Losing a pregnancy is an extremely difficult experience to go through. It can become even more difficult if things don’t physically progress or if you develop complications along the way.
Dilation and curettage (D&C) is a routine procedure where a doctor uses a special medical instrument to scrape the contents of the uterus. It removes fetal tissue and products of conception so the body can return to its prepregnancy state.
We explain exactly why this procedure is performed, what you’ll experience, and how to evaluate the benefits versus risks.
Up to 20 percent of known pregnancies end in miscarriage. Most happen within the first 12 weeks in what’s considered early miscarriage.
D&C is an option for early miscarriages in cases where:
- the miscarriage doesn’t start on its own (missed miscarriage)
- tissue remains in the uterus (incomplete miscarriage)
- no embryo forms in the uterus (blighted ovum)
This procedure is also a choice your doctor may present you if you’ve discovered you’ll miscarry but you don’t wish to wait for a miscarriage to start on its own.
Most D&Cs are done as what’s called an outpatient procedure. This means that you’ll go into an office or hospital, have the D&C, and go home within the same day.
You may or may not need to fast before heading to your appointment — your doctor will let you know.
After you check in and gown up, the nursing staff will check your vital signs. You’ll then wait for the doctor to arrive and explain the procedure before taking you to the operating room (OR).
Also before you’re taken to the OR, you may have an intravenous line (IV) placed to deliver anesthesia. The type of anesthesia you receive depends on factors specific to your case and your health history.
Some women may go under general anesthesia while others may have light sedation. Other options include local or regional anesthesia, which are injections to provide numbing specific to where the procedure is being performed.
During the D&C:
- You’ll rest on your back with your feet in stirrups, similar to the position when you have a pelvic exam.
- Your healthcare provider will place a speculum into your vagina. This tool helps spread apart the vaginal walls so they can visualize the cervix.
- The cervix is carefully cleaned using an antiseptic solution. (Your doctor may also inject any local anesthesia at this time.)
- Your doctor will dilate your cervix using thin rods that get progressively bigger in diameter.
- Your doctor will then use an instrument called a curette to scrape the tissue that lines the uterus. The curette is shaped like a spoon and has sharp edges. Suction is occasionally used to remove tissue at this stage of the procedure as well.
- The D&C takes around 30 minutes to complete. When finished, your doctor will collect tissue to send to a lab for evaluation. They’ll also remove all instruments from your body and send you on your way to the recovery room.
After the procedure, a nurse will place a pad in your hospital underwear. That said, the initial bleeding you’ll experience is usually light.
You’ll likely be in the recovery room for around 45 minutes to an hour before being discharged.
In general, D&C is a safe procedure. As with any type of surgery, however, there are some risks involved.
If you have concerns, be sure to chat with your doctor about the benefits and risks of having a D&C in your specific case.
Complications include things like:
- bleeding that can be heavy
- scar tissue (adhesions) inside the uterus
- tearing of the cervix
- perforation of either the uterus or bowel
You may have heard of Asherman syndrome as a possibility following D&C. This refers to the adhesions that can develop in the uterus after the procedure.
The scar tissue may change your menstrual flow and potentially lead to infertility. This condition is rare and can be treated with surgery.
It’s probably hard to feel like there are any benefits to having a D&C. However, there are some things that this procedure can help you with — both physically and emotionally.
- It eliminates waiting time. If you’re waiting for a miscarriage to start, you can schedule D&C. This is especially helpful for some people going through pregnancy loss, as the loss is hard on its own without an unpleasant physical process looming overhead.
- It can reduce pain. While you’ll have some cramping and discomfort during or after the procedure, it’s generally going to be less pain than you’d experience with a natural miscarriage — mostly because you’ll be under some type of anesthesia or pain relief during the procedure itself.
- It can lessen emotional distress. It can be quite upsetting to see all the blood and fetal tissue expelled from the uterus during a natural miscarriage. With D&C, the tissue is removed by your doctor. And in many cases, you’ll be under anesthesia and unaware of what’s going on.
- It allows for testing. While you certainly can collect your own tissue for testing during a natural miscarriage, it may be difficult for a variety of reasons. When the tissue is removed in the OR, your doctor can properly package it up to send to a lab.
- It’s relatively safe. While there are some rare (and treatable) complications that may lead to infertility, D&C is generally considered a safe procedure that will not impact your future fertility.
You may feel tired or nauseated immediately following D&C. And in the days that follow, you may experience some mild cramping and light bleeding that can last for up to a couple of weeks.
Your doctor may recommend that you take over-the-counter (OTC) medications, like Advil or Motrin (ibuprofen), or prescribe you another medication for pain.
After a couple of days of rest, you may be able to go back to your normal level of activity and work. But everyone is different — so be sure to check in with your doctor for any specific guidelines.
And remember, even if your body is physically ready, it’s OK to need more time to be mentally and emotionally ready.
As far as putting anything into your vagina, this is another area where you’ll want to consult with your doctor. It takes some time for your cervix to return to its normal dilation after D&C. This means you’re more prone to infection from things like tampons, douches, or sex that involves vaginal penetration.
You may also be wondering when your cycle will return to your normal. This varies by person.
Your doctor just removed all the lining of the uterus, so it may take some time for that lining to build back up to its previous levels. Your periods may be lighter or just different until this happens.
Pregnancy is another topic likely on your mind. When is it OK to try again? This also varies and depends on your specific case.
Your doctor may say it’s fine to start trying again right away. Other doctors may suggest waiting several months or until lab results are collected (to check for things like chromosomal abnormalities) before trying to conceive.
Regardless, the American College of Obstetricians and Gynecologists explains that your period may be early or late following a D&C. Since ovulation generally happens 2 weeks before your period starts, this means that you may ovulate soon after the procedure or, alternatively, it may take several weeks.
Speak with your doctor about birth control options if you don’t wish to become pregnant soon after your D&C.
It’s completely normal to have cramping after D&C. The pain may be more intense at first and then gradually fade with time. Bleeding is generally light, and some people may only have spotting.
Call your doctor ASAP if you experience signs of infection or anything else that seems off from your normal. Don’t worry about bugging them — they deal with this sort of stuff all the time.
Warning signs include:
- discharge that has a foul or strange odor
- pain in your abdomen
- heavy bleeding
- severe cramping
- cramping that lasts longer than 48 hours
- fever or chills
Speak with your doctor to learn if a D&C procedure is a good option to manage your miscarriage.
While the decision is a tough one, it may help you get through the physical aspects of miscarriage so that you can focus on your emotions and other responsibilities.
No matter what you choose, take care of yourself. Surround yourself with support and be sure to give yourself plenty of time to heal and process your feelings.