Dilation and Curettage

Dilation and curettage, also called a D&C, is a surgical procedure in which the cervix of the uterus is dilated (expanded) and the endometrial lining of the uterus is scraped with a curette (a loop-, ring-, or scoop-shaped instrument with a long handle).

Purpose

This procedure is often used in the diagnosis of diseases of the uterus (such as cancer) and to halt excessive bleeding. It is also used to perform an abortion and may be employed after a miscarriage (involuntary expulsion of a fetus before it is able to live on its own) to remove any remains of tissue and thereby lower the risk of hemorrhage and infection.

Dilation alone may be performed to enlarge the passageway out of the uterus. This might be done if a severely narrowed cervix is causing painful menstruation because of restricted flow of menstrual fluid. For treatment of this problem, multiple dilations may be necessary since the cervix will often become narrow again after several months.

The Procedure

A D&C is a relatively minor procedure, seldom requiring hospital admission. Because the rectum should be empty before the procedure, an enema may be given; the urinary bladder should also be emptied.

The procedure is performed in an operating room under sterile conditions. Anesthesia may be general (the patient is put to sleep) or local. The patient rests on her back with her feet in stirrups. The surgeon inserts metal dilators of progressively larger sizes into the cervix until it is open enough to permit the insertion of the surgical instruments.

A curette is used to remove endometrial tissue. Special forceps may also be used to remove tissue. When the operation is finished, an absorbent pad is placed over the entrance to the vagina. The pad is checked every 15 minutes for two hours, and excessive bleeding is reported to the physician.

Mild painkillers should be enough to control discomfort from the operation. If there is pain in the abdomen that cannot be relieved in this way or that is continuous or sharp, it should be reported immediately. Some difficulty in urinating is to be expected immediately after the procedure.

In most cases, the patient stays in bed for one to two hours after surgery. Most women return home several hours after the procedure or the next day. A return to many daily activities is possible immediately, and in a week all normal physical activities may be resumed. Sexual intercourse and use of tampons are not recommended, however, until after the follow-up visit to the doctor (usually about two weeks after the procedure).

Risks

The principal risks of a D&C are hemorrhage, infection, and perforation (puncture) of the uterus. The latter is more likely during pregnancy, when the uterine walls are especially soft and thin.