Gynaecology

Dilation and curettage (D&C) is a minor surgical procedure that enlarge (dilate) the cervix (opening of the uterus) so that an instrument can be inserted into the uterus and scrape (curettage) away and remove the lining of the uterus.

There are two types of D&C, namely diagnostic D&C and therapeutic D&C. In a diagnostic D&C, the obtained tissues from the uterine scraping are sent to pathological laboratory to diagnose the medical condition of the patient. While therapeutic D&C is performed to remove the unwanted contents in the uterus.

Indication for D&C

Irregular bleeding: You may experience irregular bleeding from time to time, including spotting between periods. If the spotting develops into continuous midcycle bleeding, your doctor may perform a D&C to investigate the cause of bleeding. The endometrium lining tissue is sent to the laboratory for histopathological analysis.

Heavy vaginal bleeding: Bleeding with long, heavy periods, or bleeding after menopause, can signal a number of problems.

a) Fibroids and polyps: Fibroid are non-cancerous muscle growths that appear within the uterus or on its surface. Some of them grow on the wall of the uterus while others grow into the cavity of the uterus. When it enlarged, there will be heavy menses and severe pain. Polyps are fleshy tissues that grow from the uterine lining into the uterine cavity. Both the polyps and fibroids can cause irregular vagina bleeding. Hysteroscopy (a telescope inserted into the uterine cavity) can differentiate the two.

b) Endometrial cancer: D&C are commonly performed for woman above 40 years of age with abnormal vaginal bleeding to confirm cancer of the endometrium.

Therapeutic D&C: D&C is done for missed abortion or incomplete miscarriage. If the product of conceptus is left in the uterine cavity untreated, the woman will have heavy vaginal bleeding, infection will set in. The product of conceptus will prevent the uterus from contracting and it is a good medium for bacteria to grow. D&C is also done when there is retained product of conceptus after a normal delivery. The retained tissue in the uterine cavity will cause excessive bleeding which can be life threatening to the mother.

Reasons for a Therapeutic Dilation and Curettage

Therapeutic dilation and curettage (D&C) is performed to remove the unwanted contents in the uterus. The reasons for doing a D&C are:

Miscarriage ¨C In a miscarriage, the tissues of the pregnancy may be retained in the uterus. D&C is done to remove the retained tissues and prevent infection.
Abortion ¨C When a woman has decided to terminate her pregnancy due health reason, a D&C is performed to remove the product of conceptus (POC).
Molar pregnancy ¨C D&C is performed to remove the polar pregnancy. Molar pregnancy has a 10% risk of becoming cancerous later.
Prolonged or excessive vaginal bleeding ¨C D&C is a short-term treatment for prolonged or excessive vaginal bleeding that does not respond to medical treatment.
Postpartum haemorrhage ¨C Postpartum haemorrhage is often due to retained POC. D&C will evacuate the retained POC and stop the bleeding.

Procedures of Dilation and Curattage

You are required to fast 6 hours prior to the procedure.
Anaesthetic is then given to you. It can be general or local anaesthesia.
The vagina is held opened with a speculum.
The cervix (opening of the uterus) is enlarged with a few dilators (thin and flexible metal rod) of different sizes, until the cervix dilates to the width of 8 mm.
A curette (metal loop on the end of a long, thin handle) is placed through the dilated cervix and up to the uterus cavity.
The uterine wall is scraped and sucked by applying controlled electrically powered suction.
The instruments are removed after the curettage is completed.
You will be transferred to the recovery room to rest for an hour or until you become fully awake. You will need to arrange for someone to bring you home because you cannot drive for the next 24 hours.

The entire procedure takes about 20 minutes.

Precautions after Dilation and Curettage

Avoid sexual intercourse for the next 2 weeks. Your dilated cervix needs time to return to its normal size.
Do not use tampons or douches for 2 weeks.
You can resume your routine activities within a day or two.
You will have your next menses within 4 to 6 weeks.

How safe is Dilation and Curettage?

Overall, dilation and curettage (D&C) is safe, simple and has little risk. It is safe if it is performed by a trained doctor in an equipped clinic or hospital.

Risks and Complications of Dilation and Curettage

You may experience light bleeding and menstrual cramps after dilation and curettage (D&C) for a few hours to several days. Although the happening of serious complications after a D&C is rare, the possibility is there. The complications include:

Infections, chance: 10%
Repeat D&C for bleeding or retained product of conceptus (POC), chance: 1%
Injury to the cervix, 1%
Uterine perforation, chance: 0.2%
severe bleeding that requires transfusion, chance: 0.1%
Maternal mortality, chance: 0.001%

Contraindication for D&C

Vaginal infection: If you have an obvious infection involving your lower reproductive tract, then there is a chance that the surgical instruments will bring along bacteria from the vagina and cervix into the uterine cavity and fallopian tubes. Spread of infection to the uterine cavity and fallopian tube will later lead to infertility. For these reasons, your doctor may prefer to wait until after the infection has cleared up with antibiotics treatment.

Blood clotting disorders: Woman with bleeding disorder, may have heavy bleeding after D&C. This woman should have their bleeding disorder temporarily corrected before the procedure.

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