Dilation and Curettage (D&C)

What is Dilation and Curettage?

Removal of uterine tissue (womb) is performed in a minor surgical procedure called dilation and curettage (D&C).

There are two stages to the procedure:

Dilation- A special instrument or medication is used to dilate or open the cervix.

Curettage- In this situation, the lining of the uterus is scraped or suctioned out to get rid of tissue. If necessary, the removed tissue can be tested in a lab.

A D&C may be carried out to make a diagnosis or for treatment.

Why is Dilation and Curettage performed?

Diagnostic purposes

A D&C can be used to determine the source of:

• Heavy menstrual bleeding.
• Irregular menstrual periods.
• Bleeding after menopause.
• Thickened uterine lining.
• Abnormal ultrasound findings.
• Suspected endometrial hyperplasia.
• An unexpected result of the investigation was the identification of possible uterine (endometrial) cancer.
• Uterine Polyp
• Investigation of selected individuals for infertility.
• The removed tissue is examined under a microscope to check for infection, hormonal changes, polyps, precancerous changes or cancer.

Therapeutic purposes

A D&C can also be utilised to:

• Remove retained tissue after miscarriage, abortion or delivery
• Manage a missed miscarriage
• Reduce heavy bleeding caused by retained tissue
• Remove some uterine polyps
• Help restore normal periods

How should I prepare before Dilation and Curettage?

Talk with the doctor about your health history.

• Make sure to let your doctor know if you have any medical conditions, allergies, surgeries or if you have the possibility of becoming pregnant.
• Tell them what medicines, vitamins and herbal treatments you take.

Review your medications

• Blood-thinning medications (like aspirin or warfarin) may need to be discontinued a few days before the procedure if your doctor recommends it.
• Do not use or discontinue any other medications without instruction.

Avoid food and drinks before the procedure

• If general anaesthesia or sedation is to be used, do not eat or drink for 6-8 hours before the procedure (as directed by the hospital).

Have someone pick you up on the way home

• Anaesthesia or sedation should not be used to drive home. Have someone else in your family or a friend with you.

Wear comfortable clothing

• On the day of the procedure, wear loose flowing clothing that is comfortable and not tight around the neck or wrists, and don’t wear jewellery, makeup, nail polish, or contact lenses.

Bring the necessary documents

• Bring identification, previous medical records, test reports and a list of your current medications.

Ask questions

Before the procedure, it is important to be aware of:

• Explain the reason for the D&C.
• Type of anaesthesia to be used.
• Risks and benefits that may occur.
• Time to recover, and continuing treatment.
• If any other instructions are given, follow them.
• Before the procedure, your doctor might require blood tests or other investigations.
• Dispose of any instructions for bathing, medications or arrival time at the hospital.

How is Dilation and Curettage performed?

A short gynaecologic procedure in which tissue lining the uterus (womb) is scraped, it is called Curettage. It may be done to test if periods are heavy or for other conditions such as the presence of pregnancy tissue, abnormal growth, or miscarriage.

Step-by-Step Procedure

Before the procedure

• You will be getting dressed in a hospital gown.
• Your blood pressure, pulse and vital signs will be taken by a nurse.
• An intravenous (IV) line will be inserted for medicines and fluids.
• You will not experience any pain during the procedure, and you will be moderately sedated, under general anaesthesia, under regional anaesthesia (spinal or epidural) or local anaesthesia and sedation.

Positioning

• You will be on an examination table with your feet in stirrups, like the pelvic exam table.

Inserting the speculum

• The doctor will insert a speculum into the vagina to hold the vagina open, so he/she can see the cervix clearly.

Dilating the cervix

• An antiseptic solution is used to clean the cervix.
• The cervix can be held steady with a device called a tenaculum or vulsellum.
• Thin rods called dilators are put into the cervix, and the cervix is slowly opened (dilated). Sometimes, the doctor will prescribe the medication before the procedure to make the cervix soft.

The procedure of removing the inner lining of the uterus.

• When the cervix is sufficiently dilated, the doctor puts in a curette (a small spoon-like tool) and/or a suction cannula into the uterus.
• Gently removing the inner lining of the uterus.
• Lifting (Vacuum aspiration) should be used when picking up by hand.
• Using the curette, sharp curettage.
• If necessary, the tissue that is removed can be taken to a lab.

Completing the procedure

• Care is taken in the removal of the instruments.
• Bleeding is checked so that it is kept to a minimum.
• This typically lasts 10-30 minutes, but you might need to remain in the hospital for a couple of hours as the effects of the anaesthesia fade away.

After the Procedure

• Normal is some mild cramping and spotting for several days.
• Most will be given a choice to go home on the same day.

You might get a recommendation to get:

• Avoid tampons, douching or engaging in sexual activity for about 2 weeks or according to your doctor.
• Follow pain medication instructions.

What should I avoid after Dilation and Curettage?

Your doctor may want you to avoid the following for at least 1–2 weeks and to prevent infection and give the uterus time to recover.

• Sexual intercourse.
• Tampons
• Vaginal douching.
• Bathing, in any form, including a hot tub.
• Heavy lifting.
• Intense exercise.
• If you get light bleeding, use sanitary pads and not tampons.

What are the benefits of Dilation and Curettage?

Diagnostic benefits:

• Helps in finding the reason for abnormal uterine bleeding.
• Detecting uterine polyps.
• Detect infections in the lining of uterus.
• Detect early changes in the lining which may be precancerous or cancerous.
• Early diagnosis can help in timely treatment and may improve the health outcome.

Treatment benefits

• After miscarriage removed retained tissue.
• Stop the bleeding caused by retained pregnancy tissue.
• The risk of infections after pregnancy loss is reduced.
• Help in emptying the uterus safely.
• Relieve symptoms caused by retained tissue.

What are the complications of Dilation and Curettage?

• Pelvic infections.
• Heavy bleeding.
• Injury to the cervix.
• Perforation of the uterus.
• Asherman syndrome (formation of scar tissue inside the uterus).

Will a Dilation and Curettage affect my future fertility?

No, The procedure does not affect a woman fertility, but sometimes repeated procedures of D and C can create complications such as Asherman Syndrome that may affect fertility.

What are the modern innovations used in Dilation and Curettage?

Nowadays, Modern innovations are advanced technology have significantly enhanced the accuracy, comfort and safety of D & C procedures.

D & C guided by ultrasound

• Performing D&C under real-time ultrasound guidance has been a major advancement. While removing tissue, the clinician has a view of the uterus.

Among the advantages are,

• Reduced risk of uterine rupture.
• It is simpler to remove the residual tissue.
• Women who have atypical uterine shapes will feel safer and more secure.

Hysteroscopy assisted D and C.

Many hospitals today use hysteroscopy in conjunction with the D&C procedure rather than a blind procedure. The doctor passes a thin camera (hysteroscope) into the uterus through the cervix to look directly into the uterus.

Advantages are,

• Direct visualisation of the uterine cavity.
• New methods and tools for the diagnosis of polyps, fibroids and adhesions.
• Better tissue removal – more precisely.

This is recently the best treatment option for women with abnormal uterine bleeding due to its diagnostic and therapeutic advantages.

Vacuum Aspiration with a bio-membrane instead of Sharp Curettage.

In suitable cases, manual vacuum aspiration (MVA) or electric vacuum aspiration (EVA) is recommended over sharp metal curettes and is being used by many healthcare centres.

Benefits are,

• Reduced pain.
• Less respiratory distress from breathing in the scar tissue of the ruptured lung.
• Shorter procedure time.
• Faster recovery.
• Less bleeding.

The role of artificial intelligence (AI) in the Diagnosis of endometria.

The use of AI helps to pathologists to read endometrial tissues.

Benefits include:

• Accurate identification of abnormal cells.
• There is improved recognition of pre-cancerous cells.
• Reduced diagnostic errors

Digital patient education and telemedicine.

• Digital technology is now used more and more in modern healthcare to enhance patient care. They can now be treated with Teleconsultations before and following surgery.

Applications include tracking recovery on mobile devices.

• Digital consent forms.
• Medication reminders ensure.
• These innovations have helped to increase patient understanding, decrease patient anxiety, and facilitate post-procedure management.

This is an important procedure in modern gynaecology. This helps in diagnosing the cause of incomplete miscarriage, removing retained tissue, abnormal uterine bleeding, identify conditions affecting the lining of the uterus. Great advancements in medical technology have made this procedure more safe, more accurate, and more comfortable.