Dilation and curettage (D and C)

Description
Dilation and curettage (D and C) is a common, minor surgical procedure that involves widening or dilating the opening of the cervix (the neck of the uterus) and gently scraping the tissue lining the uterus. This is the same layer of tissue you pass during a menstrual period.

Purpose
D and C is used to help doctors diagnose a variety of gynecological problems and treat certain conditions. The extracted tissue may be sent to the lab for further examination.

Indications
Specifically, D and C may be used to:
evaluate or treat the cause of abnormal bleeding, such as heavy menstrual bleeding or bleeding after sex, between periods or after menopause
evalute conditions relating to cancer
diagnose or treat certain conditions in the uterus, such as fibroids (noncancerous tumors of connective and muscular tissue), polyps (abnormal tissue growths) or hyperplasia (the excessive proliferation of cells)
evaluate hormonal abnormalities
remove retained products after childbirth, miscarriage or an incomplete abortion
end a pregnancy

Patient preparation
It's important to discuss your options and concerns before the procedure. If you decide to have D and C, the doctor or anesthesiologist will discuss the risks associated with the type of anesthesia you'll receive. Local anesthesia, used most often for this type of procedure, numbs a small area of the body. General anesthesia completely relaxes your pelvic muscles and prevents the sensation of pain during a deep sleep.
Your doctor will provide specific instructions to follow before surgery, which may include not eating the night before the procedure. You'll need to sign a consent form before the procedure and arrange to have someone drive you home.

Ask your doctor what type of medication you can use to manage pain after the procedure -- you may have to avoid aspirin. You'll also want to know when you can return to work and resume sexual intercourse. Make sure you understand symptoms that may indicate a problem after the procedure.


Procedure
Although every surgery has its own standard procedure, your individual health history could play a role in any variation to the procedure. Discuss these issues with your doctor.
D and C may be done in a hospital or outpatient surgical unit, depending on your general health and the reason for the procedure.

You'll be positioned on your back with your feet in stirrups. The doctor will begin with a pelvic exam to assess the size and position of your cervix and uterus.

Next, your cervix will be dilated with tapering rods (dilators) until an appropriately sized curette (a scraping instrument) can be inserted. Sometimes the dilation of the cervix is started several hours earlier by inserting a laminaria (a thin rod that causes the cervix to widen) or applying a hormone medication to the cervix.

Once the cervix is dilated, the doctor will insert the curette to scrape the lining from the uterine wall. Depending on the procedure, tissue may be removed with a suction device.

The procedure typically takes only a few minutes, but timing can vary.


Postprocedure care
While the anesthesia wears off, your temperature, blood pressure and pulse will be checked often. A sanitary pad will be used to absorb vaginal discharge, which will initially resemble a typical or somewhat heavy menstrual period.
Most women are sent home after about an hour of observation. At home, be sure to rest, drink plenty of fluids and eat healthfully. If you have general anesthesia during the procedure, you may have some restrictions on your diet immediately afterward and your recovery time may be somewhat longer.

Cramping for a day or two after D and C is typical. Light vaginal bleeding may continue for a few more days. Don't have sex, douche or use tampons for two weeks or until your doctor says it's OK -- these may cause infection while the cervix is closing.

Call the doctor if you:

have a fever
have persistent heavy clotting
have bright red or heavy vaginal bleeding or drainage
have foul-smelling discharge
have abdominal pain that worsens or persists after taking pain medication
Be sure to keep all follow-up appointments with your doctor. You'll be evaluated to make sure there are no signs of infection and you're healing as expected. Any reports of tissue samples that were taken during the procedure will be discussed during your follow-up visit.


Benefits
D and C often helps the doctor make a quicker diagnosis, which leads to optimal treatment. In some cases, simply scraping the uterine lining is enough to treat the problem.

Risks
As with any surgery, anesthesia may cause complications, such as an allergic reaction. During D and C, the uterus or surrounding organs may be punctured by the curette. Rarely, D and C can lead to infections or hemorrhaging.

Pregnancy-specific information
Again, this procedure may be used to remove retained tissue after childbirth, miscarriage or incomplete abortion. D and C may also be used to end a pregnancy. If you think you may be pregnant, be sure to discuss this with your doctor before the procedure.

Senior-specific information
Growing older isn't a risk factor for needing this procedure. Serious health conditions, such as heart or lung disease, can increase the risk of complications after D and C.