Dilation and curettage (D and C or D&C) is a minor gynecological procedure commonly used to diagnose and treat abnormal bleeding from the uterus or to remove unhealthy tissue if a woman has a miscarriage. It can also be used to diagnose uterine cancer or precancerous cells (endometrial hyperplasia) by removing the endometrial cells for pathological evaluation.
D&C can be performed in the doctor’s office, at a surgical center or at the hospital. It typically takes 10—20 minutes to complete the procedure and the duration depends on the indication and difficulty. If it’s done for diagnostic purposes, the procedure is very short, but it can take longer in cases of late miscarriages when more tissue needs to be removed. The risks of the procedure are rare, but include bleeding, pain, infection and rarely perforation of the uterus (instrument puncturing through the muscle layer of the uterus). Antibiotics are commonly administered during the procedure and patients are observed in the recovery room before discharging home.
D&C is done under anesthesia which is mostly intravenous sedation that allows patients to be free of any discomfort or pain during the procedure. Initially, the patient will lie back on the procedure table and the legs will be placed in stirrups (this is done after the patient is asleep). A speculum is inserted vaginally (similar to a gynecological exam) and cervix is grasped with a clamp. Cervix is then slowly dilated (opened) to allow placement of the curette or the suction instrument to remove the tissue. Once the tissue is obtained, it is sent to pathology for evaluation. In cases of miscarriage, tissue can be tested for chromosomal abnormalities by checking the karyotype (evaluation of all 46 chromosomes). All instruments are then removed vaginally; patient wakes up within minutes and she is transferred to the recovery room.
Patients may experience sore throat, feeling tired, spotting or abdominal cramping following the procedure for a few days. The recovery period is very short and most patients can return back to work within a day or two. It is recommended that patients observe “pelvic rest” for a week which includes avoiding intercourse, tampons and any irritation or trauma to the cervical area. Patients would typically follow up with their doctor within 1-2 weeks following the procedure.