Dilation and Curettage (D&C)

Dilation and Curettage (D&C) is a procedure performed for diagnostic or therapeutic purposes, such as exploring the cause of abnormal uterine bleeding or cleaning excess tissue in the uterus after a miscarriage or abortion. (1)

Procedure Overview

The D&C typically includes two main steps: (1)

• Dilation: The doctor widens the cervix (the passage connecting the uterus to the upper part of the vagina) using specialized tools.
• Curettage: Using a thin instrument, the doctor gently scrapes the uterine lining to collect a sample for examination or to remove unwanted tissue.

Indications

D&C may be performed for diagnostic or treatment purposes: (2)

Diagnostic Reasons

A doctor may request a biopsy of the uterine lining if a woman is having unusual symptoms, such as:

• Abnormal uterine bleeding.
• Postmenopausal bleeding.
• Detection of abnormal cells during a routine cervical screening.

After examining the sample, doctors can diagnose and treat various conditions, including:

• Endometrial hyperplasia: Excessive cell growth in the uterine lining that could become cancerous.
• Uterine polyps: Usually benign growths.
• Uterine cancer.

Therapeutic Reasons

D&C is also performed to:

• Remove residual tissue after a miscarriage to prevent infection or excessive bleeding.
• Remove abnormal tissue after a molar pregnancy.
• Treat postpartum hemorrhage by removing any remaining placental tissue.
• Remove fibroids or uterine polyps to prevent the risk of cancerous changes.

Risks

D&C is a common procedure, and serious complications are rare but can include: (2)

• Uterine perforation: Surgical tools may puncture the uterus, especially if the procedure is done during or after pregnancy when the uterine lining is soft. Most cases heal on their own, but some may require additional surgery.
• Cervical tears: The cervix may tear during dilation. If necessary, this can be treated by applying pressure, medication, or stitches.
• Heavy bleeding: Blood transfusions are rarely required.
• Infection.
• Intrauterine adhesions (scar tissue).

Preparations

• Fasting: You may need to fast starting the night before the procedure, as instructed by your doctor.
• Cervical Preparation: You may need medication like Misoprostol (Cytotec) or a laminaria stick (absorbs fluids in the cervix) to soften and dilate the cervix. This process may begin hours or even a day before the procedure.
• Planning for Discharge: Since anesthesia is used, it’s important to arrange for someone to drive you home afterward. (1)

Surgery Steps

D&C is performed in a clinic or hospital. General steps include the following: (1)

• Doctors choose the appropriate anesthesia type (general, regional, or local) based on your health and the reason for the procedure.
• You’ll be asked to lay down on the exam table with knees bent and feet in stirrups, similar to a routine gynecological exam.
• The doctor will insert a speculum into the vagina to open the cervix, followed by securing it with a clamp.
• Thin metal rods, called dilators, are used to gently expand the cervix.
• A spoon-shaped metal instrument (curette) or suction device is used to gently remove tissue for diagnostic purposes or to clear the uterine lining.

Afterward, you’ll rest in a recovery room for a few hours before being discharged.

Dr. Soliman Fakeeh Hospital: Comprehensive Care for Women’s Health

At the Obstetrics & Gynecology Department, we’re dedicated to supporting your health with a full range of personalized care.

Our services include:

• Diagnosing and treating common gynecological conditions.
• Performing specialized surgeries, like D&C, using the latest technology.
• Providing special care to ensure a smooth and speedy recovery.

For appointments or inquiries, click here.

Recovery

It's normal to experience some mild symptoms after a D&C, including: (3)

• Cramping: Usually strongest on the first day and gradually lessens. Pain relief like ibuprofen can help.
• Light bleeding: Can last from a few days up to two weeks.
• Dizziness or nausea: Due to anesthesia, and should resolve within a few hours.

To care for yourself after a D&C: (3)(4)

• Rest for a day or two before returning to light activities.
• Use sanitary pads instead of tampons for light bleeding until your doctor advises otherwise.
• Avoid intercourse or douching until your doctor says it is OK, usually after 2 weeks.
• See your doctor if you notice any concerning symptoms, such as:some text
  • Heavy bleeding (needing to change pads every hour).
  • Severe abdominal or back pain that doesn’t respond to painkillers.
  • Fever over 100.4°F (38°C) with chills.
  • Foul-smelling vaginal discharge.
  • Persistent cramps or bleeding lasting more than two weeks.
  • Dizziness or faintness.

FAQs

How long does a D&C procedure take?

The procedure itself lasts about 5 to 10 minutes, but the entire process, including preparation and recovery, can take longer. (1)

Is the procedure painful?

D&C procedure is not painful, as you won't feel anything due to the anesthesia. However, you may experience cramping similar to menstrual cramps after the procedure. (1)

What is the best position for sleeping after a D&C?

Sleeping on your back is generally the most comfortable, as it avoids putting pressure on the abdomen, allowing for better healing. Your doctor may also approve side sleeping if that feels more comfortable for you.

When will my period return?

Menstrual cycles can be irregular post-D&C and may come earlier or later than usual. This depends on how long it takes for the uterine lining to rebuild itself. (1)

Are there alternatives to D&C?

Depending on the situation, not all women require a D&C after a miscarriage. In cases of miscarriage before 10 weeks, the fetus and tissue may naturally pass on their own or with the help of medication. However, D&C is often recommended after 10 weeks to ensure the uterus is completely cleared. (3)

References

1. Cleveland Clinic - Dilation and Curettage (D&C)
2. Mayo Clinic - Dilation and curettage (D&C)
3. American Pregnancy Association - D&C Procedure After a Miscarriage
4. ACOG - Dilation and Curettage (D&C)