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Dilation and curettage - D&C
Reviewed by Dr Philip Owen, consultant obstetrician and gynaecologist
Curettage of the uterus (womb) is the scraping of the lining of the uterus (the endometrium). The procedure is commonly known as dilation and curettage or D&C.
When is D&C carried out?
There are two main reasons for performing a D&C:
an evacuation D&C is performed in a recently pregnant woman to remove tissue remaining in the womb.
After, or sometimes during, a miscarriage, the gynaecologist will examine you to see if there is any tissue from the pregnancy remaining in the womb.
An ultrasound scan is the most reliable way to determine this. An evacuation is usually advised to avoid heavy bleeding and prevent a possible infection of the uterus.
An alternative to surgery is a medical evacuation that uses tablets to cause the womb to contract and empty itself. The success rate of a medical evacuation in completely emptying the uterus is slightly less than the surgical approach, but is an option for some women.
If you miscarried at an early stage in pregnancy, or if the amount of remaining tissue is small, a D&C may not be necessary since the remaining tissue will be passed as part of the next period.
What happens during a D&C?
First you will be given a general anaesthetic by an anaesthetist.
The gynaecologist opens (dilates) the cervix with instruments called dilators, and then inserts a hollow tube through the cervix. Suction is applied to remove the retained tissue.
The procedure usually takes less than five minutes.
Warning signs
Contact your doctor if you experience any of these symptoms after a D&C:
heavy bleeding with large clots
severe lower abdominal pain
bleeding
smelly vaginal discharge
a high temperature.
How soon can you return to work after a D&C?
Most women will take the following day off work, but, physically, you recover quickly.
Most women experience psychological effects after a miscarriage, because the pregnancy might have been anticipated with much joy. It is helpful to talk through thoughts and feelings with friends and relatives or with your midwife or doctor.
It is normal to experience irregular bleeding in the days following the D&C.
Why are gynaecological curettages performed?
Sometimes, the character or amount of a woman's period can change. Or there may be breakthrough bleeding or spotting in between periods or during sexual intercourse. Such changes can be caused by hormonal disturbances or may be due to a disease of the cervix or uterus.
Older women, especially those who experience postmenopausal bleeding, receive a gynaecological D&C. A gynaecologist will scrape (curette) the lining of the womb to make a diagnosis and find out which treatment is best.
Few women under the age of 40 require this procedure because disease in the uterus is rarely seen in young women.
How is a gynaecological curettage performed?
Gynaecological curettage is often an outpatient investigation that is performed in hospital by a gynaecologist.
The gynaecologist will perform a pelvic examination. After this, a small tube (the width of a very thin straw) is inserted in the uterus. A biopsy of the lining of the womb can be obtained.
A woman usually experiences discomfort similar to a painful period, but this passes within seconds.
The sample is sent to a pathologist for examination and results are ready within a week. However, this kind of D&C provides a limited amount of information.
Most gynaecologists recommend a hysteroscopy (telescopic examination of the inside of the womb) as well as the biopsy procedure. Most hysteroscopy examinations can be performed without general anaesthesia.
Sometimes a D&C (with or without a hysteroscopy) is performed under general anaesthesia. This is usually done if the gynaecologist anticipates that the neck of the womb will be difficult to dilate or if the woman is very anxious or requests a general anaesthetic.
Rarely, a woman may need an emergency D&C if she has heavy bleeding that can't be stopped with tablet treatment. (or in case Jesus isn't within reach to touch the hem of his garment) In such cases, the D&C is used to treat the problem. However a D&C is usually used to make a diagnosis, and is not used as part of treating the bleeding problem.
How soon can you return to work after a gynaecological curettage?
After a curettage, it is a good idea to relax for the rest of the day, but recovery is quick. (except for recovering from the anesthesia) It is normal to have a small amount of vaginal bleeding for a few days afterwards.
Contact your doctor if heavy bleeding occurs (similar to a heavy period) or if you have severe lower abdominal pain or a high temperature.
Are there any risks with a D&C?
Almost none: the medical or surgical procedure is virtually risk free, and complications following a D&C are rare.
Possible complications include:
Reviewed by Dr Philip Owen, consultant obstetrician and gynaecologist
Curettage of the uterus (womb) is the scraping of the lining of the uterus (the endometrium). The procedure is commonly known as dilation and curettage or D&C.
When is D&C carried out?
There are two main reasons for performing a D&C:
an evacuation D&C is performed in a recently pregnant woman to remove tissue remaining in the womb.
- a gynaecological D&C is part of the investigation of a woman who is experiencing heavy or irregular periods or vaginal bleeding after the menopause.
After, or sometimes during, a miscarriage, the gynaecologist will examine you to see if there is any tissue from the pregnancy remaining in the womb.
An ultrasound scan is the most reliable way to determine this. An evacuation is usually advised to avoid heavy bleeding and prevent a possible infection of the uterus.
An alternative to surgery is a medical evacuation that uses tablets to cause the womb to contract and empty itself. The success rate of a medical evacuation in completely emptying the uterus is slightly less than the surgical approach, but is an option for some women.
If you miscarried at an early stage in pregnancy, or if the amount of remaining tissue is small, a D&C may not be necessary since the remaining tissue will be passed as part of the next period.
What happens during a D&C?
First you will be given a general anaesthetic by an anaesthetist.
The gynaecologist opens (dilates) the cervix with instruments called dilators, and then inserts a hollow tube through the cervix. Suction is applied to remove the retained tissue.
The procedure usually takes less than five minutes.
Warning signs
Contact your doctor if you experience any of these symptoms after a D&C:
heavy bleeding with large clots
severe lower abdominal pain
bleeding
smelly vaginal discharge
a high temperature.
Most women will take the following day off work, but, physically, you recover quickly.
Most women experience psychological effects after a miscarriage, because the pregnancy might have been anticipated with much joy. It is helpful to talk through thoughts and feelings with friends and relatives or with your midwife or doctor.
It is normal to experience irregular bleeding in the days following the D&C.
Why are gynaecological curettages performed?
Sometimes, the character or amount of a woman's period can change. Or there may be breakthrough bleeding or spotting in between periods or during sexual intercourse. Such changes can be caused by hormonal disturbances or may be due to a disease of the cervix or uterus.
Older women, especially those who experience postmenopausal bleeding, receive a gynaecological D&C. A gynaecologist will scrape (curette) the lining of the womb to make a diagnosis and find out which treatment is best.
Few women under the age of 40 require this procedure because disease in the uterus is rarely seen in young women.
How is a gynaecological curettage performed?
Gynaecological curettage is often an outpatient investigation that is performed in hospital by a gynaecologist.
The gynaecologist will perform a pelvic examination. After this, a small tube (the width of a very thin straw) is inserted in the uterus. A biopsy of the lining of the womb can be obtained.
A woman usually experiences discomfort similar to a painful period, but this passes within seconds.
The sample is sent to a pathologist for examination and results are ready within a week. However, this kind of D&C provides a limited amount of information.
Most gynaecologists recommend a hysteroscopy (telescopic examination of the inside of the womb) as well as the biopsy procedure. Most hysteroscopy examinations can be performed without general anaesthesia.
Sometimes a D&C (with or without a hysteroscopy) is performed under general anaesthesia. This is usually done if the gynaecologist anticipates that the neck of the womb will be difficult to dilate or if the woman is very anxious or requests a general anaesthetic.
Rarely, a woman may need an emergency D&C if she has heavy bleeding that can't be stopped with tablet treatment. (or in case Jesus isn't within reach to touch the hem of his garment) In such cases, the D&C is used to treat the problem. However a D&C is usually used to make a diagnosis, and is not used as part of treating the bleeding problem.
How soon can you return to work after a gynaecological curettage?
After a curettage, it is a good idea to relax for the rest of the day, but recovery is quick. (except for recovering from the anesthesia) It is normal to have a small amount of vaginal bleeding for a few days afterwards.
Contact your doctor if heavy bleeding occurs (similar to a heavy period) or if you have severe lower abdominal pain or a high temperature.
Are there any risks with a D&C?
Almost none: the medical or surgical procedure is virtually risk free, and complications following a D&C are rare.
Possible complications include:
- in recently pregnant women there is the small risk of making a hole in the uterus (uterine perforation) because the wall of the recently pregnant womb is very soft. (wince!)
- sometimes tissue may be left behind (incomplete evacuation). This tissue is usually passed without complication, but increased bleeding or infection may require a repeat procedure.
- the risks of a D&C in non-pregnant women is much lower, although there is still the small risk of the uterus being perforated.
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