Dilation and curettage is an abdominal procedure in which tissue is removed from inside the uterus. This is performed to diagnose and treat uterine conditions. It can also be used to clear out the uterine lining after an abortion or miscarriage.
Mostly used after a miscarriage, this procedure can significantly help the process move along more quickly. Since it is also used as an abortion technique, both are going to be mentioned throughout. This procedure can be a relief to those who do not want to carry a miscarried fetus.
However, there are risks that you should know about, and you should seriously consider them before going ahead with this procedure. It is not always going to be right for everyone. Other ways exist to help ease the passage of the uterine contents.
Table of Contents
- D&C Procedure
- D&C Complications
- Pregnancy after D&C
- Types of Miscarriage Treated by D&C
- D&C Alternatives
This procedure is done using small instruments or medication to open the cervix. Then, a curette is used to remove tissue from the uterus. These curettes can use suction, or they can be sharp.
The DnC pregnancy procedure is generally performed as an inpatient or outpatient procedure in a surgical center. You should have someone there to drive you home, for general anesthesia is often used as well as paracervical or IV anesthesia. Your cervix is then dilated, and a speculum is inserted into the vagina.
With a plastic cannula attached to a suction, the contents of the uterus are cleared. A curette tool may also be used to scrape the contents away. The contents may be sent off to a lab. When your uterus has become firm, and the bleeding is minimal or stopped, the speculum will be removed and then you will be sent to recovery.
1. Diagnosing illnesses and checking for other complications
- DnC might be recommended in the case of:
- Abnormal uterine bleeding
- Bleeding after menopause
- Discovery of abnormal endometrial cells during cervical cancer test
- DnC surgery can check for:
- Uterine cancer
- Uterine polyps
- Endometrial hyperplasia: This is a precancerous condition where uterine lining becomes too thick
2. Treatments that are done using dilation and curettage
- Removal of:
- Molar pregnancy
- A pregnancy in which the embryonic tissue turns into a mass instead of a fetus.
- Could be caused by a genetic problem in the egg or sperm
- Cervical or uterine polyps
- These are common tumors of the cervical canal’s surface. May sometimes cause irregular periods but more often than not they show no symptoms.
- Fibroid tumors
- Fibroids are tumors that can become relatively large and can cause heavy periods and abdominal pain.
- Usually benign growths
- Tissue that remains after a miscarriage or abortion
- Infection prevention
- Prevent heavy bleeding
3. Treat excessive bleeding after pregnancy by clearing out placenta remains
- The placenta staying behind can cause some pretty severe bleeding. Making sure that it is all gone is one of the primary goals in this situation.
4. Used as a method of abortion
- DnC pregnancy termination is done until 16 weeks of gestation.
- The suction style dilation and curettage is used in this case most of the time.
- Any use of anesthesia can be risky. Know how you react to it and make sure that the practitioners know, too. The body can have adverse reactions to it, so it is better to be safe than sorry. General or local anesthesia is used.
- Medication reaction
- You could have a reaction to the medication provided after your procedure. A pain killer and sometimes an antibiotic may be given.
- Hemorrhage or heavy bleeding
- It is possible to cause more harm than good and to cause excess bleeding.
- Laceration or weakening of the uterus
- This can cause preterm births in the future
- Perforation or puncture of the uterus
- As said previously, this can cause preterm births
- Incomplete procedure causing another to be performed
- Sometimes they cannot get it all, or some is missed. If this goes unnoticed, it is possible for infection to start
- Scarring of the uterus or cervix
- May require further treatment
Taking care of your body is important after a D&C. You can manage the pain with the medication they give and fight infection with an antibiotic they will provide as well. You should feel well enough within 24 hours to a few days. You can return to non-strenuous activity when recovery has progressed a little.
Painful cramping should not be expected after 24 hours. Light cramping may occur, however. The cramping and light bleeding can take up to two weeks to subside. Nothing should be inserted into the vaginal area, including douching, tampons, and intercourse for at least two weeks. Your doctor will probably have specific intercourse instructions when you are able to resume.
You should keep an eye out for certain things that will signal that there may be a problem after your procedure. The following are some symptoms of DnC complications:
- Fainting or dizziness
- Prolonged cramping or bleeding (over two weeks)
- Severe or increased pain
- Bleeding heavier than menstrual period or filling more than one pad per hour
- Fever over 100.4 degrees Fahrenheit
- Foul smelling discharge
If any of these are happening, call your doctor immediately. Taking care of yourself after a D&C is super important. With such a sensitive nature, it can be hard to deal with, however. Do not let yourself get caught up in emotions but also do not be afraid to embrace them.
There may be long term complications with this kind of procedure. They can be serious or minor, but should be tended to immediately if possible. Knowing about these complications should help you to recognize their signs.
- Difficulty in carrying pregnancy to term
- Uterine scarring
- Scar tissue can make it harder to get pregnant due to its effect on the functional lining of the uterus.
- Premature births
- Since the cervix is forced open during the procedure, it may not be able to handle the pressure of a baby pressing down on it, resulting in preemie births
- Uterine rupture can cause death to mother and baby
- This can be a devastating event. The myometrial wall is compromised in an incomplete rupture. With a complete rupture, the contents of the uterus can spill into the broad ligament or peritoneal cavity.
- This can be caused by D&C procedures lacerating or weakening the uterus as well as perforation or puncture.
Pregnancy after D&C
Getting pregnant after a DnC is similar to getting pregnant after a miscarriage. Your sex life is probably going to be different, especially after a miscarriage. Regardless of what happens, you should take care of yourself and make new habits to improve your own health. The healthier you are physically and emotionally, the more likely you are to conceive.
Also, your doctor will probably recommend that you avoid sex for at least three months in order to allow your uterus to heal from such a traumatic procedure. Your chances of getting pregnant are not any less than they were before the procedure. Your body will heal rapidly and can be followed by a good amount of successful pregnancies.
1. Eat right
- There are plenty of foods, and even a special diet, that you can eat to increase your fertility. This includes but is not limited to: dairy that is whole, protein rich foods, and foods that have plenty of vitamins and minerals.
2. Folic acid
- Folic acid has been shown to decrease the risk of miscarriage. Taking a daily supplement will help raise those levels. These have been found to help prevent neural defects such as spina bifida. Higher doses help to prevent miscarriages, too.
- Being overweight or underweight can cause complications you do not need to deal with. Maintaining the correct weight for you individually is necessary to staying healthy. You will soon be eating and sleeping for two, so keep your weight at a reasonable level for your body.
- Avoid drugs and alcohol, and stop smoking cigarettes. This may seem like a given, but it is still important to stress. These can cause serious complications during your pregnancy and afterward, with possible defects.
5. Sex life
- Regular sex increases your chances relatively well. At least three times a week is enough to ensure you are having intercourse on some of your fertile days.
- As mentioned before, you should still wait the amount of time that you were told by your doctor.
6. Emotional health
- Addressing the pain of a previous miscarriage is important. Getting help and talking to someone can help significantly. Consult with someone who can help you get through it and get you ready for another try.
- Regardless of why you are having this procedure, ignoring the facts and trying to hold it in will not do you very much good. Your emotional state is directly linked to how your body reacts to things.
When you do get pregnant, pay attention to the following factors to ensure that you will have the best pregnancy possible:
- Keep the abdomen safe
- Do not drink alcohol
- Avoid smoking and being around smoke
- Check medications with your doctor
- Stay away from x rays, diseases, and radiation
Types of Miscarriage Treated by D&C
There are few types of miscarriages, and most can be treated by this procedure. Here are the types that will benefit from a dilation and curettage:
- A missed miscarriage is one in which the fetus dies, and the body does not recognize the end of pregnancy. This can only be discovered by loss of pregnancy symptoms and the absence of fetal heart tones on an ultrasound.
2. Incomplete miscarriage
- A miscarriage where not all of the uterine tissue is passed through the vagina during a miscarriage. Also known as an inevitable miscarriage, bleeding and cramps will continue if is not completed. This can cause problems with heavy blood loss and can lead to infection.
3. Complete miscarriage
- A D&C can be performed even if there has been a complete miscarriage. It is used to ensure that there is no extra tissue left over. In these cases, there will not be anything left over.
4. Molar pregnancy
- This is the result of a genetic error the leads to the tissue not developing into an embryo. The most common pregnancy symptoms can happen with this type of pregnancy. These rarely have a developing embryo.
If dilation and curettage do not sound right for you, there are other ways to expel the miscarried tissue from the uterus. A medication that is usually used to induce labor has been successful. There are several side effects of this medication, however.
The side effects include nausea, sometimes a fever, and diarrhea. This style of abortion can be taken in the privacy of your own home. There is no anesthesia, either, and the success rate is 95 percent when done before nine weeks.
This might not always be a good method for a procedure being done after a miscarriage. Even if this medication is being taken, it might have to be accompanied by a D&C procedure.
Overall, a dilation and curettage procedure can be a great thing for those who need to have a diagnosis or treatment regarding the uterus. It can find polyps and other issues, and tissue samples can be collected for analysis.
Be aware of the complications that may arise to ensure that you are not in any danger after the procedure. Getting pregnant again may have to wait as your body heals. This can take a few months, but it is best to wait.
No matter what you end up doing, a dilation and curettage procedure can be a great thing. As long as you know the risks, you will be prepared for recovery and to move on with your life.
This is a procedure that you sometimes cannot avoid. The risks of something going wrong are low, and it is not likely to affect your future pregnancies. However, the possibility is still there for complications.