What you need to know about:

Dilation and Curettage

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Recovery Period:

2 to 3 days

Permanence:

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Time it takes:

5-10 minutes

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Anesthetize:

General or regional anesthesia

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Overview of

Dilation and Curettage

in Thailand

Dilation and Curettage (D&C) is an obstetric procedure to remove the uterine contents through the insertion of instruments through the vagina and cervix. A curette is used to open the cervix and dilate the vagina and is inserted into the uterus. It removes tissues from inside the uterus.

Goals of

Dilation and Curettage

D&C is used to diagnose and treat a variety of uterine conditions, including abnormal bleeding. It may also be done after a miscarriage. It is also used to examine any abnormal cells inside the uterus by getting sample tissues. Other procedures like hysteroscopy, where the uterus is viewed inside using a thin lighted telescope, can be done with D&C.

A D&C is performed for the following reasons:

Miscarriage: the removal of residual fetal or placental tissues in order to prevent infection and hemorrhage.
Presence of benign or malignant growth in the uterine cavity where the tissue is removed for further laboratory examination.
For the diagnosis and/or treatment of excessive or abnormal uterine bleeding.
To find out the cause of infertility,
To diagnose hormonal abnormalities in postmenopausal women who still have vaginal bleeding.

Price of

Dilation and Curettage

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Pros and cons of

Dilation and Curettage

Pros

It helps to find out the reason for abnormal bleeding.
It can help in the diagnosis of uterine cancer by detecting the presence of endometrial cell abnormalities.
It can help pathologists identify any normal or abnormal tissue, polyps, or cancer using sample cells.
Through the removal of any leftover tissues, it prevents heavy bleeding or infection after miscarriage or abortion.
It can be performed under general anesthesia or sedation.
Patients can return to their normal routine after a day or 2, since they only experience mild cramps after the procedure.

Cons

D&C is a safe and routine procedure, but it also has risks like any other surgery. The risks include the following:

Cervical insufficiency (an incompetent cervix)—it is the weakening of the cervical muscles and tissues. It can cause preterm birth or miscarriage because of the premature dilation of the cervix. Research showed that repeated D&C procedures are often associated with cervical insufficiency and preterm birth.
Asherman syndrome – this is caused by repeated D&C procedures that caused scar tissues to form in the uterus or cervix. These scars form adhesions overtime and obliterates the uterine cavity.

How it works:

Dilation and Curettage

The patient lies on her back and her legs are placed in stirrups. A speculum is inserted inside the vagina and a special instrument will hold the cervix in place. A series of rods (one rod slightly larger than the other) are inserted in the cervical opening to dilate the cervix. Only less than one-half inch in diameter of dilation is needed. A curette or suction will be used to remove the tissue lining of the uterus. The samples will then be examined in the laboratory.

Preparation before

Dilation and Curettage

Pre - treatment

The doctor will explain the procedure and answer all your questions.
You will need to sign a consent form stating that you are allowing the procedure. Please read it carefully and ask questions to clarify.
A complete medical history and a physical examination may be done in order to ensure that you are in good health. Blood tests and other diagnostic tests may also be required.
Fasting for eight hours after midnight before the procedure will be needed if you will be under general, spinal, or epidural anesthesia during the procedure. For local anesthesia, the doctor will give you instructions on how to fast.
Notify the healthcare provider if you are pregnant or suspect you are pregnant (a pregnancy test may be recommended).
Inform your doctor of any known allergies to any medications, iodine, latex, tape, or local or general anesthetics.
Inform your doctor about any medications (prescribed or over-the-counter) and herbal supplements that you are taking.
If you have a history of bleeding or are taking any anticoagulant (blood-thinning) medications, aspirins, or any blood-clotting medications, notify your doctor as you may be required to stop taking them prior to the procedure.

During the procedure

Before surgery, the doctor will start to dilate the cervix using a laminaria. A laminaria is a natural or synthetic slender rod that is inserted into the cervix. It will be placed there for several hours in order to absorb the fluid from the cervix, which then expands to open the cervix. A medication that causes the cervix to dilate easily can also be used. Before or during the D&C, you may receive some type of anesthesia.

Recovery after

Dilation and Curettage

Post - treatment

Depending on the type of procedure and the anesthesia administered, the recovery process varies. You will be taken to the recovery room for observation if you received regional or general anesthesia.

When you become alert and your blood pressure, pulse, and breathing are stable, you will be taken to your hospital room or be discharged.

If an out-patient procedure was done, have someone else drive you home. If you are under local anesthesia, rest for about two hours before going home. Wear a sanitary pad for the bleeding.

A few days after the procedure, you may still experience some light vaginal bleeding or spotting. Cramping may also be felt for the first few days.

For two to three days after D&C or for a period of time recommended by the doctor, you may be instructed not to have intercourse, not to douche, or use tampons. The doctor may also restrict you from doing heavy lifting or strenuous activities.

Because a D&C removes the uterine lining, the lining must regenerate. It's possible that your next menstrual period will start earlier or later than usual. Unless your doctor advises otherwise, you may resume your regular diet.

For cramping or soreness, take a pain reliever as directed by your doctor. Aspirin and other pain relievers can increase the risk of bleeding. Take only the medications that have been prescribed for you.

Risks & side effects

Complications like bleeding, infection, or perforation of the uterus (as the tip of the instrument passes through the uterine wall)
Anesthesia-related problems may rarely occur.
Asherman syndrome—happens when D&C is performed after a miscarriage and adhesions or scar tissues form inside the uterus. These adhesions may cause changes in menstrual flow or cause infertility. Surgery can successfully treat the syndrome.

FAQs:

Dilation and Curettage

Will my menstrual cycle be affected after undergoing dilation and curettage (D & C)?

Your next menstrual period may be early or late after undergoing D&C. For a while, you should avoid using tampons or having sex. You're at a higher risk of bacteria entering your vagina and causing an infection until your cervix returns to its normal, closed state. When you can resume having sex and using tampons will be advised by your doctor.

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What should I watch out for after the procedure?

Contact your healthcare provider if you are experiencing any of the following:

Heavy vaginal bleeding.
Fever
Abdominal pain
Foul-smelling vaginal discharge

Your next menstrual period may be early or late because your uterus is building up a new lining. It is also important not to put anything in your vagina after the procedure. Because bacteria from the vagina may enter the uterus and cause infection. Ask your healthcare provider as to when you can resume using tampons and have sex again.

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Do I need dilation and curettage (D & C) after a miscarriage?

Half of the women who had a miscarriage did not need to undergo D&C. A miscarriage will not cause any problems if it happens before 10 weeks of pregnancy. Having an incomplete miscarriage is likely to happen after the 10^th week. In this case, D&C is needed to clean the uterus.

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