Dilatation and curettage (D&C) is a gynecological procedure in which the lining of the uterus (endometrium) is scraped away.
Purpose
D&C is commonly used to obtain tissue for microscopic evaluation to rule out cancer. The procedure may also be used to diagnose and treat heavy menstrual bleeding and to diagnose endometrial polyps and uterine fibroids. D&C can be used to remove pregnancy tissue
after a miscarriage, incomplete abortion, or childbirth, or as an early abortion technique up to 16 weeks. Endometrial polyps may be removed, and sometimes benign uterine tumors (fibroids) may be scraped away.
Description
D&C is usually performed under general anesthesia, although local or epidural anesthesia can also be used. Using local anesthesia reduces risk and costs, but the patient will feel cramping during the procedure. The type of anesthesia used often depends upon the reason for the D&C.
To begin the procedure (which takes only minutes to perform), the doctor inserts an instrument to hold open the vaginal walls, and then stretches the opening of the uterus to the vagina (the cervix). This is done by inserting a series of tapering rods, each thicker than the previous one, or by using other specialized instruments. The process of opening the cervix is called dilation.
Once the cervix is dilated, the physician inserts a spoon-shaped surgical device called a curette into the uterus. The curette is used to scrape away the uterine lining. One or more small tissue samples from the lining of the uterus or the cervical canal are sent for analysis by microscope to check for abnormal cells.
Although simpler, less expensive techniques such as a vacuum aspiration are quickly replacing the D&C as a diagnostic
method, it is still often used to diagnose and treat a number of conditions, especially when cancer is suspected.
Preparation
Because opening the cervix can be painful, sedatives may be given before the procedure begins. Deep breathing and other relaxation techniques may help ease cramping during cervical dilation.
Aftercare
A woman who has had a D&C performed in a hospital can usually go home the same day or the next day. Many women experience backache and mild cramps after the procedure, and may pass small blood clots for a day or so. Vaginal staining or bleeding may continue for several weeks.
Most women can resume normal activities almost immediately. Patients should avoid sexual intercourse, douching, and tampon use for at least two weeks to prevent infection while the cervix is closing and to allow the endometrium to heal completely.
Risks
The primary risk after the procedure is infection. Signs of infection include:
fever
heavy bleeding
severe cramps
foul-smelling vaginal discharge
A woman should report any of these symptoms to her doctor, who can treat the infection with antibiotics before it becomes serious.
D&C is a surgical operation, which carries certain risks associated with general anesthesia. Rare complications include puncture of the uterus (which usually heals on its own) or puncture of the bowel or bladder (which requires further surgery to repair).
Normal results
Results are considered normal if no unusual thickening, growths, or cancers are found. Removal of the uterine lining causes no side effects, and may be beneficial if the lining has thickened so much that it causes heavy periods. The uterine lining soon grows again normally, as part of the menstrual cycle.
Abnormal results
Some types of uterine thickening, called hyperplasia, are considered abnormal. Simple hyperplasia is a benign
condition in which the uterine lining becomes thicker and with more endometrial glands. In complex hyperplasia, another condition where the uterine lining has thickened, the endometrial glands are crowded together. In 80% of cases these conditions will improve, and there is little risk of cancer. Only 1% of simple hyperplasia and 3% of complex hyperplasia will become cancerous.
Atypical hyperplasia is a more serious finding. In this type of endometrial thickening, the cells are abnormal. Twenty-nine percent of women with atypical hyper-plasia develop cancer. In fact, in 17% to 25% of women with atypical hyperplasia who have a hysterectomy within one month of diagnosis, a carcinoma is found elsewhere in the endometrium.
A D&C is not a fool-proof procedure because only a portion of the uterine lining is sampled. Therefore, it is possible for a cancer to be missed. Because of this, patients with atypical hyperplasia must have another D&C in three or four months. Combining a hysteroscopy (a procedure where a physician can see the lining of the uterus using a special tool) with D&C may increase the accuracy of the diagnosis in some cases. However, this combination is not recommended when endometrial carcinoma is suspected because of the possibility that the hysteroscopy itself can aid in the spread of cancer through the fallopian tubes.
Berman, Michael L. and Michael T. McHale. "Uterus." In Cancer Treatment, 5th ed., edited by Charles M. Haskell. Philadelphia: W.B. Saunders, 2001, pp. 951-55.
Byers, Lowell J. et al. "Uterus." In Clinical Oncology, 2nd ed., edited by Abeloff, Martin D. et al. Philadelphia: Churchill Livingstone, 2000, pp. 1987-97.
Carlson, Karen J., Stephanie A. Eisenstat, and Terra Ziporyn. The Harvard Guide to Women's Health. Cambridge: Harvard University Press, 1996.
ORGANIZATIONS
American College of Obstetricians and Gynecologists. 409 12th St. SW, PO Box 96920, Washington, DC 20090-6920. <http://www.acog.org>.
Carol A.Turkington
Endomerial hyperplasia
—Thickening of the uterine lining. The types of hyperplasia include: simple, complex, and atypical.
Endometrial polyps
—A growth in the lining of the uterus (endometrium) that may cause bleeding and can develop into cancer.
Epidural anesthesia
—A type of anesthesia that is injected into the epidural space of the spinal cord to numb the nerves leading to the lower half of the body.
Hysteroscopy
—A procedure in which the doctor can see the uterine lining with a tube and viewing system. This is sometimes done with a D&C.
Uterine fibroid
—A noncancerous tumor of the uterus that can range from the size of a pea to the size of a grapefruit. Small fibroids require no treatment, but those causing serious symptoms may need to be removed.
QUESTIONS TO ASK THE DOCTOR
What are you looking for in the D&C?
Do you recommend any special preparation before the procedure?
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