Dilation and Curettage (D and C)

A dilation and curettage procedure is also called a D&C. It is a surgery to remove abnormal tissues in the uterus. Your doctor will first expand (dilate) the lower narrow part of the uterus (cervix). Next, they will scrape out the lining of the uterus (endometrium) with a spoon-shaped tool.

A suction D&C uses suction to remove uterine contents. This is sometimes called a dilation and evacuation (D&E).

Your doctor may suggest a D&C to diagnose or treat abnormal uterine bleeding. They may also use D&C to find cancer, or as part of infertility testing.

Abnormal bleeding may be caused by fibroids, polyps, or cancer of the uterus or its lining. Abnormal uterine bleeding may also be due to a hormone problem. This is especially true in women around menopause.

Your doctor may use a D&C after miscarriage to remove the fetus and other tissues if they have not all passed on their own. Infection or heavy bleeding can happen if these tissues are not fully removed. This type of D&C may also be called a surgical evacuation of the uterus or a D&E.

Sometimes after giving birth, small pieces of the placenta stay stuck to the endometrium and are not passed. This can cause bleeding or infection. Your doctor may use D&C to remove these pieces so that the endometrium can heal.

Your doctor may have other reasons to suggest a D&C.

Some possible complications of a D&C may include:

• Heavy bleeding
• Infection
• Tearing of the uterine wall or bowel
• Scar tissue may develop inside the uterus

Tell your doctor if you are allergic to or sensitive to medicines, iodine, or latex.

If you are pregnant or think you could be, tell your doctor.

You may have other risks based on your condition. Be sure to discuss any concerns with your doctor before the procedure.

A vaginal, cervical, or pelvic infection may interfere with a D&C.

• Your doctor will tell you about the procedure and you can ask questions.
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• Your doctor will review your health history and do a physical exam to be sure you are in good health before having the procedure. You may have blood tests or other diagnostic tests.
• If you get general, spinal, or epidural anesthesia, you will need to fast for 8 hours before the procedure, generally after midnight. If your procedure is done under local anesthesia, your doctor will give you instructions about fasting.
• If you are pregnant or think you could be, tell your doctor. They may urge a pregnancy test before the procedure.
• Tell your doctor if you are sensitive to or are allergic to any medicines, iodine, latex, tape, or anesthesia.
• Tell your doctor about all medicines (prescribed and over-the-counter) and herbal supplements that you are taking.
• Tell your doctor if you have a history of bleeding disorders or if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may be told to stop these medicines before the procedure.
• If a sedative is given before the procedure, you will need someone to drive you home afterwards.
• You may want to bring a sanitary pad to wear home after the procedure.
• Follow any other instructions your doctor gives you to get ready.

Your doctor may do a D&C in their office or during a hospital stay. Procedures may vary based on your condition and your doctor's practices.

The type of anesthesia will depend on what procedure you have. You may be asleep under general anesthesia. Or, you may stay awake under spinal or epidural anesthesia. In this case, you will have no feeling from your waist down. The anesthesiologist will continuously check your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

Generally, a D&C follows this process:

1. You will remove your clothing and put on a hospital gown.
2. You will empty your bladder.
3. You will be positioned on an operating or exam table with your feet and legs supported as for a pelvic exam.
4. A doctor may start an intravenous (I.V.) line in your arm or hand.
5. A doctor will insert a urinary catheter.
6. Your doctor will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to expose the cervix.
7. Your cervix may be cleaned with an antiseptic solution.
8. For local anesthesia, the doctor may numb the area using a small needle to inject medicine.
9. If general or regional anesthesia is used, the anesthesiologist will continuously keep track of your heart rate, blood pressure, breathing, and blood oxygen level during surgery.
10. A type of forceps may be used to hold the cervix steady for the procedure.
11. The inside of the cervical canal may be scraped with a small curette if the cervical tissue needs to be examined.
12. A thin, rod-like instrument, called a uterine sound, may be inserted through the cervical opening to determine the length of the uterus. If you have local anesthesia, this may cause some cramping. The sound will then be removed.
13. Your doctor will insert a series of thin rods to expand the cervix. Each rod is larger in diameter than the previous one. This process will gradually enlarge the opening of the cervix so that they can insert the curette.
14. Your doctor will insert the curette through the cervical opening into the uterus and pass it across the uterine lining to scrape away the tissues. In some cases, they may use suction to remove tissues. If you have local anesthesia, this may cause cramping.
15. Your doctor will remove the instruments and send any tissues collected to the lab for testing.
16. If they removed pregnancy tissues (called products of conception), your doctor will send them to the lab for testing for genetic problems.

The recovery process will vary based on the type of procedure done and type of anesthesia that was used.

If you get regional or general anesthesia, you will go to the recovery room and be watched. Once your blood pressure, pulse, and breathing are stable and you are alert, you will go to your hospital room or be discharged home. If you had this procedure as an outpatient, have another person drive you home.

After a D&C using local anesthesia, you may rest for about 2 hours before going home.

You may want to wear a sanitary pad for bleeding. It is normal to have some spotting or light vaginal bleeding for a few days after the procedure.

You may have cramping for the first few days after a D&C.

Do not use tampons, or have sex for 2 to 3 days after a D&C, or for a period recommended by your doctor.

You may also have other limits on your activity, including no strenuous activity or heavy lifting.

Because a D&C removes the lining of the uterus, the lining must build back up. Your next period may start earlier or later than usual.

You may go back to your normal diet unless your doctor tells you otherwise.

Take a pain reliever for cramping or soreness as recommended by your doctor. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines.

Your doctor will advise you when to return for more treatment or care.

Tell your doctor if you have any of the following:

• Heavy bleeding
• Foul-smelling drainage from your vagina
• Fever or chills
• Severe belly pain
• Flu-like symptoms lasting more than 24 hours
• Fainting

Your doctor may give you other instructions after the procedure, based on your situation.

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure
• The reason you are having the test or procedure
• What results to expect and what they mean
• The risks and benefits of the test or procedure
• What the possible side effects or complications are
• When and where you are to have the test or procedure
• Who will do the test or procedure and what that person's qualifications are
• What would happen if you did not have the test or procedure
• Any alternative tests or procedures to think about
• When and how will you get the results
• Who to call after the test or procedure if you have questions or problems
• How much will you have to pay for the test or procedure