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Dilation and Curettage (D&C)
A dilation and curettage (also called a dilatation and curettage, or D&C surgery) is a procedure used to remove the contents of the uterus. The name comes from the dilation of the cervix and the use of a curette, a sharp surgical instrument, to scrape out the uterine contents.
Dilation and curettage is most often performed to remove tissue inside the uterus that is causing problems. The procedure is sometimes performed after a woman suffers a miscarriage or for postpartum complications, and may also be used for other conditions not directly related to pregnancy. Rarely, it is used during the first trimester for an induced abortion; it is also used to remove any remaining tissue after more common abortion procedures.
A D&C is performed while the patient is under anesthesia, usually general anesthesia (i.e. completely "asleep"). Regional or spinal anesthesia may be used instead. Rarely, a woman who wants to avoid general or regional anesthesia may decide with her doctor to use local anesthesia.
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In order for the doctor to gain access to the uterus, the cervix (the muscular opening of the uterus), must be opened (dilated). The patient is anesthetized first because the cervix is extremely sensitive. Over several hours, rods are inserted to gradually open the cervix; medication may be used to assist the process.
Once the cervix is open, a sterile curette is inserted to gently scrape the inner sides of the uterus and remove unwanted tissue. A curette is a hand-held instrument with a small, sharp-edged gouge or spoon at the end. This part of the procedure usually takes less than thirty minutes.
The patient is moved to a recovery room for a few hours to allow her to recover from the effects of anesthesia. During this time, the medical staff monitors her for complications from the surgery or anesthesia. She can normally go home the same day and resume normal activities within a few days.
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If all goes well, the patient should not experience any negative effects other than a few days of cramping and light spotting. Dilation and curettage carries a risk of uterine perforation, or a hole in the uterine wall. This surgical trauma is rare, occurring in perhaps 1% of all D&C procedures (Hefler et al. 2009). For indications related to pregnancy, the rate is higher. Laparoscopy (the use of a small camera to visualize the uterus) is used to assess whether a uterine perforation requires further treatment.
Other potential D&C complications include laceration (cuts or tears) of the uterus or cervix and heavy bleeding. Infections are very rare after D&C surgery.
Dilation and curettage often results in scarring of the uterus. This complication is known as uterine adhesions or Asherman's syndrome, and the risk increases with each subsequent D&C surgery. One study (Friedler et al. 1993) found that after one D&C, scarring occurred in about one sixth of patients and was always mild; after three procedures, about one third of patients experienced scarring, and in the majority of these cases it was severe. Uterine adhesions can cause painful periods and miscarriages, but can be treated with hormones and/or surgery.
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- S. Friedler et al. "Incidence of post-abortion intra-uterine adhesions evaluated by hysteroscopy--a prospective study." Human Reproduction 1993 Mar;8(3):442-4.
- Richard S. Guido, M.D., and Dale W. Stovall, M.D. "Dilation and Curettage (D&C)." UpToDate.com.
- L. Hefler et al. "The intraoperative complication rate of nonobstetric dilation and curettage." Obstetrics and Gynecology 2009 Jun;113(6):1268-71.
- Mayo Clinic staff. "Dilation and Curettage." MayoClinic.com.
- Web MD. "Dilation and sharp curettage for abortion."