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What is D & C? Why is it done?

Introduction

A dilation and curettage procedure, also called D & C, is a surgical procedure wherein the cervix (narrow, lower part of the uterus) is dilated (expanded) so that endometrium (the uterine lining) can be scraped with a curette (a spoon-shaped instrument) to remove abnormal tissues.

The procedure is done for various reasons. Some of these include a diagnostic purpose, treatment for uterine conditions, and clearing the lining of the uterus following an abortion or miscarriage.

Types of D & C

There are a couple of different types of D&C procedures, which you can get depending on whether your doctor is trying to diagnose a condition or treat one.

  • Diagnostic D & C,. This type of dilation and curettage procedure is used to diagnose a condition such as abnormal or excessive uterine bleeding( due to fibroids, cancers, hormonal disturbance ), to detect cancer, or as part of infertility (inability to become pregnant) investigation.
  • Therapeutic D&C., This type of dilation and curettage procedure, is used to treat certain conditions that result from an abortion, a miscarriage, or a delivery, or to treat benign tumors or polyps in the uterus.

How is a D & C done?

In general, the dilation and curettage procedure is done by opening up or dilating the cervix using medication or instruments. Then, the uterine tissue is surgically removed using suction or an instrument called a curette.

However, endometrial sampling and therapeutic dilation and curettages differ. To perform this test, your doctor collects tissue sample from endometrium (the lining of your uterus) and sends the tissue sample to a lab for analysis. The test can check for:

  • Uterine cancer
  • Endometrial hyperplasia, a pre-cancerous condition wherein the uterine lining becomes too thick
  • Uterine polyps

The procedure may be paired with a hysteroscopy, a procedure that allows the doctor to view the uterine lining on screen and examine it for any abnormalities.

For what symptoms is a D & C procedure  prescribed?

If you have one of the following signs, symptoms or conditions, then your doctor may prescribe a dilation and curettage. The choice of the specific procedure depends on whether it is required for diagnosis or treatment.

Your doctor might prescribe a  D and C  for endometrial sampling if:

  • You have bleeding after your menopause
  • There are abnormal endometrial cells found in a check-up for cervical cancer
  • You experience abnormal bleeding from the uterus

Your doctor might prescribe a therapeutic dilation and curettage:

  • To clear the uterus of tissues and protect it from infection and bleeding post-miscarriage or abortion
  • In pregnancies where a tumor forms in place of a normal fetus [molar pregnancy]
  • To clear out placenta in the wake of heavy bleeding after giving birth or to get rid of benign uterine or cervical polyps

What are the risk factors and complications linked to D & C?

It is usually very safe to have a dilation and curettage.It israre to face any complications. But, there’re a few possible risk factors to look out for.

  • There is a small chance for the uterus to get perforated during the procedure. In other words, the surgical instruments used to carry out the D&C can tear through the uterine wall during the procedure. Women who have recently gone through a pregnancy or menopause are the ones most at risk of suffering perforations of their uterus. These tears usually heal naturally, but a procedure may be needed if there is damage to any organ or blood vessel.
  • There is also a small chance for the cervix to get torn during the dilation and curettage procedure. This can be managed by closing the wound with stitches, through the application of pressure, or with medicines.
  • Rarely, an infection can develop after a D&C procedure is done.
  • Adhesions (scar tissue) can develop inside the uterus
  • Heavy Bleeding

When to see your doctor after a D & C?

If you happen to experience one or more of the below-mentioned symptoms following a dilation and curettage procedure, see your doctor as soon as possible:

  • Heavy bleeding during periods (requiring an hourly change of pads)
  • Fever
  • Cramps that last over two days
  • Pain that worsens and doesn’t improve
  • Vaginal discharge with a foul odour

How to prepare for a D&C?

Here are a few things to keep in mind before your dilation and curettage is carried out:

  • Your doctor will give you a set of instructions regarding your diet. Follow these guidelines strictly
  • Arrange for someone to pick you up following the procedure as the anesthetics used as part of the procedure can make you drowsy ,
  • Set aside a few hours after the procedure for  rest and recovery.
  • If your cervix needs to be dilated more than normal, such as for an abortion or hysteroscopy, your doctor may start the dilation process of your cervix a day or a few hours before the curettage procedure. This is done with medications or by inserting a slender rod of laminaria into the cervix to help it expand gradually.

What happens during a D&C?

You can expect the following conditions during a dilation and curettage procedure:

  1. With you lying on your back on an examination table, your heels are supported by stirrups. Then, a speculum is inserted into the vagina so that the cervix can be seen.
  2. Then the doctor will insert a number of rods of increasing thickness, one by one, to gradually dilate the cervix to the required extent.
  3. Then the doctor removes the rods and inserts an instrument into the vagina, which is spoon-shaped and has a sharp edge, or uses a suction device to remove tissues from the uterus.

The procedure will not cause any discomfort as you will be anesthetized for the entire duration.

What happens after a D&C?

After the dilation and curettage procedure is completed, you will have to rest for a few hours to recover from the anesthesia. Your doctor will also monitor you for any side-effects or complications like heavy bleeding.

What are the side-effects of a D&C?

The side-effects of the dilation and curettage procedure can include:

  • Mild cramps
  • Light bleeding or spotting
  • Delayed period since a new uterine lining needs to be built again

Conclusion

Overall, the dilation and curettage procedure is safe  and relatively free of any discomfort. The chance of complications is low and any side-effects are mostly manageable. The results of the D&C procedure will be analyzed by your doctor, who will then recommend the next steps to treat your condition.

Frequently Asked Questions (FAQs)

1.What can I do to deal with cramps?

Your doctor may prescribe medication to help you deal with cramps.

2.What medications are used to dilate the cervix?

Medications like Misoprostol, also called Cytotec, which can be taken vaginally or orally, are used to dilate the cervix.

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Verified By Dr Amitav Mohanty
MBBS, MD -Medicine, Senior Consultant - General Medicine, Apollo Hospitals Bhubanswar

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