Dilation and curettage (D&C)

Dilatation And Curettage Doctors Hospital in Pune

Dilation and curettage (D&C) :

Dilation and curettage (D&C) is a procedure to remove tissue from inside your uterus. Doctors perform dilation and curettage to diagnose and treat certain uterine conditions — such as heavy bleeding — or to clear the uterine lining after a miscarriage or abortion.
In a dilation and curettage — sometimes spelled "dilatation" and curettage — your doctor uses small instruments or a medication to open (dilate) your cervix — the lower, narrow part of your uterus. Your doctor then uses a surgical instrument called a curette to remove uterine tissue. Curettes used in a D&C can be sharp or use suction.

Why it's done?

Dilation and curettage can diagnose or treat a uterine condition.

To diagnose a condition :

Your doctor might recommend a type of D&C called endometrial sampling to diagnose a condition if:

    • You have abnormal uterine bleeding.
    • You experience bleeding after menopause.
    • Your doctor discovers abnormal endometrial cells during a routine test for cervical cancer.

    To perform the test, your doctor collects a tissue sample from the lining of your uterus (endometrium) and sends the sample to a lab for testing. The test can check for:

      • Endometrial hyperplasia — a precancerous condition in which the uterine lining becomes too thick.
      • Uterine polyps.
      • Uterine cancer.

      To treat a condition :

      When performing a therapeutic D&C, your doctor removes the contents from inside your uterus, not just a small tissue sample. Your doctor may do this to:

        • Clear out tissues that remain in the uterus after a miscarriage or abortion to prevent infection or heavy bleeding.
        • Remove a molar pregnancy, in which a tumor forms instead of a normal pregnancy.
        • Treat excessive bleeding after delivery by clearing out any placenta that remains in the uterus.
        • Remove cervical or uterine polyps, which are usually noncancerous (benign).

        Your doctor may perform the D&C along with another procedure called a hysteroscopy. During a hysteroscopy, your doctor inserts a slim instrument with a light and camera on the end into your vagina, through your cervix and up into your uterus.

        Your doctor then views the lining of your uterus on a screen, noting any areas that look abnormal, making sure there aren't any polyps and taking tissue samples as needed. During a hysteroscopy, your doctor can also remove uterine polyps and fibroid tumors.

        Risks :

        Dilation and curettage is usually very safe, and complications are rare. However, there are risks. These include:

          • Perforation of the uterus :Perforation of the uterus occurs when a surgical instrument pokes a hole in the uterus. This happens more often in women who were recently pregnant and in women who have gone through menopause.
            Most perforations heal on their own. However, if a blood vessel or other organ is damaged, a second procedure may be necessary to repair it.
          • Damage to the cervix : If the cervix is torn during the D&C, your doctor can apply pressure or medicine to stop the bleeding, or can close the wound with stitches (sutures).
          • Scar tissue on the uterine wall : Rarely, a D&C results in development of scar tissue in the uterus, a condition known as Asherman's syndrome. Asherman's syndrome happens most often when the D&C is done after a miscarriage or delivery.
            This can lead to abnormal, absent or painful menstrual cycles, future miscarriages and infertility.
          • Infection : Infection after a D&C is possible, but rare.

          Contact your doctor if you experience any of the following after a D&C:

            • Bleeding that's heavy enough that you need to change pads every hour.
            • Fever.
            • Cramps lasting more than 48 hours.
            • Pain that gets worse instead of better.
            • Foul-smelling discharge from the vagina.

            How you prepare :

            Dilation and curettage may be performed in a hospital, clinic or your doctor's office, and it's usually done as an outpatient procedure.

            Before the procedure:

              • Follow your doctor's instructions on limiting food and drink.
              • Arrange for someone to help you get home because you may be drowsy after the anesthesia wears off.
              • Clear your schedule to allow enough time for the procedure and recovery afterward. You'll likely spend a few hours in recovery after the procedure.

              In some cases, your doctor may start the process of dilating your cervix a few hours or even a day before the procedure. This helps your cervix open gradually and is usually done when your cervix needs to be dilated more than in a standard D&C, such as during pregnancy terminations or with certain types of hysteroscopy.

              To promote dilation, your doctor uses a medication called misoprostol (Cytotec) — given orally or vaginally — to soften the cervix or inserts a slender rod made of laminaria into your cervix. The laminaria gradually expands by absorbing the fluid in your cervix, causing your cervix to open.