Dilation and Curettage (D & C)

Dilation and curettage (D& C) is a procedure to remove tissue from the uterus. This procedure helps in removing unwanted tissue from within the lining of the uterus. Gynecologists usually perform D & C to treat conditions like heavy menstrual bleeding; and also, to clear the uterus after an abortion or miscarriage.

Your gynecologist uses medication to open or dilate the cervix (the lower part of the uterus). She then uses a curette (a sharp surgical instrument or a suction device to remove uterine tissue).

Let us try to understand…

Why You Need D & C?

Your gynecologist may recommend D&C for the following reasons:

1. To determine the cause of excessive or abnormal uterine bleeding
2. To detect cancer of the uterus
3. As a part of the infertility investigation

The abnormal uterine bleeding can be due to the growth of abnormal tissue in the uterus – the growth of polyps and fibroid tumors. These are benign tumors (myomas). In addition, D&C also helps in detecting the cancer of the endometrium or uterus. Experts who perform D&C scrap some of the tissue sample and send it for laboratory analysis to detect cancer. Hormonal imbalances can also cause abnormal uterine bleeding in perimenopausal and postmenopausal women.

To remove fetus and other tissues following a miscarriage

An obstetrician & gynecologist performs D&C following a miscarriage to remove fetus and other tissues, if they remain and not clear completely. She uses a suction to remove the leftover contents. These leftover tissues can cause infection and heavy bleeding if they are not removed completely.

To remove leftover placenta after a childbirth

In some cases, small part of placenta remains adhered to endometrium following childbirth. It can lead to infection, bleeding and other issues. A gynecologist performs D&C to remove these fragments from the endometrium to ensure its proper healing after delivery.

Sometimes, you have a D&C and hysteroscopy. During this procedure, your provider inserts a device into your cervix to see the inside of your uterus. You may have a hysteroscopy with a D&C if your provider is trying to diagnose a problem.

Hysteroscopy guided D &C

Your obstetrician or gynecologist can perform both D&C and hysteroscopy procedure together. In this procedure she inserts a sleek tube with a light and camera at its front end through the vagina, cervix into the uterus. The gynecologist views uterine lining on a screen to look for any abnormalities. During this procedure she may remove uterine polyps or fibroids if any and takes tissue sample for biopsy. Before planning a D&C procedure, your gynecologist can perform hysteroscopy along with endometrial biopsy.

Bottom line

The procedure involving the removal of abnormal uterine tissue by dilating the cervix and inserting sharp instruments through it is known as dilation and curettage (D&C)

Preparation for D&C

Your gynecologist & obstetrician may give instructions before the procedure. Follow all the instructions of your doctor. You should have to fast for at least 8 hours before the procedure because the procedure is done under general anesthesia. If you have any health issues, then inform your gynecologist regarding your health and medicines that you are taking. Inform your doctor if you have any bleeding disorders or if you take blood thinners or if you are sensitive to certain drugs. In a nutshell, follow all the instructions of your doctor.

After the Procedure

You will spend some time in the recovery room after the D&C procedure. Your gynecologist will watch and monitor you for bleeding or any other potential health issues in the post-operative room. In addition, you will also get some time to recover from the effects of anesthesia.

You may experience slight discomfort after a D&C for a couple of days – which is quite normal. Light spotting or bleeding is common and you may also develop cramping. Your doctor may suggest you to take pain relieving medications such as ibuprofen.

You will feel quite normal within two to three days and resume your activities within 36 to 48 hours after the procedure.

Precautions

Your uterus may take some time to get to its normal state. Therefore, avoid doing those things that can interfere with its healing. For instance, do not insert anything (tampons) inside your vagina. You can talk to your gynecologist about when can you start sexual activity. To avoid getting infected ensure proper hygiene.

Your next period can occur earlier or get delayed after a D&C procedure. This is normal as your uterus needs time to regenerate its lining. After a miscarriage, if you had undergone D&C procedure, then talk to your obstetrician as to when can you attempt your pregnancy again.

When to see a gynecologist?

Any abnormality or unusual signs and symptoms should always be taken seriously. If you suddenly start to have heavy and abnormal bleeding, then see your gynecologist. Never delay seeing a gynecologist if you experience heavy bleeding prior to menopause or after menopause. Though this could be a major sign of uterine polyps or fibroids or endometrial hyperplasia, it could also indicate a more serious uterine or cervical cancer. For any other health concerns and issues or problematic symptoms, meet me personally.