A dilatation and curettage (D&C) is an operation which is usually performed on women to scrape away the womb lining. 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 spoon-shaped instrument called a curette.
Problems that may require D&C
D&C can be used as a diagnostic test or as a form of treatment for a range of conditions. Some of the problems that may require D&C include:
Medical issues to consider before D&C
The patient will be advised to have nothing to eat or drink for at least six to eight hours before D&C surgery. In some cases, the patient is given an injection an hour before the operation to make them feel drowsy and help dry up internal fluids. Women younger than 35 years are generally advised against undergoing D&C, unless there is no other alternative.
Procedure for D&C operation
D&C is regarded as a relatively minor operation and can be done as day surgery, but a general anesthesia is usually given. The typical D&C procedure includes:
- Once the patient is anesthetized, her uterus is examined to determine its size and position.
- The walls of the vagina are held apart by an instrument called a speculum (the same instrument used during a Pap test).
- An instrument is inserted into both positions the cervix and administer local anesthesia, in case the local anesthesia is required.
- Rods (dilators) that increase in size are introduced into the cervix, one at a time, to gently widen the entrance of the cervix to the right diameter.
- A spoon-shaped curette is inserted through the dilated cervix and into the uterus.
- The lining of the uterus (endometrium) is scraped off using the curette.
- What happens next depends on the condition. Tissue samples will be prepared and taken to a laboratory for investigation if the D&C was needed to help diagnose suspected uterine cancer.
Immediately after D&C
After surgery the patient can expect:
- Nurses to record the patient's vital signs such as temperature, pulse and blood pressure.
- The patient is observed for any vaginal bleeding.
- The patient shouldn't need pain relief after the operation, although some patients experience mild abdominal cramps. A light pain-killing tablet may be suggested.
- The patient should be able to get out of bed within a few hours and often are allowed home four to six hours after the operation if there is no vaginal bleeding.
- If the patient has lost a lot of blood before the operation, they might be required to stay in the hospital overnight.
- Make arrangements for someone to come and collect the patient from the surgery or hospital, as the patient should not drive until at least the next day.
Complications of D&C
Some of the possible complications of D&C include:
- Reactions to the medications used, such as allergic reaction to the general anesthesia
- Cervical damage due to dilation or the passage of instruments
- Hemorrhage (bleeding)
- Infection of the uterus or other pelvic organs
- Scar tissue within the uterus, if the scraping was too vigorous
- Puncture or perforation of the uterus.