A procedure in which the cervix is dilated and intrauterine tissue is removed with a curette or suction device. Used for abnormal bleeding, missed abortion, and diagnostic evaluation.
Indication
- Investigation of abnormal uterine bleeding and endometrial sampling
- Removal of retained tissue after missed or incomplete abortion
- Voluntary termination of pregnancy — within legal and regulatory limits
- Sampling under hysteroscopic guidance for endometrial hyperplasia, endometrial polyps, or submucous fibroids
- Removal of retained placental tissue after delivery
- Endometrial cancer screening in postmenopausal bleeding
- Evaluation of persistent bleeding or infection after a previous procedure
Preparation
- Pelvic ultrasound and, if needed, beta-hCG to assess pregnancy status
- Complete blood count, blood type, and coagulation tests when indicated
- Fasting for 6-8 hours before the procedure; assessment for sedation or general anesthesia
- Planning of anti-D immunoglobulin in Rh-negative patients when needed
- Treatment of any genital infection beforehand; antibiotic prophylaxis when indicated
How it's performed
- The procedure is generally performed under sedation or brief general anesthesia in operating room conditions
- The patient is placed in the gynecologic position; a vaginal speculum is inserted and the cervix is grasped
- The cervix is gently dilated with special dilators; particular care is needed in very young or postmenopausal patients
- Intrauterine contents are removed by vacuum aspiration (preferred for pregnancy tissue) or sharp curette
- If performed with hysteroscopy, the uterine cavity is directly visualized and polyps/fibroids can be removed in a targeted manner
- Removed tissues are sent to pathology and bleeding is controlled
Post-procedure
- Generally same-day discharge after a few hours of observation
- Mild bleeding or spotting lasting 1-2 weeks is normal
- Avoid intercourse, tampons, and pool use for the first 1-2 weeks
- Prompt medical attention if there is high fever, foul-smelling discharge, severe pain, or heavy bleeding
- Pathology results are reviewed within 1-2 weeks and additional treatment is planned if needed
Risks
- Uterine wall tear (perforation) — rare
- Cervical injury and risk of future cervical insufficiency
- Infection (endometritis, pelvic inflammatory disease) and bleeding
- Asherman syndrome (intrauterine adhesions) — may occur particularly after repeated or extensive curettages and may cause problems in future pregnancies
- Reactions related to anesthesia and sedation
FAQ
Does D&C always mean termination of pregnancy?
No. D&C is a procedure used for many purposes such as investigating abnormal bleeding, removing retained tissue after a miscarriage, or diagnostic sampling.
Will it affect future pregnancies?
In most patients there is no permanent effect. However, especially after repeated or extensive curettages, Asherman syndrome (intrauterine adhesions) may develop, which can lead to infertility and miscarriage.
Is the procedure painful, and how long does it take?
Because it is performed under sedation or general anesthesia, no pain is felt during the procedure. The procedure itself usually takes 10-30 minutes; mild lower-abdominal pain and spotting may follow.
When will menstruation return to normal?
Menstrual cycles generally return within 4-6 weeks. Irregular or delayed bleeding, or absence of bleeding for a long time, should prompt a follow-up visit.
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