D&C Procedure After A Miscarriage

Unfortunately, miscarriage is the most common type of pregnancy loss according to the American College of Obstetricians and Gynecologists (ACOG). Studies reveal that anywhere from 10-25% of clinically recognized pregnancies will end in miscarriage, and most miscarriages occur during the first 13 weeks of pregnancy.Pregnancy can be such an exciting time, but with the number of  miscarriages that occur, it is beneficial to be informed in the unfortunate event that you or someone you know faces one.

The main goal of treatment during or after a miscarriage is to prevent hemorrhaging and/or infection. The earlier you are in your pregnancy, the more likely your body will expel all the fetal tissue by itself and will not require further medical procedures. If the body does not expel all the tissue, the most common procedure performed to stop bleeding and prevent infection is a D&C.

What is a D&C Procedure?

A D&C, also known as dilation and curettage, is a surgical procedure often performed after a first-trimester miscarriage. In a D&C, dilation refers to opening the cervix; curettage refers to removing the contents of the uterus. Curettage may be performed by scraping the uterine wall with a curette instrument or by a suction curettage (also called vacuum aspiration).

Is a D&C necessary after a miscarriage?

About 50% of women who miscarry do not undergo a D&C procedure. Women can safely miscarry on their own with few problems in pregnancies that end before 10 weeks. After 10 weeks, the miscarriage is more likely to be incomplete, requiring a D&C procedure. Choosing whether to miscarry naturally (called expectant management) or to have a D&C procedure is often a personal choice that is best decided after talking with your health care provider.

Some women feel comfort in miscarrying in their own home, trusting their body to do what it needs to. Some see this as a vital part of the healing process, eliminating the question of “what if?” about the viability of the pregnancy. There are also many women who miscarry who have a history of gynecological problems and don’t want to risk the possibility of any complications occurring from having a D&C procedure. For most first trimester miscarriages, expectant management should be a reasonable option.

For some women, the emotional toll of waiting to miscarry naturally is too unpredictable and too much to handle in an already challenging situation. Healing for them may only start once having a D&C procedure. A D&C may be recommended for women who miscarry later than 10-12 weeks, have had any complications, or have medical conditions in which emergency care could be needed.

How is a D&C procedure performed?

A D&C procedure may be performed as an outpatient or inpatient procedure in a hospital or other type of surgical center. A sedative is usually given first to help you relax. Most often, general anesthesia is used, but IV anesthesia or paracervical anesthesia may also be used. You should be prepared to have someone drive you home after the procedure if general or IV anesthesia is used.

1. You may be given antibiotics intravenously or orally to help prevent infection.
2. The cervix will be examined to determine if it is open. If the cervix is closed, dilators (narrow instruments in varying sizes) will be inserted to open the cervix to allow the surgical instruments to pass through. A speculum will be placed to keep the cervix open.
3. The vacuum aspiration (also called suction curettage) procedure uses a plastic cannula (a flexible tube) attached to a suction device to remove the contents of the uterus. The cannula is approximately the diameter in millimeters as the number of weeks gestation the pregnancy is. For example, a 7mm cannula would be used for a pregnancy that is 7 weeks gestation. The use of a curette (sharp-edged loop) to scrape the lining of the uterus may also be used, but this is often not necessary.
4. The tissue removed during the procedure may be sent off to a pathology lab for testing.
5. Once the health care provider has seen that the uterus has become firm and the bleeding has stopped or is minimal, the speculum will be removed and you will be sent to recovery.

What are the possible risks and complications of a D&C procedure?

• Risks associated with anesthesia such as an adverse reaction to medication and breathing problems
• Hemorrhage or heavy bleeding
• Infection in the uterus or other pelvic organs
• Perforation or puncture to the uterus
• Laceration or weakening of the cervix
• Scarring of the uterus or cervix, which may require further treatment
• Incomplete procedure that requires another procedure to be performed

What to expect after the D&C Procedure:

Most women are discharged from the surgical center or hospital within a few hours of the procedure. If there are complications or you have other medical conditions, you may need to stay longer. You will more than likely be given an antibiotic to help prevent infection and possibly some pain medication to help with the initial cramping after the procedure.

Things to know about taking care of yourself at home:

• Most women can return to normal activities within a few days, and some feel good enough to return to normal non-strenuous activity within 24 hours.
• You may experience some painful cramping initially, but this should not last longer than 24 hours.
• Light cramping and bleeding can be expected from a few days to up to 2 weeks. Ibuprofen is usually suggested for treating cramps.
• You should not insert anything into the vaginal area (including using a douche or having sexual intercourse) for at least 2 weeks or until the bleeding stops. Your health care provider should give you specific instruction for when intercourse can resume.
• Tampons should not be used until you start your next regular period, which could be anywhere from 2-6 weeks after the D&C procedure.
• It is unknown when ovulation will return, so once sexual intercourse is allowed, you should use a method of contraception until your health care provider says it is okay to try to get pregnant again.
• Make sure to attend your follow-up appointment.

When to contact your healthcare provider:

Most women experience few complications after a D&C procedure, but you should be aware of symptoms that could signal a possible problem.

Your health care provider should give you specific instructions on what to expect, but contact them as soon as possible if you experience any of the following:

• Dizziness or fainting
• Prolonged bleeding (over 2 weeks)
• Prolonged cramping (over 2 weeks)
• Bleeding heavier than a menstrual period, or filling more than one pad per hour
• Severe or increased pain
• Fever over 100.4 °F
• Chills
• Foul smelling discharge

credit/source: https://americanpregnancy.org/pregnancy-complications/d-and-c-procedure-after-miscarriage/

Note: All information and image/s are credited to the original writer's sources and references.   Please click the link for complete information.

The information contained on this site is for educational purposes only and should not be taken as expert advice.  

Dilation and Curettage (D and C)

What is a dilation and curettage (D&C)?

(Dilatation and Curettage, D&C)

A dilation and curettage procedure, also called a D&C, is a surgical procedure in which the cervix (lower, narrow part of the uterus) is dilated (expanded) so that the uterine lining (endometrium) can be scraped with a curette (spoon-shaped instrument) to remove abnormal tissues.

Other related procedures used for diagnosing and treating the endometrium include endometrial ablation, hysteroscopy, and hysterectomy. Please see these procedures for additional information.

image credit: hopkinsmedicine.org

What are female pelvic organs?

The organs and structures of the female pelvis are:

• Endometrium . This is the lining of the uterus.
• Uterus (also called the womb). The uterus is a hollow, pear-shaped organ located in a woman's lower abdomen, between the bladder and the rectum. The uterus sheds its lining each month during menstruation, unless a fertilized egg (ovum) becomes implanted and pregnancy follows.
• Ovaries. Two female reproductive organs located in the pelvis in which egg cells (ova) develop and are stored and where the female sex hormones estrogen and progesterone are produced.
• Cervix. The lower, narrow part of the uterus located between the bladder and the rectum, forming a canal that opens into the vagina, which leads to the outside of the body.
• Vagina (also called the birth canal). The passageway through which fluid passes out of the body during menstrual periods. The vagina connects the cervix and the vulva (the external genitalia).
• Vulva. The external portion of the female genital organs.
• Fallopian tube. Two thin tubes that extend from each side of the uterus, toward the ovaries, as a passageway for eggs and sperm.

The menstrual cycle

With each menstrual cycle, the endometrium prepares itself to nourish a fetus, as increased levels of estrogen and progesterone help to thicken its walls. If implantation of the fertilized egg does not occur, the lining of the endometrium, coupled with blood and mucus from the vagina and cervix (the lower, narrow part of the uterus located between the bladder and the rectum), make up the menstrual flow (also called menses) that leaves the body through the vagina. After menopause, menstruation stops and a woman should not have any bleeding.

Reasons for the procedure

A D&C may be used as a diagnostic or therapeutic procedure for abnormal bleeding. A D&C may be performed to determine the cause of abnormal or excessive uterine bleeding, to detect cancer, or as part of infertility (inability to become pregnant) investigation.

Causes of abnormal bleeding include the presence of abnormal tissues, such as fibroid tumors (benign tumors that develop in the uterus, also called myomas) polyps, or cancer of the endometrium or uterus. Tissues obtained from the D&C can be examined under a microscope. Abnormal uterine bleeding may also be due a hormone imbalance or disorder (particularly estrogen and progesterone) especially in women approaching menopause or after menopause.

A suction D&C uses suction to remove uterine contents. A suction D&C may be used following a miscarriage to remove the fetus and other tissues if they have not all been naturally passed. Infection or heavy bleeding can occur if these tissues are not completely removed.

Occasionally following childbirth, small pieces of the placenta (afterbirth) remain adhered to the endometrium and are not passed. This can cause bleeding or infection. A D&C may be used to remove these fragments so that the endometrium can heal properly.

There may be other reasons for your doctor to recommend a D&C.

Risks of the procedure

As with any surgical procedure, complications may occur. Some possible complications of a D&C may include, but are not limited to, the following:

• Heavy bleeding
• Infection
• Perforation of the uterine wall or bowel
• Adhesions (scar tissue) may develop inside the uterus

Patients who are allergic to or sensitive to medications, iodine, or latex should notify their doctor.

If you are pregnant or suspect that you may be pregnant, you should notify your health care provider.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

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

Before the procedure

• Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
• 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.
• In addition to a complete medical history, your doctor may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
• If your procedure requires general, spinal, or epidural anesthesia, you will be asked to fast for eight hours before the procedure, generally after midnight. If your procedure is to be done under local anesthesia, your doctor will give you instructions about fasting.
• If you are pregnant or suspect that you are pregnant, you should notify your health care provider. He or she may recommend a pregnancy test prior to the procedure.
• Notify your doctor if you are sensitive to or are allergic to any medications, iodine, latex, tape, and anesthetic agents (local and general).
• Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
• Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to 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 napkin to wear home after the procedure.
• Based on your medical condition, your doctor may request other specific preparation.

During the procedure

A D&C may be performed in a doctor’s office, on an outpatient basis, or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.

image credit: hopkinsmedicine.org

The type of anesthesia will depend on the specific procedure being performed. Some D&C procedures may be performed while you are asleep under general anesthesia, or while you are awake under spinal or epidural anesthesia. If spinal or epidural anesthesia is used, you will have no feeling from your waist down. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

Generally, a D&C follows this process:

1. You will be asked to remove clothing and be given a gown to wear.
2. You will be instructed to empty your bladder.
3. You will be positioned on an operating or examination table, with your feet and legs supported as for a pelvic examination.
4. An intravenous (IV) line may be started in your arm or hand.
5. A urinary catheter may be inserted.
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 cleansed with an antiseptic solution.
8. For local anesthesia, the doctor may numb the area using a small needle to inject medication.
9. If general or regional anesthesia is used, the anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during surgery.
10. A type of forceps, called a tenaculum, 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. The cervix will be dilated by inserting a series of thin rods. Each rod will be larger in diameter than the previous one. This process will gradually enlarge the opening of the cervix so that the curette (spoon-shaped instrument) can be inserted.
14. The curette will be inserted through the cervical opening into the uterus and the sharp spoon-shaped edges will be passed across the lining of the uterus to scrape away the tissues. In some cases, suction may be used to remove tissues. If you have local anesthesia, this may cause cramping.
15. The instruments will be removed.
16. Any tissues collected with the procedure will be sent to the lab for examination. Pregnancy tissues (called products of conception) may be sent to the lab for culture or testing for genetic or chromosomal abnormalities.

After the procedure

The recovery process will vary depending on the type of procedure performed and type of anesthesia that was administered.

If you received regional or general anesthesia, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. If this procedure was performed on an outpatient basis, you should plan to have another person drive you home.

After a D&C using local anesthesia, you may rest for about two 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 experience cramping for the first few days after a D&C.

You may be instructed not to douche, use tampons, or have intercourse for two to three days after a D&C, or for a period of time recommended by your doctor.

You may also have other restrictions 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 menstrual period may begin earlier or later than usual.

You may resume your normal diet unless your doctor advises you differently.

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

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

Notify your doctor if you have any of the following:

• Heavy bleeding
• Foul-smelling drainage from your vagina
• Fever and/or chills
• Severe abdominal pain

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

credit/source: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/dilation-and-curettage-d-and-c

Note: All information and image/s are credited to the original writer's sources and references.   Please click the link for complete information.

The information contained on this site is for educational purposes only and should not be taken as expert advice.  

Dilation and Curettage (D&C)

What Is Dilation and Curettage (D&C)?

The curettage procedure (D&C) involves dilating the uterine cervix so that the lining tissue (endometrium) of the uterus can be removed by scraping or suction.
The D&C is a safe procedure that is done for a variety of reasons. It is minor surgery performed in a hospital or ambulatory surgery center or clinic. D&C is usually a diagnostic procedure and seldom is therapeutic.
A D&C is often done as an adjunct procedure to a hysteroscopy and/or polypectomy. In addition, a D&C is often used for the following conditions:
1) Irregular or excessive bleeding: Irregular bleeding includes spotting or bleeding between periods. Bleeding with long, heavy periods, or bleeding after menopause can signal a number of problems. A D&C allows removal of the uterine lining and examination of the tissue under a microscope by a pathologist. This can help establish the cause of the abnormal bleeding.
The causes of irregular or abnormal bleeding include:

• Fibroids and polyps: These conditions are very common. Fibroid tumors are noncancerous growths appearing in and on the uterus. Some even grow out from the uterine wall on a stalk. Fibroids can cause chronic pain and heavy bleeding. Polyps, like fibroids, are noncancerous growths and are a common cause of irregular bleeding. Polyps and fibroids can have symptoms that resemble other more serious causes of bleeding.
• Endometrial cancer: A D&C and hysteroscopy are often performed to make certain patient's symptoms are not caused by uterine cancer or precancerouschanges. It is, of course, important to detect cancer in its earliest, most curable stages.

2) Therapeutic D&C: A D&C is often planned as treatment when the source of the problem is already known. One situation is an incomplete miscarriage or even full-term delivery when, for some reason, the fetal or placental tissue inside of the uterus has not been completely expelled. If the tissue is left behind, excess bleeding can result, perhaps even life-threatening bleeding.
Your health care professional will avoid D&C in the following situations, except when absolutely necessary:

• Pelvic infection: If you have an infection involving the reproductive organs, there is a chance the surgical instruments that will enter the vagina and cervix can carry the bacteria from your vagina or cervix into your uterus. There is also an increased risk of injury to infected tissue. For these reasons, the doctor may prefer to wait until after the infection is cleared up with antibiotics before performing the D&C.
• Blood clotting disorders: Doctors depend on the body's natural ability to clot to stop bleeding after curettage. Women with certain blood disorders are usually not given this surgery.
• Serious medical problems: Heart and lung disease, for example, can make general, and sometimes local, anesthesia riskier.

In fact, D&C is no longer performed as commonly as it was even a decade ago, thanks to advances in diagnosis (for example, ultrasound and hysteroscopy) and nonsurgical hormonal (for example, oral contraceptives) and antihormonal therapies.

Dilation and Curettage Pictures

image credit: https://www.emedicinehealth.com

Normal anatomy showing the cervix and uterus in preparation for dilation during the dilation procedure. Click to view larger image.

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Curettage showing the instrument inserted into the uterus. Click to view larger image

The following are risk factors of dilation and curettage:

• Hemorrhage: Heavy bleeding is rare, but it can happen if an instrument injures the walls of the uterus. It also can occur if an undetected fibroid is cut during curettage.
• Infection: There is always a slight possibility of infection once instruments are inserted into the uterus. Most infections can be easily cured with antibiotics.
• Perforated uterus: This complication, though rare, is more common in women who have a uterine infection at the time of the procedure, in elderly postmenopausal women, and if the procedure is being done for a miscarriage. If the doctor suspects this condition has developed, the patient may be asked to stay in the hospital for observation or further surgery.
• Asherman syndrome: This complication is rare and involves the formation of scar tissue in the uterus, caused by aggressive scraping or abnormal reaction to the scraping. Thick scars can result, which can fill up the uterus completely. This can lead to infertility and cessation of menstrual periods.
• Missed disease: Since the procedure cannot completely remove all the endometrium (lining tissue of the uterus), there is a chance that disease could go undetected. This is why the procedure is seldom done without a hysteroscopy (examination of the uterine lining using an instrument that allows direct visualization ).

credit/source: https://www.emedicinehealth.com/dilation_and_curettage_dandc/article_em.htm#what_is_dilation_and_curettage_dc

Note: All information and image/s are credited to the original writer's sources and references.  Please click the link for complete information.

The information contained on this site is for educational purposes only and should not be taken as expert advice.