Dilation and Curettage


Dilation (or dilatation) and curettage (D&C) refers to the dilation of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping (curettage).

A therapeutic gynecological procedure as well as the most often used method of first trimester miscarriage or abortion.

WHO recommends D&C only when manual vacuum aspiration is unavailable.

Performed under heavy sedation or general anesthesia.

Has a risk of perforation.

D&C normally refers to a procedure involving a curette.

Procedure that involves the processes of dilation and removal of uterine contents, which includes the more common suction curettage procedures of manual and electric vacuum aspiration.

The first step in a D&C is to dilate the cervix.

The curette is inserted into the uterus through the dilated cervix, and is used to gently scrape the lining of the uterus and remove the tissue in the uterus.

This tissue is examined for completeness in the case of abortion or miscarriage treatment.

The tissue is examined by pathology for abnormalities (in the case of treatment for abnormal bleeding).

Commonly performed for the diagnosis of gynecological conditions with abnormal uterine bleeding, to resolve abnormal uterine bleeding, and to remove the excess uterine lining in women who have conditions such as polycystic ovary syndrome, and to remove tissue in the uterus that may be causing abnormal vaginal bleeding, including postpartum retained placenta, to remove retained tissue, in the case of a missed or incomplete miscarriage.

Because medicinal and non-invasive methods of abortion now exist, and because D&C requires heavy sedation or general anesthesia and has higher risks of complication, the procedure has been declining as a method of abortion.

The World Health Organization recommends D&C as a method of surgical abortion only when manual vacuum aspiration is unavailable.

Most D&Cs are now carried out for miscarriage management and other indications such as diagnosis.

Hysteroscopy is a valid alternative to D&C for many surgical indications from diagnosis of uterine pathology to the removal of fibroids and even retained products of conception.

It poses less risk because the doctor has a view inside the uterus during surgery, unlike with blind D&C.

Medical management of miscarriage and medical abortion using drugs such as misoprostol and mifepristone are safe, non-invasive and cheaper alternatives to D&C.

One risk of sharp curettage is uterine perforation.

Infection of the uterus or fallopian tubes is also a possible complication, especially if the woman has an untreated sexually transmitted infection.

Another risk is intrauterine adhesions, or Asherman’s syndrome.

Untreated Asherman’s syndrome, especially if severe, also increases the risk of complications in future pregnancies, such as ectopic pregnancy, miscarriage, and abnormal placentation

Vacuum aspiration can also lead to intrauterine adhesions.

In approximately 60% of procedures, less than half of the uterine cavity is curetted, questioning the adequacy of this method to diagnose endometrial pathology.

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