Dilation and curettage also known as D & C, is a surgical procedure to remove tissue from inside of the uterus. In general terms it is known as a process of cleaning uterus. It is used to diagnose and treat various uterine problems.
This process is named so, as it involves the dilation of the cervix and using a curettage to scrape the inner side of the uterus.
This is a simple process which takes only 10- 15 minutes. This process is majorly performed in hospitals, clinics, operation theater etc by obstetricians and gynecologists.
During dilation, cervix is dilated i.e. opened and in curettage, tissues are extracted from the uterine wall. Curettage can be done by scraping inner lining of uterus with a sharp curette or with a suction type curette.
Dilation and curettage D & C surgery is recommended in following conditions:
- Abnormal Bleeding During Menstrual Period: Some woman have a problem of abnormal menstrual flow during period or bleeding between two periods. This problem can be cured with this surgery.
- Abortion: If a woman is having unwanted pregnancy or is having a problem in keeping the pregnancy she can get it aborted by D and C process. This procedure is also applied to clean any remaining tissue after a miscarriage.
- Molar Pregnancy: Molar pregnancy is the development of a non cancerous tumor in uterus in place of a normal pregnancy. It is formed as a result of non viable pregnancy.
- Fibroid In Uterus: Fibroid in uterus can be removed by D and C procedure.
- Excess Bleeding: This process is also used to treat excess bleeding after delivery. It clears out any remaining placenta after delivery from the uterus and reduce bleeding.
- Endometrial Hyperplasia: In this condition uterine lining become too thick. It is a precancerous condition. Tissues extracted from uterus by D and C process are tested in lab for this condition.
- Uterine Cancer: D and C is also used to eliminate the doubt of uterine cancer. Tissue are extracted by D and C from the uterus and tested in lab if these are cancerous cells or not.
- Cramping Or Pain In Any Body Part: Generally women come to doctor with complaint of continuous pain or cramping. To diagnose the cause of this cramping, doctors suggest them D and C.
Pre- Procedure Of Dilation And Curettage
Since, D and C is performed on the most sensitive part of a woman, any negligence can cause a serious issue. Hence, to keep the conditions normal, doctors take every precaution and do every necessary test of woman undergoing this process.
Following tests are performed before Dilation and Curettage:
Pregnancy Test: This process is also performed for abortion, so it is necessary to check if the women is pregnant or not.
Allergy: Before the procedure, doctors check if the patient is allergic to anything or not.
Bleeding Disorders: Before performing this surgery, doctors thoroughly study the history of bleeding disorders of the patient.
Step 1: Anesthesia
This is the first step of this procedure. A general anesthesia is given to the patient, so that she don’t feel any pain during the process.
Step 2: Inserting Scapulum
After injecting anesthesia, scapulum is inserted into the vagina to visualise cervical opening. Scapulum is a surgical instrument which is used to expand the tissue to easily access the surgical field.
Step 3: Inserting Rod
After inserting scapulum, surgeon insert a series of thicker and thicker rods into the cervix to slowly dilate it.
Step 4: Curettage
After dilating the cervix, a spoon shaped device named as curettage is used to scrape tissues from inside the uterus. Sometimes a cannula is also used to suction out any remaining tissue inside uterus.
Step 5: Extracting the instruments
After completion of the process, doctor extracts all the instruments that are applied in the uterus and sends the extracted tissues to lab for examination.
Many other steps are done following the procedure and these are as follows:
Shifting to recovery room: After the D and C procedure, patient is transferred to a recovery room where her health is monitored.
Painkillers: Immediately after the procedure, patient have bleeding and pain. To deal with this, painkillers are given to the patient.
Hospital Stay: This process do not take much time and patient is allowed to leave hospital in a few hours.
In a few cases it is seen that woman is having excess bleeding, in such cases patients are advised to stay in hospital overnight and when they are stable, they are allowed to go home.
There are some risks in the D and C process, but some precautions can be prevent them, which are as follows:
Avoid Use Of Tampons And Menstrual Cups: It is normal to have some vaginal bleeding after the D and C procedure, but some women have high amounts of bleeding. In such a situation, they should use the sanitary napkin and should avoid using tampon or menstrual cups.
Mild Exercises: To avoid any type of risk, mild exercises such as moving, dipping, etc should be done. Doing this strengthens the muscles and decreases the chance of having a problem of cramps.
Avoid Sexual Activities: Since D and C process is done in the female uterus, therefore, after this process, they should not do sexual activities for some time as it can be detrimental to them.
Avoid Heavy Or Tiring Work: After the D and C process, patient will feel weakness for some time. So, heavy or tiring work should not be done while recovery period.
Should Remain In Touch With The Doctor: If a woman has had D & C recently, then she should be in touch with the doctor till the doctor declares that woman is completely healthy.
Like any other surgery D and C has some complications and risks. These are as follows:
Perforation Of Uterus: There is a risk that an instrument might poke into the uterus and perforate it. However perforation mostly heal on their own but if a blood vessel or an organ has been damaged, it will require an another procedure to repair it.
Also watch Dr. Deepa Dureja(Obstetrics & Gynecologist) briefing The Risks & Complications of Dilation & Curettage.
Asherman’s Syndrome: It is a condition in which scar tissue form inside the uterus or cervix. However, In rare cases D and C result in scarring but if it happens, it leads to irregular or absent menstrual period.
Excess bleeding: Some amount of bleeding after D and C is common but some women may have a problem of excess bleeding.
Cramping: Sometimes after this surgery women feel pain and crampings.
Abdominal Pain: After dilation and curettage some women may have a problem of abdominal pain.
Irregular Menstrual Period: After dilation and curettage next menstrual period is delayed or it is irregular.
Infection: Sometimes after dilation and curettage an infection might happen but it’s rare. If you see Symptoms of an infection, you should immediately contact your doctor. Symptoms of uterine infection after D and C are: fever, heavy bleeding, cramps for more than 48 hours, increasing pain and foul smelling vaginal discharge.