dilatation and curettage

Dilatation and Curettage

Definition

Dilatation and curettage (D & C) is a gynecological procedure in which the lining of the uterus (endometrium) is scraped away.

Purpose

D & C is commonly used to obtain tissue for microscopic evaluation to rule out cancer. D & C may also be used to diagnose and treat heavy menstrual bleeding, and to diagnose endometrial polyps and uterine fibroids. A D & C can be used as a treatment as well, to remove pregnancy tissue after a miscarriage, incomplete abortion, or childbirth. Endometrial polyps may be removed, and sometimes benign uterine tumors (fibroids) may be scraped away. D & C can also be used as an early abortion technique up to 16 weeks.

Description

D & C is usually performed under general anesthesia, although local or epidural anesthesia can also be used. A local lessens risk and costs, but the woman will feel cramping during the procedure. The type of anesthesia used often depends upon the reason for the D & C.In the procedure (which takes only minutes to perform), the doctor inserts an instrument to hold open the vaginal walls, and then stretches the opening of the uterus to the vagina (the cervix) by inserting a series of tapering rods, each thicker than the previous one, or by using other specialized instruments. This process of opening the cervix is called dilation.Once the cervix is dilated, the physician inserts a spoon-shaped surgical device called a curette into the uterus. The curette is used to scrape away the uterine lining. One or more small tissue samples from the lining of the uterus or the cervical canal are sent for analysis by microscope to check for abnormal cells.Although simpler, less expensive techniques such as a vacuum aspiration are quickly replacing the D & C as a diagnostic method, it is still often used to diagnose and treat a number of conditions.

Preparation

Because opening the cervix can be painful, sedatives may be given before the procedure begins. Deep breathing and other relaxation techniques may help ease cramping during cervical dilation.

Aftercare

A woman who has had a D & C performed in a hospital can usually go home the same day or the next day. Many women experience backache and mild cramps after the procedure, and may pass small blood clots for a day or so. Vaginal staining or bleeding may continue for several weeks.Most women can resume normal activities almost immediately. Patients should avoid sexual intercourse, douching, and tampon use for at least two weeks to prevent infection while the cervix is closing and to allow the endometrium to heal completely.

Risks

The primary risk after the procedure is infection. Signs of infection include:

fever
heavy bleeding

Dilatation and curettage (D & C) is used primarily to diagnose and treat heavy menstrual bleeding and to diagnose endometrial polyps, uterine fibroids, uterine cancer and cervical cancer. When performing a D & C, the physician inserts a speculum to separate and hold the vaginal walls, then stretches open the cervix with a dilator. Once the cervix is dilated, the physician will insert a curette into the uterus and scrape away small portions of the uterine lining for laboratory analysis. (Illustration by Electronic Illustrators Group.)

severe cramps
foul-smelling vaginal discharge

A woman should report any of these symptoms to her doctor, who can treat the infection with antibiotics before it becomes serious.D & C is a surgical operation, which carries certain risks associated with general anesthesia. Rare complications include puncture of the uterus (which usually heals on its own) or puncture of the bowel or bladder (which require further surgery to repair).

Normal results

Removal of the uterine lining causes no side effects, and may be beneficial if the lining has thickened so much that it causes heavy periods. The uterine lining soon grows again normally, as part of the menstrual cycle.

Key terms

Endometrial polyps — A growth in the lining of the uterus (endometrium) that may cause bleeding and can develop into cancer.Epidural anesthesia — A type of anesthesia that is injected into the epidural space of the spinal cord to numb the nerves leading to the lower half of the body.Uterine fibroid — A noncancerous tumor of the uterus that can range from the size of a pea to the size of a grapefruit. Small fibroids require no treatment, but those causing serious symptoms may need to be removed.

Resources

Books

Carlson, Karen J., Stephanie A. Eisenstat, and Terra Ziporyn. The Harvard Guide to Women's Health. Cambridge, MA: Harvard University Press, 1996.