Dilation and Curettage
Also known as a D & C procedure, dilation and curettage is the procedure used to remove the fetus after a miscarriage, stop the bleeding, and prevent infection in the mother. The goal of treatment during and after a miscarriage is to prevent hemorrhaging and 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 be necessary.
The D stands for dilation, which means enlarging. The C stands for curettage, which means scraping. The procedure involves enlarging the entrance of the uterus to make room for a thin, sharp instrument to 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 Dilation and Curettage Procedure?
Twenty years ago this procedure wasn’t available to women who’d had a miscarriage. Instead, doctors performed hysterectomies to completely remove the uterus. Nowadays the dilation and curettage procedure is common in cases where a miscarriage occurs after the first 13 weeks of pregnancy, after an incomplete miscarriage, or even after a normal, healthy, full-term delivery when the uterus has not pushed out all 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, due to advances in non-surgical hormonal therapies and anti-hormonal therapies. Your doctor will only perform a dilation and curettage if there is a pelvic infection, a blood clotting disorder, or some other sort of serious medical problem.
Risks of Dilation and Curettage
There are unfortunately risks involved with this procedure, including:
- Infections and spreading of infections
- Uterine perforation
- Future pregnancy complications
- Asherman’s Syndrome
You must understand that these procedures are generally done blindly, and therefore complications are sometimes inevitable. The sharp instrument that is used to scrape away the remaining tissue can possibly puncture the uterus. Future pregnancy complications can also arise, including ectopic pregnancies, miscarriages, placenta previa, and placenta accreta. This is why doctors are generally reluctant to perform this procedure unless it is absolutely necessary, and when they do they always perform a hysteroscopy at the same time. A hysteroscopy allows the doctor to see inside the uterus, enabling them to perform the D&C more accurately.
During the Dilation and Curettage Procedure
This procedure can be done in an outpatient or inpatient hospital or in any other type of surgical center, such as a clinic. You’ll probably be given general anesthesia, and you may also be given antibiotics to help prevent infections. 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. Using a vacuum aspiration or suction curettage, the contents of the uterus are removed and sent to a pathology lab for testing. Once the doctor sees that the uterus has firmed up and bleeding has stopped or is minimal, the speculum is removed and you are sent to recovery.
Is a Dilation and Curettage the Right Procedure for You?
Fifty percent of women who miscarry do not undergo a dilation and curettage procedure. Generally, if a woman miscarries before 12 weeks of 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 to perform the D & C or to miscarry naturally. Some women prefer to go through the miscarriage in the comfort of their homes. Other women do not want to risk future problems and elect to have the D & C preformed. Whether or not a dilation and curettage is right for you 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.