variety of reasons. Most commonly, this surgery is done in order to help determine the cause of
abnormal uterine bleeding. It can also be done to help determine the degree of abnormality of the endometrium in
cases of cancer or pre-cancerous cells that are detected by an in-office biopsy. D&C is also sometimes necessary to
remove tissue after a miscarriage.

Why is a D&C done?

In general, a D&C is used to help determine the health of the uterine lining or to remove abnormal tissue.
Occasionally, the procedure can correct some of the problems in the uterus such as polyps, scar tissue, or tissue
overgrowth.

What are reasons not to perform a D&C?

There are very few contraindications to D&C. Generally if a patient is too ill to undergo surgery, then she should
probably not have this procedure. Furthermore, if the patient is unable to move her legs apart, such as with
severe arthritis in the hips, the surgeon may not be able to perform the procedure since it requires enough movement
of the legs to accommodate a speculum and the surgeon. If the patient is pregnant or thinks that she could
be pregnant, she should not have the operation unless the D&C is for the purpose of an abortion.

Pre-op: What happens before surgery?

Before a D&C, the same general recommendations as for other outpatient procedures apply. It is recommended that
the patient take nothing by mouth (food, water, etc.) for at least 7 hours before the scheduled operation. Often, the
doctor will see the patient the day before surgery to discuss the procedure and the potential complications in greater
detail.

What type of anesthesia is used for a D&C?

Most D&Cs are done under general anesthesia. The procedure is typically very short, and the general anesthetic can
be quickly reversed, with the patient going home later the same day. Some patients prefer or require spinal or
epidural blocks, but these forms of anesthesia take more time for the anesthesiologist to perform and require more
recovery time for the patient. Occasionally, in a very motivated patient, the procedure can be done under a local
anesthetic with or without intravenous pain medication or twilight sleep. Overall, the choice of anesthetic is a
generally determined by the anesthesiologist and the patient. The surgeon performing the procedure only requires
that the patient not move during the surgery.

How is a D&C performed?

The actual procedure is done in an operating room, either in a hospital, surgery center, or a specially designated
room in a physician's office. After adequate anesthesia has been administered, and with the patient in position
(similar to that for a Pap smear), the vagina and cervix are cleansed with an antibacterial scrub (usually Betadine). An
instrument is used to grasp the upper portion of the cervix, and then the opening to the uterus is gradually widened
with metal dilators to about the size of a large pencil.
Once the dilation has been completed, the curette, which is an instrument with a flat metal loop at the end, is inserted
into the uterine cavity and is used to gently scrape the lining of the uterus. When the surgeon feels the gritty layer of
cells just above the muscle of the uterus, then he/she knows that the scraping has gone deep enough to sample the
tissue adequately. This scraping is done throughout the uterus, and the tissue that is removed is then sent to a
pathologist for microscopic examination.

After the surgeon feels that enough tissue has been obtained, that the entire uterine cavity has been sampled, or that
any abnormal growths that were seen on ultrasoundwere removed, then the procedure is stopped. Often, the doctor
uses a viewing instrument to examine the uterus visually (hysteroscopy) prior to the D&C to make the procedure
more complete. This is not, however, always necessary.

What are possible complications of a D&C?

The D&C procedure has a low risk of serious complications. It is normal to experiencevaginal bleeding and/or pelvic
cramping (similar to menstrual cramping) for a few days after a D&C. Over-the-counter pain medications are usually
sufficient for pain control.

The most common complication that can occur is perforation of the uterus with either the dilators or the curette. When
this happens, as long as no internal organs (intestines, bladder, or rectum) or large blood vessels are damaged, the
hole will almost always heal itself without further surgery. The risk for this problem is increased in patients with a
narrowed opening to the cervix (cervical stenosis) or in patients with distorted internal uterine anatomy. This risk is
also increased if the uterus is infected or has undergone previous surgeries such ascesarean
sections or myomectomies.

Injury to the cervix is another possible complication. Tears or cuts in the cervix can usually be treated by application
of pressure and application of local medications to stop bleeding. In some cases, stitches in the cervix may be
required, but this is not common.

Other complications, as with any surgery, include bleeding and infection. Most bleeding is mild and resolves on its
own. Infection is also rare and can normally be managed with oral antibiotics. Most D&Cs do not require the routine
use of post-operative antibiotics. On occasion, in patients with certain heart defects, the surgeon may give the patient
antibiotics before and after the surgery to prevent bacteria from the vagina from infecting the heart valves.

What happens after a D&C?

After the surgery, the patient is cared for in a post-anesthesia care unit during recovery from the anesthesia. Most
patients can return to normal activities within a few days.Nonsteroidal anti-inflammatory medications may be
recommended to relieve the mild pain and cramping that may follow. To decrease the chance of developing an
infection, doctors advise that patients not use tampons or insert anything into the vagina for two weeks following the
surgery, and to abstain from sexual intercourse for the same time period.

The follow-up office care depends on the surgeon. Most doctors have the patient return to the office to make sure that
all is well and to discuss the results of the tissue samples that were removed. Usually, this is done 2 to 6 weeks post-
operatively. Sometimes, the patient will simply be notified by a phone call with the results, and no direct contact with a
health professional is necessary.
Uterine scraping (D & C) may be done to: 

 Diagnose conditions by collecting tissue samples for biopsy. 

 To treat irregular or heavy bleeding.

 Evacuation of retained products of conception (ERPOC) - removes any leftover tissue after a
spontaneous abortion .

The other indications for D & C include:

 Treat intermenstrual bleeding.

 To investigate the causes of infertility.

 To remove polyps in the endometrial or inner lining of the uterus.

 To diagnose endometrial cancer.

 To remove an embedded intrauterine device (IUD) used for contraception.

 To perform abortion in the early stages of pregnancy.

 To evacuate spontaneous abortion products. 

 To investigate the cause of abnormal bleeding in postmenopausal women taking hormone
replacement therapy.