D&C (Dilation & Curettage)

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). A D&C is often done as an adjunct procedure to a hysteroscopy and/or polypectomy. The D&C is a safe procedure that is done for a variety of reasons. A D&C may be required to diagnosed and/or treat a problem such as heavy or prolonged menstruation, as well as unexplained bleeding between periods. There are many possible causes for these menstrual abnormalities, one of the most common being a hormonal imbalance. Hormonal imbalance causes a thickening of the endometrium which sometimes causes irregular or prolonged menstrual cycles. Although this can happen at any age it most commonly occurs in young women just starting menstruation and in older pre-menopausal women. Dilation and Curettage also provides important information about whether uterine cancer is present.

Types of D&C:

D&C is usually a diagnostic procedure and seldom is therapeutic.

A D&C and hysteroscopy are often performed to make certain patient's symptoms are not caused by uterine cancer or precancerous changes. It is, of course, important to detect cancer in its earliest, most curable stages.

Therapeutic D&C: A D&C is often planned as treatment when the source of the problem is already known. One situation is an incomplete miscarriage or even full-term delivery when, for some reason, the fetal or placental tissue inside of the uterus has not been completely expelled. If tissue is left behind, excess bleeding can result, perhaps even life-threatening conditions.

Conditions:

It is a therapeutic gynecological procedure used to treat many conditions:

D&Cs are commonly performed for the diagnosis of gynecological conditions leading to abnormal uterine bleeding or to resolve abnormal uterine bleeding by removing the tissues in the uterus including postpartum retained placenta. The causes of irregular or abnormal bleeding include: Fibroids and polyps or an endometrial cancer.
To remove excess uterine lining in women who have conditions such as polycystic ovary syndrome.
D & C removes the retained tissue in the case of a missed or incomplete miscarriage and rarely used as a method of first trimester abortion.

Procedure:

Dilation: The cervix is holding 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 to expand the cervix. Another method being used with increasing frequency is to insert laminaria tents, cigarette-shaped pieces of 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: After dilation, the doctor holds the vagina open again with the speculum. With the view of hysteroscope, a tiny spoon is inserted to obtain a specimen of the cervical lining. The doctor may see fibroids, polyps, or overgrowths of the endometrium. At that time, instruments may be inserted through the hysteroscope and biopsy, or removal, of the fibroids, polyps, or endometrial overgrowths may be accomplished. A slightly longer and larger curette is inserted through the dilated cervix and up into the uterus. With steady, gentle strokes, the uterine wall is scrapped. This tissue is sent to the lab for analysis. When the curettage is completed, the instruments are removed.

Recovery: The recovery time is generally short following a D&C. Cramps, similar to menstrual cramps, will probably be the patient's strongest sensation. Although most women experience cramps for less than an hour, some women may have cramps for a day or more. The patient may also have some light bleeding for several days. The patient will most likely be placed in the recovery room immediately after the procedure. Most hospitals and outpatient clinics will keep the patient for an hour or until she is fully awake. It is recommended to contact your doctor if you have fever above 100.4 F or 38 C, severe persistent pain or cramps not relieved by ibuprofen or naproxen, prolonged or heavy bleeding or a foul-smelling discharge from the vagina.

Risk factors of dilation and curettage:

Hemorrhage: Heavy bleeding is rare, but it can happen if an instrument injures the walls of the 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.
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.
Asherman syndrome: This is a rare condition 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 lead to infertility and cessation of menstrual periods.
Missed disease: Since the procedure cannot completely remove all the endometrium, there is a chance that disease could go undetected. To avoid this the procedure done with a hysteroscopy