Background Information:

What are the other Names for the Procedure?

• D & C
• Suction Curettage
• Surgical Curreting of Endometrium

What is Dilatation & Curettage of the Uterus surgical procedure?

• A Dilatation & Curettage of the Uterus procedure involves opening the cervix and surgically removing the inner lining and tissue present in the uterus
• The procedure is performed not only as an option for elective abortion but also as a preventive and curative measure for ailments of the uterus

What part of the Body does the Procedure involve?

The procedure involves the uterus, cervix, and vagina.

Why is the Dilatation & Curettage of the Uterus surgical procedure Performed?

The reasons for performing a Dilatation & Curettage of the Uterus procedure include:

• Suspected cancer of the uterus
• Abnormal bleeding
• Incomplete miscarriage
• Prevent hemorrhage or infection following a miscarriage
• Death of fetus in uterus
• Complications in pregnancy
• Retained placenta (removal of uterine contents after child birth)
• Biopsy of the uterine tissues

What are some Alternative Choices for the Procedure?

Alternatives to the procedure are hormone therapy, uterus removal, ultrasound and imaging techniques, and so on.

What are the Recent Advances in the Procedure?

Dilatation and Curettage is no longer used as a diagnostic procedure. It is only used for treating serious uterine problems and as a last option; due to certain complications it can cause, if not performed carefully.

What is the Cost of performing the Dilatation & Curettage of the Uterus surgical procedure?

The cost of Dilatation and Curettage procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Dilatation and Curettage procedure and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://womenshealth.about.com/cs/surgery/a/d_and_c_2.htm (accessed on 7th August, 2012)

http://www.nhs.uk/Conditions/Dilatation-and-curettage-(DC)/Pages/Risks.aspx (Accessed on 7th August, 2012)

Prior to Dilatation & Curettage of the Uterus surgical procedure:

How is the Dilatation & Curettage of the Uterus surgical procedure Performed?

• During a Dilatation and Curettage procedure, the vagina is cleansed with an antiseptic solution
• The cervix is then dilated or widened using medical instruments, i.e. by inserting metal rods of varying diameters, or a sea weed called laminaria, which is placed in cervix 8-10 hours prior to the procedure
• Next a suction tube is passed through the vagina, the cervix, and in the uterus to create a gentle suction which removes the endometrium, uterine tissue, and placenta
• Alternatively, a curette or a loop-holed instrument can also be used to scrape the uterine walls

Where is the Procedure Performed?

The procedure is usually performed in an out-patient surgery facility or a hospital. Normally, the person can go home once the procedure is completed (or as advised by the physician).

Who Performs the Procedure?

The procedure can be performed by an obstetrician or a gynecologist or a healthcare provider along with an anesthesiologist and pathologist.

How long will the Procedure take?

The procedure takes anywhere between 10-30 minutes.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc. 

What Preparations are needed, prior to the Procedure?

• No particular preparation is required before the procedure
• Your physician may perform a physical examination before performing the procedure
• Alternatively, the physician may also evaluate the patient’s medical history to gain a comprehensive knowledge of the medications that are being taken currently
• Some of the medications may increase the patient’s chances of bleeding and hence the physician may recommend them to stop such medications for a period of time before performing the procedure
• Sometimes, blood tests might be performed to determine if the patient has a bleeding tendency or any other medical conditions that prevent them from undergoing the procedure
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged

What is the Consent Process before the Procedure?

A physician will request your consent for the Dilatation and Curettage of the Uterus procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Dilatation & Curettage of the Uterus surgical procedure?

Before proceeding with a Dilatation and Curettage procedure, the physician may suggest certain tests, which could be as follows:

• Routine blood and urine analysis
• Pregnancy test
• Ultrasound Scan

The physician may suggest further tests depending on the health of the patient and their medical history.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Dilatation and Curettage of the Uterus procedure?
• What does the procedure involve?
• How soon should I get it done? Is there an emergency?
• What are the alternatives I have?
• Can oral medication help?
• Will there be any problem, if I want to get pregnant in future?
• What is the risk involved?
• Will there be any complications during or after the procedure?
• How long will it take to recover? When can I resume normal work?
• What is the cost of the procedure?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• How many procedures have you (the physician) performed?

During the Dilatation & Curettage of the Uterus surgical procedure:

What kind of Anesthesia is given, during the Procedure?

During the procedure the patient is administered local anesthesia either with or without sedation. However, in some cases, general anesthesia may be administered. When general anesthesia is necessary, the procedure is usually performed at a hospital surgery facility.

How much Blood will you lose, during the Procedure?

The amount of blood lost may vary depending on the condition the patient is suffering from. It also depends on the duration of pregnancy or miscarriage (as relevant). The blood lost usually exceeds the amount of blood lost during menstruation.

What are the possible Risks and Complications during the Dilatation & Curettage of the Uterus surgical procedure?

The possible risks or complications that may arise during the procedure are as follows:

• Excessive bleeding
• Infection
• Accidental injury to the uterine walls
• Pain
• Discomfort
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Dilatation & Curettage of the Uterus surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise. 

After the Dilatation & Curettage of the Uterus surgical procedure:

What are the possible Risks and Complications after the Dilatation & Curettage of the Uterus surgical procedure?

Post Dilatation and Curettage of the Uterus procedure, the following complications may arise:

• Infection of uterus or fallopian tubes
• Intrauterine adhesions
• Cramps
• Pain and fever due to infection
• Foul odor of vaginal discharge
• Asherman’s syndrome: A condition characterized by scarring inside the uterus due to D & C, which may lead to infertility
• Uterine perforation
• Possible complication in the next pregnancy, such as an ectopic pregnancy

What is the Prognosis after the Surgery?

The prognosis after the surgery is usually good, though the patient may suffer minor side effects, like cramping, dizziness, and bleeding.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Excessive vaginal bleeding
• Excessive pain
• Abdominal or vaginal swelling
• Foul vaginal discharge
• Increase in vaginal discharge
• Fever
• Nausea
• Dizziness
• If any new signs of infection or discomfort are observed

What Post-Operative Care is needed at Home after the Dilatation & Curettage of the Uterus surgical procedure?

At home, the following post-operative care is recommended, after Dilatation and Curettage of the Uterus procedure:

• Avoid sex for few weeks after the procedure, until advised otherwise by the physician
• Complete the prescribed course of oral medication or any hormone therapy
• It may be required to use sanitary napkins (for bleeding) for about a week or more
• Avoid non-prescription pain killers; do not take them for more than 4-5 days
• Resume normal/regular activities, as early as possible

How long does it normally take to fully recover, from the Procedure?

It normally takes anywhere between 1-2 weeks to completely recover from the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue may be taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue that is removed is processed in the laboratory under a pathologist's supervision
• The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Dilatation & Curettage of the Uterus surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility charges and the physician charges. Alternatively, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility or hospital
• An obstetrician or gynecologist
• A pathologist (if the tissue was sent for analysis)
• An anesthesiologist (if anesthesia was administered)

The patient is advised to inquire and confirm the type of billing, before a Dilatation and Curettage of the Uterus procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA