Dilation and Curettage (D and C)
What is a dilation and curettage (D&C)?
A dilation and curettage procedure is also called a D&C. It is a surgery to remove abnormal tissues in the uterus. Your healthcare provider will first expand (dilate) the lower narrow part of the uterus (cervix). Next, he or she will scrape out the lining of the uterus (endometrium) with a spoon-shaped tool.
A suction D&C uses suction to remove uterine contents. This is sometimes called a dilation and evacuation (D&E).
Why might I need a D&C?
Your healthcare provider may suggest a D&C to diagnose or treat abnormal uterine bleeding. He or she may also use D&C to find cancer, or as part of infertility testing.
Abnormal bleeding may be caused by fibroids, polyps, or cancer of the uterus or its lining. Abnormal uterine bleeding may also be due a hormone problem. This is especially true in women around menopause.
Your provider may use a D&C after miscarriage to remove the fetus and other tissues if they have not all passed on their own. Infection or heavy bleeding can happen if these tissues are not fully removed. This type of D&C may also be called a surgical evacuation of the uterus or a D&E.
Sometimes after giving birth, small pieces of the placenta stay stuck to the endometrium and are not passed. This can cause bleeding or infection. Your provider may use D&C to remove these pieces so that the endometrium can heal.
Your healthcare provider may have other reasons to suggest a D&C.
What are the risks of a D&C?
Some possible complications of a D&C may include:
Tearing of the uterine wall or bowel
Scar tissue may develop inside the uterus
Tell your healthcare provider if you are allergic to or sensitive to medicines, iodine, or latex.
If you are pregnant or think you could be, tell your healthcare provider.
You may have other risks based on your condition. Be sure to discuss any concerns with your healthcare provider before the procedure.
A vaginal, cervical, or pelvic infection may interfere with a D&C.
How do I get ready for a D&C?
Here is what to expect:
Your healthcare provider will tell you about the procedure and you can ask questions.
You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
Your healthcare provider will review your health history and do a physical exam to be sure you are in good health before having the procedure. You may have blood tests or other diagnostic tests.
If you get general, spinal, or epidural anesthesia, you will need to fast for 8 hours before the procedure, generally after midnight. If your procedure is done under local anesthesia, your healthcare provider will give you instructions about fasting.
If you are pregnant or think you could be, tell your healthcare provider. He or she may urge a pregnancy test before the procedure.
Tell your healthcare provider if you are sensitive to or are allergic to any medicines, iodine, latex, tape, or anesthesia.
Tell your healthcare provider of all medicines (prescribed and over-the-counter) and herbal supplements that you are taking.
Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may be told to stop these medicines before the procedure.
If a sedative is given before the procedure, you will need someone to drive you home afterwards.
You may want to bring a sanitary pad to wear home after the procedure.
Follow any other instructions your provider gives you to get ready.
What happens during a D&C?
Your healthcare provider may do a D&C in his or her office or during a hospital stay. Procedures may vary based on your condition and your healthcare provider's practices.
The type of anesthesia will depend on what procedure you have. You may be asleep under general anesthesia. Or, you may stay awake under spinal or epidural anesthesia. In this case, you will have no feeling from your waist down. The anesthesiologist will continuously check your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
Generally, a D&C follows this process:
You will remove your clothing and put on a hospital gown.
You will empty your bladder.
You will be positioned on an operating or exam table, with your feet and legs supported as for a pelvic exam.
A healthcare provider may start an intravenous (IV) line in your arm or hand.
A healthcare provider will insert a urinary catheter.
Your healthcare provider will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to expose the cervix.
Your cervix may be cleaned with an antiseptic solution.
For local anesthesia, the healthcare provider may numb the area using a small needle to inject medicine.
If general or regional anesthesia is used, the anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during surgery.
A type of forceps may be used to hold the cervix steady for the procedure.
The inside of the cervical canal may be scraped with a small curette if the cervical tissue needs to be examined.
A thin, rod-like instrument, called a uterine sound, may be inserted through the cervical opening to determine the length of the uterus. If you have local anesthesia, this may cause some cramping. The sound will then be removed.
Your healthcare provider will insert a series of thin rods to expand the cervix. Each rod is larger in diameter than the previous one. This process will gradually enlarge the opening of the cervix so that he or she can insert the curette.
Your provider will insert the curette through the cervical opening into the uterus and pass it across the uterine lining to scrape away the tissues. In some cases, he or she may use suction to remove tissues. If you have local anesthesia, this may cause cramping.
Your provider will remove the instruments and send any tissues collected to the lab for testing.
If he or she removed pregnancy tissues (called products of conception), your provider will send them to the lab for testing for genetic problems.
What happens after a D&C?
The recovery process will vary based on the type of procedure done and type of anesthesia that was used.
If you get regional or general anesthesia, you will go to the recovery room and be watched. Once your blood pressure, pulse, and breathing are stable and you are alert, you will go to your hospital room or be discharged home. If you had this procedure as an outpatient, have another person drive you home.
After a D&C using local anesthesia, you may rest for about 2 hours before going home.
You may want to wear a sanitary pad for bleeding. It is normal to have some spotting or light vaginal bleeding for a few days after the procedure.
You may have cramping for the first few days after a D&C.
Do not use tampons, or have sex for 2 to 3 days after a D&C, or for a period recommended by your healthcare provider.
You may also have other limits on your activity, including no strenuous activity or heavy lifting.
Because a D&C removes the lining of the uterus, the lining must build back up. Your next period may start earlier or later than usual.
You may go back to your normal diet unless your healthcare provider tells you otherwise.
Take a pain reliever for cramping or soreness as recommended by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines.
Your healthcare provider will advise you on when to return for more treatment or care.
Tell your healthcare provider if you have any of the following:
Foul-smelling drainage from your vagina
Fever and/or chills
Severe belly pain
Your healthcare provider may give you other instructions after the procedure, based on your situation.
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how will you get the results
Who to call after the test or procedure if you have questions or problems
How much will you have to pay for the test or procedure