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.

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

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 ).

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