D & C – Dilatation and Curettage

Often used to diagnose or treat abnormal uterine bleeding, the D&C is one of the most common surgical procedures performed on women. Dilation and Curettage also provides important information about whether uterine cancer is present.

Before you can understand D&C you need to know a little about the uterus and cervix. The uterus is a pear-shaped, muscular organ that sits in the lower abdomen. The top of the uterus is wide and it narrows like the neck of a bottle at the bottom. The lower third portion of the uterus is its neck which is called the cervix. The cervix is round and has a small opening called the OS. During your internal (vaginal) examination, your doctor or gynaecologist can see the cervix by using a speculum — an instrument used to separate the walls of the vagina.

The inner wall of the uterus is lined by endometrial tissues. The endometrial tissues thicken during the first part of your menstrual cycle. Once ovulation occurs progesterone acts to stop this thickening, and changes the endometrial lining so that it is ready to accept a pregnancy should it occur. If pregnancy doesn’t occur, hormone production ceases and the endometrium breaks up and is shed as menstrual blood.

Who Needs A D&C?

A D&C may be required to diagnosed and/or treat a problem such as heavy or prolonged menstruation, as well as unexplained bleeding between periods. The are many possible causes for these menstrual abnormalities, one of the most common being a hormonal imbalance. Hormonal imbalance causes a thickening of the endometrium which sometimes causes irregular or prolonged menstrual cycles. Although this can happen at any age it most commonly occurs in young women just starting menstruation and in older pre-menopausal women.

Abnormal uterine bleeding is also a warning of various types of growths, which are most often non-cancerous. One of these benign growths are polyps which attach either by a stem or a stalk most often to the lining of the uterus or the cervix. Polyps inside the uterus can usually be removed by D&C. Fibroid tumors are another common benign growth that occurs in the uterus. Fibroids can be silent causing no symptoms, or they can cause heavy bleeding and painful cramping. Although fibroid tumors are sometimes detected during dilation and curettage, another surgical procedure is necessary to remove them.

Abnormal bleeding is sometimes a sign of endometrial cancer, particularly in women over 40. Women over 40, especially those past menopause, may have a D&C or another procedure called an endometrial biopsy. Occasionally a hysteroscopy is performed at the same time as a D&C, allowing the doctor a better view of inside the cervix, vagina, and uterus.

Dilatation and curettage is also commonly performed following miscarriage or abortion in cases where the uterus fails to fully empty its content. Abortions induced before the 12th week of pregnancy are performed in a manner which is similar to the D&C.

How Am I Prepared for D&C?

• Do not eat or drink anything before surgery for a time period to be determined by your doctor.
• Before the surgery starts an antiseptic will be used to cleanse the skin around the vagina and cervix.

Be sure to ask your doctor if there are any additional preparations that you should make before your dilation and curettage.

What Are The Steps For Dilation And Curettage?

• The doctor completely inspects the pelvic reproductive organs for any abnormal changes.
• Next, a speculum is inserted into the vagina to open the walls so the doctor can see the cervix.
• A clamp-like instrument holds the cervix in place.
• The cervix is dialated with a series of tapered rods of increasing widths which are inserted into the cervical opening (the OS).
• A curette is passed through the uterus and used to scrape the uterine walls. This loosens pieces of the lining which are removed and sent to a lab for microscopic examination. Another method of obtaining a sample of the uterine lining is by applying suction through a narrow tube.

What To Expect After Surgery

You may have some discomfort from general anesthesia which can include nausea, vomiting, and a sore throat that can last a few days. Many women will notice mild cramping for a few days following D&C, as well as spotting or slight bleeding for up to a week. Your next period may be early or late.

You will need a friend or family member to accompany you home a few hours after your D&C. The affects of anesthesia wear off at different rates for each individual; however you should be able to drive and return to normal activities within a few days.

Points To Remember After D&C

• To prevent bacteria from entering the cervix following D&C, you should refrain from sexual intercourse, tampon use, and douches for at least a week.
• Showering, bathing, or swimming is permitted as soon as you feel well enough.
• Notify your doctor if fever, abdominal pain, heavy bleeding, or a vaginal discharge with a bad odor occur.
• Make sure you follow up with your doctor as recommended after the surgery.

Complications of Dilation and Curettage

As with any surgical procedure it’s important for you to understand any possible complications or risks. Although complications with D&C are rare they can include:

• A perforation of the uterine wall caused by the tip of the surgical instrument. This injury rarely requires treatment (additional surgery) and heals on its own.
• Excessive bleeding is always a risk during surgery.
• Another rare complication is infection with pain and fever.