Dilation and Curettage (D and C)

Also known as a D&C procedure, dilation and curettage is a procedure used to remove the fetus after a miscarriage, stop the bleeding and prevent infection to the mother. The main goal of treatment during and after a miscarriage occurs is oftentimes to prevent hemorrhaging and/or infection. After a miscarriage your body will either expel the remaining tissue or it won’t. If it doesn’t, a D&C procedure is likely to happen next.

The D stands for dilation and means enlarging, while the C stands for curettage and means scraping. Combined, the procedure involves enlarging the entrance of the uterus so that enough room is available for a thin, sharp instrument to come in and scrape away the lining of the uterus and take tissue samples. It’s a minor surgery that is performed routinely in hospitals, surgery centers and clinics.

Why Do a D&C Procedure?

Twenty years ago this procedure wasn’t available to women who had a miscarriage. Instead, doctors performed hysterectomies to complete the removal of the uterus/womb. Nowadays it’s more common to happen after a miscarriage occurs after the first 13 weeks of pregnancy, after an incomplete miscarriage, and even after a normal, healthy, full-term delivery when the uterus has not pushed out all of the fetal or placental tissue. If tissue is left behind after birth, it can cause bleeding that could be life-threatening.

Doctors are not as quick these days to perform this procedure since there are new advances in diagnosis, non-surgical hormonal therapies and anti-hormonal therapies. When your doctor says he/she will perform the D&C it’s because there is either a pelvic infection, a blood clotting disorder, or if there is some sort of serious medical problem such as heart disease that would make anesthesia risky.

Risks of D&C

There are unfortunately risks involved with this procedure, including:

• Adhesions
• Infections and spreading of infections
• Uterine perforation
• Future pregnancy complications
• Hemorrhage
• Asherman Syndrome

You must understand that these procedures are generally done blindly. Complications are sometimes inevitable due to this. The sharp instrument that is used to scrape away the remaining tissues can possibly puncture the uterus. Plus, future pregnancy complications that can arise include ectopic pregnancies, miscarriages, placenta previa, and placenta accreta. This is why doctors have been reluctant to use this procedure unless it is absolutely necessary, and when they do they always perform a hysteroscopy at the same time. Hysteroscopy’s allow doctors to see inside the uterus, further allowing them to perform the D&C more accurately.

During the D&C Procedure

This procedure can be done in either an outpatient or inpatient hospital or other type of surgical center, such as a clinic. The following list describes what you will go through during the D&C procedure.

1. You’ll probably be given a sedative to relax, in most cases it’s a general anesthesia

2. You may receive antibiotics via IV or orally to help prevent infections

3. The doctor will examine your cervix to see if it’s open or closed. If it’s closed dilators are inserted to open the cervix, allowing the surgical instruments to pass in and out. A speculum is placed inside you to keep the cervix open

4. Using a vacuum aspiration or suction curettage, the contents of the uterus are removed

5. Removed tissue samples are sent to pathology labs for testing

6. Once the doctor sees the uterus firm up and bleeding has stopped or is minimal, the speculum is removed and you are sent to recovery.

Is a D&C Right For You?

Fifty percent of women who miscarry do not undergo a D&C procedure. Generally if a woman miscarries before 12 weeks gestation, her body will be able to safely pass the miscarriage through completely. In most cases, women do not even know they are pregnant and mistake the miscarriage for an extra heavy period. Doctors usually allow the mother to choose whether or not to perform the D&C or to miscarry naturally. Some women prefer to go through the miscarriage in the comfort of their home, trusting their body knows what to do. Other times, women do not want to risk future problems and elect to have the D&C preformed. It will depend on your situation; how you feel, how your body is handling the miscarriage, how you are emotionally handling the miscarriage, your doctor’s opinion and the risks involved, to determine whether or not a D&C is right for you.