• What Is A D&C?
|What Is A D&C?
A dilation and curettage (D&C) is a surgical procedure performed under general anesthesia. The cervix is opened (dilated) and the contents of the uterus (womb) is removed; curettage means to remove the contents of the womb. Curettage can be done by scraping the womb with a tool called a curette. Or it can be done by suction, a related procedure known as vacuum aspiration or dilation and evacuation (D&E). A D&C can be done to diagnose and treat a number of gynecological conditions.
In the past, a D&C was the main procedure for diagnosing suspicious vaginal bleeding, for example it can diagnose:
A D&C is sometimes performed to stop the cause of heavy periods or bleeding between periods. This may mean removing uterine polyps or fibroids. More commonly it is used to remove bits of remaining placenta tissue after childbirth (postpartum bleeding), a miscarriage or abortion. Nearly 50 percent of women who have a miscarriage have a D&C. If you miscarry on your own before 10 weeks, a D&C is not usually necessary. After 10 weeks, the miscarriage is more likely to be incomplete which means bits of placenta are not expelled from the body. If the placenta remnants are not removed they could lead to hemorrhaging (very heavy bleeding) and infection.
Until 1960, a D&C was the main method for performing abortions, but since then it has been replaced by D&E. A D&E is used to perform an abortion between 8 and 16 weeks. It could be performed up to 23 weeks but in practice it is not done after 18 weeks because the cervix would have to be dilated too much in a short period of time. Read about abortion procedures for more information.
A D&C is usually performed with general anesthesia, although regional anesthesia (such as an epidural in the spine) may also be used. You may need to stay in hospital overnight, although many centers allow their patients home the same day. An IV line will be inserted into your vein so that you can receive medications, including antibiotics to help you fight infections. Once the anesthesia has taken effect the surgeon inserts a speculum into the vagina to keep it open. Next he inserts a narrow instrument called a dilator through the vagina as far as the cervix. Once in place the instrument gently stretches the cervix open. A series of larger dilators are inserted, one after the other, to stretch the cervix gradually, the largest is about 12mm in size. Next the surgeon inserts a spoon-shaped curette which is used to scrape shreds of tissue from the wall (endometrium) of the womb. If there are polyps these are located and removed. Alternatively the doctor may insert a plastic tube called a cannula which is attached to a suction device. When the device is switched on, it sucks up any excess tissue (D&E). After a few minutes, all the instruments are removed. No stitches are required. If performed for diagnostic purposes, the tissue removed will be sent to a pathology lab for testing.
The whole procedure takes about 30 minutes to perform.
Recovery takes anywhere from a day to a few days. In this time you may experience:
When To Call A Doctor
The following indicate an infection, so call your doctor if you experience:
Complications with a D&C are rare. It is possible for the womb to be stabbed (perforated) with a surgical instrument. But even then, it usually heals itself without treatment. Although D&C is a relatively safe surgery, it should not be undertaken unless it is genuinely needed. If there is an infection of the cervix, fallopian tubes or uterus, this should be cleared up before surgery. In recent years D&Cs have been avoided with the introduction of less invasive techniques. Highly sensitive ultrasounds are now able to locate the cause of abnormal bleeding. Small amounts of saline can be inserted into the uterus to make the images even better (known as sonohysterography). Also, transvaginal ultrasound can show if a woman has ovulated or how thick the lining of the endometrium is (thick lining indicates a problem like endometriosis). However, if cancer is suspected, a D&C is still usually necessary.
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