Dilation and Curettage

A dilation and curettage procedure, commonly called a D&C, is a surgical procedure in which the cervix – the lower, narrow part of the uterus -- is expanded or dilated.  After dilation, the cervical canal and uterine lining (the endometrium) can be scraped with a spoon-shaped instrument called a curette to remove a sample that will be examined in the lab.  

Female Pelvic Organs and the Menstrual Cycle

In order to understand the procedure and some of the reasons it becomes necessary, we need a basic understanding of the pelvic organs and menstruation.  The organs and structures of the female pelvis are:

• The endometrium, or lining of the uterus
• The uterus, a hollow, muscular organ located in a woman's lower abdomen, between the bladder and the rectum. The uterus sheds its lining (the endometrium) each month during menstruation, unless a fertilized egg becomes implanted and pregnancy follows.
• The ovaries, two organs located in the pelvis in which eggs develop and are stored.  The female hormones, estrogen and progesterone are also produced in the ovaries.
  The cervix is the lower, narrow part of the uterus which opens into the vagina.
• The vagina, also called the “birth canal,” is the passageway through which fluid passes out of the body during menstrual periods
• During the menstrual cycle, increased levels of the female hormones help to thicken the walls of the uterus as the endometrium is prepared to nourish a fetus.   If fertilization of the egg does not occur, the endometrium, along with blood and mucus from the vagina and cervix make up the menstrual flow that exits the body through the vagina.

Why a D&C?

A D&C may be used as a diagnostic or therapeutic procedure for abnormal bleeding.  The results from the procedure may help the physician to determine the cause of abnormal uterine bleeding, to understand the possible cause of a miscarriage, to detect cancer, or as part of an infertility investigation.In addition, a D&C is often used after a miscarriage to remove tissues that have not been naturally passed.  If these tissues are not removed, complications such as infection and bleeding can occur.  For the same reason, it is also sometimes necessary after childbirth when small pieces of the placenta remain in the uterus.

Risks of the Procedure

Complications are rare, but as with any surgical procedure, sometimes occur.  Possible complications may include the following:

• Heavy vaginal bleeding
• Infection, causing fever, chills or pain in the abdomen
• Perforation of the uterine wall or bowel The Procedure

A D&C may be performed in a physician’s office, on an outpatient basis, or as part of a stay in a hospital. Procedures may vary depending on the woman’s condition.During the procedure, the patient is positioned on an operating or examination table, with feet supported by footrests.  An IV line and/or a urinary catheter may be inserted.  The physician will use an instrument called a speculum to gently spread the vaginal walls apart.  The cervix will be cleaned, and a type of forceps is used to hold the cervix in place for the procedure.The cervix will be dilated, often by inserting a series of thin rods. Each rod will be larger in diameter than the previous one and will gradually enlarge the opening.  Other times medication is used for dilation. The curette will be inserted through the cervix into the uterus and used to scrape some of the tissue.  In some cases, suction may be used to remove the tissue. Finally, the instruments are removed and the collected tissues are sent to a lab to be examined.

After the Procedure

The patient may experience cramping for up to a few days after the D&C, and it is not unusual to experience spotting or light bleeding after the procedure.  The patient is advised to use sanitary pads instead of tampons, and is usually instructed not to douche or have sexual intercourse for a few days after the procedure. After the procedure, a new lining must build up in the uterus.  As a result, the next menstrual period may be early or latePain relievers should be taken only as advised by the physician, since some pain medications increase the chance of bleeding.  The physician should be notified immediately if any of the following occur:

• heavy bleeding
• bad-smelling drainage from your vagina
• fever and/or chills
• severe abdominal pain

Remember

In general, a D&C is used to help determine the health of the uterine lining or to remove abnormal tissue.   It is also used as a diagnostic tool to investigate medical conditions such as abnormal bleeding or multiple miscarriages.