Dilation and Curettage

August 30, 2011

Cervical dilation and uterine curettage (D&C) is a procedure done for both diagnostic and therapeutic reasons. D&C is one of the most commonly performed operations in the United States. Dilation entails enlarging the cervical opening or “os” with instruments specifically for this purpose called dilators. Dilation may be done alone for problems of cervical stenosis (scarring and/or narrowing of the cervical os), for placing of IUDs, or for dysmenorrhea (menstrual cramps) due to a narrowed cervical canal. It may also precede procedures such as hysteroscopy, use of a scope to visualize and/or photograph the inside of the uterus for diagnosis of structural conditions such as polyps or fibroids in the uterine cavity. Minor treatments such as removal of polyps can be done through the hysteroscope. Cervical dilation may be performed under paracervical, epidural, spinal, or general anesthesia depending on the reason for the procedure.

After the cervix is dilated, curettage may be performed using a curette, a sharp instrument for scraping. Curettage is the partial or complete scraping of the uterine wall to obtain representative tissue samples for diagnosis of uterine cancer or precancerous conditions, to remove retained tissue remnants of a pregnancy following miscarriage or birth, or for termination of pregnancy (abortion). Curettage is also indicated for treatment in the occasional case of uterine bleeding that does not respond to medical therapy, generally hormones, or bleeding that is life threatening. The tissue obtained during the procedure is sent to the pathology laboratory for analysis.

Complications of a dilation and uterine curettage include perforation of the uterus, infection, bleeding, or reactions to medications used for anesthesia. Perforation of the uterus means that a surgical instrument goes through the uterine wall. This occurs in less than 1% of patients. In those instances when perforation occurs, the outcome is usually not life threatening nor is surgical intervention required. The patient may be observed for several hours after the procedure to assure that there is no life-threatening bleeding or infection requiring further treatment. Laparoscopy that allows for inspection of the abdomen and pelvis through small incisions in the abdominal wall may be used if the patient is stable but there is concern about serious organ damage to uterus, blood vessels, or bowel. Severe cases of bleeding may lead to hysterectomy. Another complication of dilation and uterine curettage is called Asherman’s syndrome. This complication is rare and involves the formation of scar tissue in the uterus. Aggressive curettage or an abnormal reaction to this scraping can cause Asherman’s syndrome. Thick scars can result, which may partially or completely obliterate the uterine cavity. This scarring can cause menstrual bleeding to stop and cause infertility if further hysteroscopic surgery is not successful. Abscess, infection, or hemorrhage can complicate the postoperative course in a very small percentage of patients.

In summary, D&C can be very helpful for the diagnosis and treatment of abnormal uterine bleeding in the nonpregnant woman. It can be the method used to evacuate the uterus for a woman with a miscarriage or unintended pregnancy.

SEE ALSO: Abortion, Hysterectomy, Miscarriage, Sexual organs, Uterine fibroids

Suggested Reading

  • Pernol, M. L. (Ed.). (1991). Obstetrics and gynecologic diagnosis and treatment (7th ed., pp. 900—902). Norwalk, CT: Appleton & Lange. Youngkin, E. Q., & Davis, M. S. (1998). Women’s health: A primary care clinical guide (p. 146). Englewood Cliffs, NJ: Prentice-Hall.

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