Dilation (or dilatation) and curettage (D&C) refers to the dilation

(widening/opening) of the cervix and surgical removal of part of the lining of the
uterus and/or contents of the uterus by scraping and scooping (curettage). This
procedure involves expanding or enlarging the entrance of a woman's uterus
so that a thin, sharp instrument can scrape or suction away the lining of the
uterus and take tissue samples.

INDICATION

 Irregular bleeding
 Too much bleeding
 Fibroids and polyps
 Endometrial cancer
 Scar tissue

REASON WHY D&C IS AVOIDED

 Pelvic infection- there is a chance the surgical instruments that will enter the
vagina and cervix can carry the bacteria from your vagina or cervix into your
uterus.

 Blood clotting disorders- depend on the body's natural ability to clot to stop
bleeding after curettage
 Serious medical problems- Heart and lung disease, for example, can make
general, and sometimes local, anesthesia risky

Preparation /Pre-operative

 Avoid unnecessary drugs- A few days before the procedure, stop taking drugs
such as aspirin, which can cause increased risk of bleeding, and any over-the-
counter medications, such as cold tablets and laxatives. Avoid alcohol and
tobacco use

 Chronic conditions- example, if you have uncontrolled high blood pressure,

you may be put on a strict treatment plan in or out of the hospital to improve
your blood pressure. This is important to avoid any unnecessary
complications during the D&C procedure.
  Eating and drinking- instruct not to eat or drink for 12 hours before D&C if it
is done under general anesthesia (you are completely asleep)or for 8 hours
before a local or regional (eg, spinal) anesthesia(just the lower portion of your
body is numbed and you have no feeling) is used.

 Preliminary tests- On the day before or day of the procedure, surgeon may
want to obtain certain routine blood, urine, and other tests to be sure no
problems have been missed.

Procedure

• Dilation (the first step): While grasping the cervix with a clamp, the
doctor will pass a thin, flexible piece of metal called a sound to
determine the depth and angle of the uterus. These measurements
allow the doctor to know how far into the uterus the curette can be
safely inserted. The usual method of dilation is to insert a thin, smooth
metal rod gently along the vaginal canal and up into the tiny cervical
opening. The rod is left in place for a moment, then withdrawn and
replaced by a slightly larger rod. This process is repeated until the
cervix has expanded to about the width of a finger. This method takes
about 10 minutes. If you are under local anesthesia, you may
experience crampy discomfort caused by stretching of the cervical
muscles to accommodate the rods. Another method being used with
increasing frequency is to insert laminaria tents (cigarette-shaped
pieces of a special dried seaweed) into the cervix 8-20 hours before
the procedure. The laminaria absorb water from the tissues and swell
up, slowly distending and dilating the cervical canal. This is less
traumatic than using the metal dilators.

• Hysteroscopy and curettage (the second step): After dilation, doctor

holds the vagina open again with the speculum. The doctor may also
reach into the cervix with a tiny spoon to obtain a specimen of the
cervical lining. At this point, the hysteroscope is usually inserted into
the uterus so that thedoctor may look at the inside of the
uterus.Thedoctormay see fibroids, polyps, or overgrowths of the
endometrium. At that time, instruments may be inserted through the
 hysteroscope and biopsy, or removal, of these things may be
accomplished.

Risk/ Complication

 Hemorrhage- Heavy bleeding is rare, but it can happen if an instrument

injures the walls of your uterus. It also can occur if an undetected fibroid is
cut during curettage.

 Infection- There is always a slight possibility of infection once instruments are

inserted into the uterus. Most infections can be easily cured with antibiotics.
Some can be very serious.

 Perforated uterus- This complication, though rare, is more common in women

who have a uterine infection at the time of the procedure, in elderly
postmenopausal women, and if the procedure is being done for a
miscarriage. If your doctor suspects this condition has developed, you may be
asked to stay in the hospital for observation or further surgery.

 Asherman syndrome- this complication is rare and involves the formation of

scar tissue in the uterus, caused by aggressive scraping or abnormal reaction
to the scraping. Thick scars can result, which can fill up the uterus
completely. This can cause your menstrual periods to stop and make you
infertile

Post Operative

After the Procedure

• Cramps, like menstrual cramps, will probably be your strongest

sensation immediately after a D&C. Although most women experience
cramps for less than an hour, some women may have cramps for a day
or longer.

• May also have some light bleeding for several days.

• Most likely be placed in the recovery room immediately after the

procedure. Most hospitals and outpatient clinics will keep you for an
 hour or until you become fully awake. You will need to arrange for a
ride home.

• It is suggested that do not drive for at least 24 hours after anesthesia.

This is recommended even after a sedative/local anesthesia because
these drugs can temporarily impair your coordination and response
time.

• Naproxen or ibuprofen are usually given for relief from cramping.

Narcotics are seldom, if ever, needed for the pain following the D&C.