Dilation and curettage

A dilatation and curettage (D&C) is an operation performed on women to scrape away the womb lining. This is done either to remove pathological content of the uterine cavity, or to collect a tissue sample of the uterine lining (see more in section Success or failure factors). The cervix (neck) of the uterus (womb) is dilated using an instrument called a dilator. The endometrium (lining of the womb) is then lightly scraped off using a curette, a spoon-like surgical instrument (Pic. 1).

D&C is usually done on an outpatient basis, as the procedure itself is very short. The patient lies on their back with their legs apart and placed in stirrups. Most D&Cs are done under general anaesthesia. A speculum is placed in the vagina, much like during a gynaecologic examination, and the cervix is dilated using a series of rods of increasing diameter. Then, a curette is inserted into the uterus and is used to remove the uterine lining or other tissue present in the uterine cavity. Sometimes, hysteroscopy (examination of uterine cavity using endoscopy) may be performed together with D&C, during shich the uterine cavity is viewed using a slender tube called the hysteroscope. The material obtained by curettage is usually sent to a laboratory for examination. 

After the procedure, the patient usually spends several hours in a recovery room, and goes home on the same day. After a D&C, mild pelvic pain and/or cramping is usually felt, and spotting or light bleeding migh be present. These side effects are normal and should subside within several days.

Success factors

D&C is done for two basic reasons:

1. To remove pathological tissue in the uterus

D&C is usually done after a miscarriage or abortion to remove any remaining tissues. This is required to prevent infection or bleeding. It is also the method of choice in the treatment of a molar pregnancy, a form of non-viable pregnancy where the fetal and placental tissues form masses resembling grapes. It can also be used to remove uterine polyps (benign protruding growths of the uterine lining) and residual placental tissue which is causing excessive bleeding following childbirth.

2. To collect a tissue sample

D&C may be also done to provide a sample of the uterine lining. This is often done to help determine the cause of abnormal uterine bleeding, and in some cases also to diagnose or rule out uterine cancer.

Failure factors

There are relatively few contraindications of a D&C. If the patient’s condition does not allow safe general anaesthesia or if she is not able to place her legs in the stirrups (such as in severe arthritis), the procedure may not be eligible. Before the procedure, it should be confirmed that the patient is not pregnant, as a D&C effectively results in an abortion.

D&C is generally a safe procedure. Complications are rare, including:

Uterine wall perforation

Perforation occurs when a hole is made in the uterine wall by the curette or other surgical instrument. This happens more frequently in women who have undergone D&C because of an abortion, miscarriage or just after childbirth. Most perforations heal spontaneously and conservative approach is advised. However, in cases of more serious damage, such as blood vessel involvement, another procedure may have to be undertaken to repair the damage. 

Infection

As with any procedure involving the removal of tissues, there is a risk of infection, but it is relativey low with D&C.

Asherman’s syndrome

When the whole of the uterine lining is removed during the procedure, instead of just the superficial part, scars form inside the uterine cavity. This condition is known as the Asherman’s syndrome and may cause menstruation disorders and infertility. Asherman’s syndrome is rare, but may occur more frequently in women who undergo a D&C because of an abortion, miscarriage or after childbirth, because the uterine wall is edematous and softened by the effect of pregnancy-associated hormonal changes.

D&C is generally a very safe, routinely performed procedure. When performed to remove pathological tissue from the uterine cavity, it significantly improves the fertility-related prognosis of the patients, who would otherwise be at risk of uterine infection and irreversible damage to their reproductive system. The complications that have a long-term detrimental effect on fertility are rare, especially in cases of a diagnostic D&C.