A dilation and curettage procedure, also known as a D&C, is a surgical procedure in which the cervix (lower, narrow part of the uterus) is dilated so that the uterine lining (endometrium) can be scraped with a curette instrument in order to remove abnormal tissues. During the dilation and curettage procedure, the patient is placed in supine position of the body with the legs separated, flexed, and supported in raised stirrups. The doctor inserts a speculum into the vagina, as during a pelvic exam, in order to see the cervix.
Then, the cervix is slowly dilated by inserting a series of thicker and thicker rods into the cervix until it’s adequately opened, usually to between 6 and 9 millimeters in diameter. After dilation, a curette is inserted to begin removing tissue. Although the D&C involves no stitches or cuts, the cervix is cleansed with an antiseptic solution. A dilation and curettage can be done as day-surgery or may require an overnight stay in the hospital. It is recommended that before the surgery, the patient take nothing by mouth (food, water, etc. ) for at least 6 hours before the scheduled operation.
Before surgery or during the previous night, a bath maybe is advisable since it helps lower the bacterial count and lessen the chances of any infection from surgery. The genital area is shaved in order to begin skin preparation. Skin preparation begins at the pubic symphysis and extends downward over the labia. Next, each inner thigh is cleansed. After, the vaginal vault and cervix are cleansed using three spongesticks. Spongesticks must be discarded after wiping the anus. The patient’s bladder is drained with a straight catheter to prevent the bladder from compromising the field.
Once the patient has been prepared, a drape sheet is tucked under the buttocks, followed by leggings and a drape sheet over the abdomen. For a dilation and curettage procedure, a scrub tech sets up the instruments on the back table, but he/she is not needed during the procedure. The surgeons take the instruments, such as Overstreet Endometrial Polyp Forceps, Skene Vulsellum Tenaculum, Schroeder Braun Tenaculum, directly off the back table themselves. Besides a Dilatation and curettage tray, a small basin, water-soluble lubricant, a Telfa (for specimen), perineal pad and sanitary napkin belt will also be needed on the back table for the dilation and curettage procedure. An antiembolism hose may be requested.
A dilation and curettage may be used as a diagnostic or therapeutic procedure for abnormal bleeding. A dilation and curettage procedure can also be performed to determine the cause of abnormal or excessive uterine bleeding, to detect cancer, or as part of an infertility investigation. Causes of abnormal bleeding include the presence of abnormal tissues, such as fibroid tumors (benign tumors that develop in the uterus, also called myomas) polyps, or cancer of the endometrium or uterus.
Abnormal uterine bleeding may also be due to a hormone imbalance or disorder when approaching menopause or after menopause. A dilation and curettage may also be performed following a miscarriage to remove the fetus and other tissues if they have not all been naturally passed. Infection or heavy bleeding can occur if these tissues are not completely removed. Occasionally following childbirth, small pieces of the placenta remain adhered to the endometrium and are not passed, which can cause bleeding or infection. A dilation and curettage is used to remove these fragments so that the endometrium can heal properly.
For the dilation and curettage procedure, there is general anesthesia, regional anesthesia and local anesthesia. General anesthesia is given through either a breathing mask or an intravenous (IV) catheter. The IV may be placed in a vein in the patients hand, arm or neck. The patient may have a breathing tube inserted through their mouth and into their windpipe to make sure they’re breathing properly. General anesthesia relaxes the muscles, which makes it easier for the doctor to perform a pelvic exam. Regional anesthesia is injected into the area around the spinal cord, blocking any pain during the procedure.
Local anesthesia, which is most common, is injected directly into and around the cervix to numb the area. The patient also receives a sedative from an IV. The dilation and curettage procedure has a low risk of serious complications. The most common complication that can occur is perforation of the uterus with either the dilators or the curette. When this happens, as long as no internal organs such as intestines, bladder, or rectum, or large blood vessels are damaged, the hole will almost always heal itself without further surgery.
The risk for this problem is increased in patients with a narrowed opening to the cervix (cervical stenosis) or in patients with distorted internal uterine anatomy. This risk is also increased if the uterus is infected or has undergone previous surgeries such as cesarean sections or myomectomies. Injury to the cervix is another possible complication. Tears or cuts in the cervix can usually be treated by application of pressure and application of local medications to stop bleeding. In some cases, stitches in the cervix may be required, but this is not common.
Other complications, as with any surgery, include bleeding and infection. Most bleeding is mild and resolves on its own. Infection is also rare and can normally be managed with oral antibiotics. On occasion, in patients with certain heart defects, the surgeon may give the patient antibiotics before and after the surgery to prevent bacteria from the vagina from infecting the heart valves. It is normal to experience vaginal bleeding and/or pelvic cramping for a few days after a dilation and curettage procedure.