Dilation is a procedure to open and widen the cervix. The cervix is the entrance to the uterus.

Curettage is the removal of the lining of the uterus by scraping. The lining is known as the endometrium.

The two procedures are done together and are often referred to as a D&C.

Dilation and Curettage

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• A D&C is usually done to determine what condition is causing abnormal bleeding. Some conditions that may cause abnormal bleeding are:
  • Miscarriage
  • Irregularities in menstrual bleeding
  • Endometrial polyps
  • Abnormal endometrial thickening
  • Endometrial cancer
• Sometimes a D&C is done to stop the bleeding, rather than to diagnose why you are bleeding. This is sometimes done after a miscarriage or after a delivery when all of the placenta did not come out like it was supposed to.
• A D&C is not advised if you have:
  • Infection of the uterus
  • Infection of the fallopian tubes

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have a D&C, your doctor will review a list of possible complications which may include:

• Complications related to the anesthetic
• Injury to the cervix
• Scarring of endometrium
• Infection of the uterus or fallopian tubes
• Uterine perforation (hole in the uterus)
• Bleeding
• Damage to other organs in the abdomen
• In case of significant injury or bleeding, possible need to open the abdomen and have the uterine wound stitched closed
• Possible need to remove the uterus ( hysterectomy)

Factors that may increase the risk of complications include:

• Pre-existing infection
• Pre-existing medical condition

What to Expect

Prior to Procedure

Talk to your doctor about all the medicines you are taking. Up to one week before the surgery, you may be asked to stop taking some medicines, such as:

• Aspirin or other anti-inflammatory drugs (may need to stop up to one week before)
• Blood-thinning medicines, such as:
  • Clopidogrel (Plavix)
  • Warfarin (Coumadin)

Arrange for a ride to and from the procedure.

Anesthesia

General or local anesthesia may be used. With general anesthesia, you will be asleep. Local anesthesia will numb the area, but you will be awake.

Description of Procedure

A pelvic exam will be done to find out the size and location of your uterus. The vagina and cervix will be cleaned with an antiseptic solution. A speculum will be placed in your vagina. An instrument called a cervical dilator is placed into the cervical canal. Once the cervical canal is slightly open, a scoop-shaped instrument, called a curette, will be inserted into the uterus. It will be used to scrape the uterine lining and remove tissue through the vagina. After sampling the endometrium, the instrument will be removed from the cervix.

Immediately After Procedure

The tissue is taken to a lab for examination.

How Long Will It Take?

About 10 minutes

Will It Hurt?

General anesthesia will prevent pain during the D&C. With local anesthetic, most report feeling some cramping and back pain. It may last for a day after the procedure. Over-the-counter pain medicines or a mild prescription drug are all that is usually needed to relieve minor discomfort.

Post-procedure Care

At the Care Center

After the procedure, you will be taken to the recovery area. After a short period of time, you can leave. Have someone assist you in getting home.

At Home

When you return home, do the following to help ensure a smooth recovery:

• Be sure to follow your doctor's instructions .
• Ask your doctor when you will be able to return to work. Also, do not drive until your doctor tells you that it is safe.
• There may be some nausea from the anesthesia.
• Mild uterine cramping may be experienced. The doctor may give pain medicine for this discomfort.
• It is not uncommon to experience vaginal bleeding and discharge for some time.
• Most commonly, normal activity may be started after a few days.
• Refrain from placing anything inside your vagina until instructed by your doctor. The cervix has been opened, and this may make it easier for you to get an infection in your uterus.
• Your next menstrual cycle may not be regular. It may be late or early.

It generally takes a few days for your doctor to receive the lab report. At your follow-up visit, your doctor will make recommendations for any additional treatment.

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:

• Signs of infection, including fever and chills, increasing pain, or foul-smelling vaginal discharge
• Nausea or vomiting that does not stop
• Abdominal pain
• Vaginal bleeding that is saturating more than one sanitary pad per hour
• Cough, shortness of breath, or chest pain