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Dilation and curettage (D&C)By Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/dilation-and-curettage/MY00345
Dilation and curettage (D&C) is a procedure in which your doctor removes tissue from the inside of your uterus. Dilation and curettage is used to diagnose or treat various uterine conditions — such as heavy bleeding — or to clear the uterine lining after a miscarriage or abortion.
In a dilation and curettage, which is sometimes spelled "dilatation and curettage," your doctor dilates, or opens, your cervix. Your cervix is the lower part of your uterus that separates your vagina and uterus. A surgical instrument called a curette is then inserted into your uterus to remove tissue. Curettes used in a dilation and curettage can be sharp or can use suction.
Why it's done
A D&C may be used to either diagnose or treat a uterine condition.
To diagnose a condition
In a diagnostic D&C, your doctor takes a sample of the tissue that lines your uterus (the endometrium) so tests can be performed on it. This is may be done when:
- You experience abnormal uterine bleeding
- You experience bleeding after menopause
- You have severe menstrual pain
- Your doctor discovers abnormal endometrial cells during a routine test for cervical cancer
Your doctor will send the tissue sample to a lab for tests, which may check for:
- Uterine cancer
- Uterine polyps
- Endometrial hyperplasia — a precancerous condition in which the uterine lining has become too thick
To treat a condition
In a therapeutic D&C, your doctor removes the contents of your uterus. Your doctor can do this to:
- Remove a molar pregnancy, in which a tumor forms instead of a normal pregnancy
- Treat excessive bleeding after delivery by clearing out any placenta that remains in the uterus
- Remove cervical or uterine polyps, which are usually benign
- Remove fibroid tumors, which are benign tumors formed on the uterine wall that sometimes protrude into the uterine cavity
- Clear out any tissue that remains in the uterus after a miscarriage or abortion — to prevent infection or heavy bleeding, and to make room for a future pregnancy
A D&C is often performed along with another procedure called a hysteroscopy. In a hysteroscopy, a slim instrument with a light and camera on the end is inserted into your uterus. This allows your doctor to see your endometrium on a screen, to take samples of any areas that look abnormal, and to make sure that no small polyps are missed.
Dilation and curettage is usually very safe, and complications are rare. However, there are risks. These include:
- Perforation of the uterus. Perforation of the uterus happens when a surgical instrument pokes a hole in the uterus. It happens in up to 1 percent of women having a D&C overall, but occurs more frequently in women who were recently pregnant and in older women who have gone through menopause. Most of these tears heal on their own. However, if a blood vessel or other organ is damaged, a second procedure may be necessary to repair it.
- Damage to the cervix. If the cervix is injured during a D&C, your doctor will treat it by applying pressure or medicine to stop the bleeding, or by suturing the tear.
- Scar tissue on the uterine wall. In rare cases, a D&C can lead to development of scar tissue in the uterus. This is called Asherman's syndrome and happens most frequently when the procedure is performed after a miscarriage or delivery. This can lead to abnormal, absent or painful menstrual cycles, future miscarriages and infertility. Asherman's syndrome can usually be treated with hormones that encourage growth of healthy uterine tissue, or scar tissue can sometimes be removed with surgery.
- Infection. Infection after a D&C is possible, but rare.
Contact your doctor if you experience any of the following:
- Bleeding that is heavy enough that you need to change protection every hour, or if light bleeding lasts longer than two weeks
- Cramps lasting more than 48 hours
- Pain that gets worse instead of better
- Foul-smelling discharge from the vagina
How you prepare
Dilation and curettage is performed in a hospital, clinic or your doctor's office, and it's usually done as an outpatient procedure. You'll likely spend a few hours after the procedure at the facility where it's done. Don't eat or drink anything before a D&C, and arrange for someone to help you get home because the residual effects of the anesthesia from the procedure may make you drowsy. You should be able to resume your normal activities within a day or two.
In some cases, your doctor may want to start dilating your cervix a few hours or even a day before your procedure to ensure that your cervix is opened gradually. This is usually done when your cervix needs to be dilated more than in a standard D&C, such as during pregnancy terminations or with certain types of hysteroscopy. In these instances, your doctor can dilate your cervix with medication that softens the cervix or by inserting a slender rod called a laminaria into your cervix. The laminaria gradually expands by absorbing the fluid in your cervix, causing your cervix to open.
What you can expect
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During the procedure
During a D&C, you receive either general, regional or local anesthesia. You and your doctor will determine this before the procedure, and the choice will depend on the reason for the D&C and your medical history.
- General anesthesia. Your doctor gives you an anesthetic through either a breathing mask or an intravenous (IV) catheter. The IV may be placed in a vein in your hand, arm or neck. The anesthetic causes unconsciousness during the procedure, so you don't feel any pain. You may have a breathing tube inserted through your mouth and into your windpipe to make sure you're breathing properly. General anesthesia relaxes your muscles, which makes it easier for your doctor to perform a pelvic exam.
- Regional anesthesia. Your doctor injects an anesthetic into the area around your spinal cord. This blocks any pain during the procedure. You may also be sedated from medicine given through an IV.
- Local anesthesia. Your doctor injects an anesthetic directly into and around your cervix to numb the area. You also receive a sedative from an IV.
During the procedure, you lie on your back with your legs in stirrups. Your doctor inserts a speculum into your vagina, as during a pelvic exam, in order to see your cervix. Your doctor then slowly dilates your cervix by inserting a series of thicker and thicker rods into your cervix until it's adequately opened, usually to between 6 and 9 millimeters in diameter. Your doctor then inserts the curette and begins removing tissue. Because you're either unconscious or sedated during this, you shouldn't feel any discomfort. A D&C usually takes about 15 to 30 minutes.
After the procedure
You spend a few hours in a recovery room after the D&C so that your doctor can monitor you for vaginal bleeding or other complications. This also gives you time to start recovering from the anesthesia.
If you had general anesthesia, you may:
- Become nauseous
- Have a sore throat if a tube was inserted into your windpipe to help you breathe
If you received general anesthesia or IV sedation, you may be drowsy for several hours.
Other normal side effects of a D&C may last a few days and include:
- Mild cramping
- Spotting or light bleeding
Cramping can be treated with medication like ibuprofen (Advil, Motrin, others).
It's important not to put anything in your vagina until your cervix returns to its normal size. This is because bacteria can enter your uterus while your cervix is dilated and cause an infection. Ask your doctor when you can resume sexual activity or use tampons again.
If you had a D&C because of a miscarriage, talk with your doctor about when it's safe to begin trying to become pregnant again.
Your uterus must build a new lining after a D&C, so your next period may not come on time.
Your doctor will make an appointment with you soon after the D&C to discuss the results of tissue tests or of the procedure itself.
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