Unfortunately, miscarriage is the most common type of pregnancy loss according to the American College of Obstetricians and Gynecologists (ACOG). Studies reveal that anywhere from 10-25% of clinically recognized pregnancies will end in miscarriage, and most miscarriages occur during the first 13 weeks of pregnancy. Pregnancy can be such an exciting time, but with the number of miscarriages that occur, it is beneficial to be informed in the unfortunate event that you or someone you know faces one.
The main goal of treatment during or after a miscarriage is to prevent hemorrhaging and/or infection. The earlier you are in your pregnancy, the more likely your body will expel all the fetal tissue by itself and will not require further medical procedures. If the body does not expel all the tissue, the most common procedure performed to stop bleeding and prevent infection is a D&C.
What is a D&C Procedure?
A D&C, also known as dilation and curettage, is a surgical procedure often performed after a first-trimester miscarriage. In a D&C, dilation refers to opening the cervix; curettage refers to removing the contents of the uterus. Curettage may be performed by scraping the uterine wall with a curette instrument or by a suction curettage (also called vacuum aspiration).
Is a D&C necessary after a miscarriage?
About 50% of women who miscarry do not undergo a D&C procedure. Women can safely miscarry on their own with few problems in pregnancies that end before 10 weeks. After 10 weeks, the miscarriage is more likely to be incomplete, requiring a D&C procedure. Choosing whether to miscarry naturally (called expectant management) or to have a D&C procedure is often a personal choice that is best decided after talking with your health care provider.
Some women feel comfort in miscarrying in their own home, trusting their body to do what it needs to. Some see this as a vital part of the healing process, eliminating the question of “what if?” about the viability of the pregnancy. There are also many women who miscarry who have a history of gynecological problems and don’t want to risk the possibility of any complications occurring from having a D&C procedure. For most first trimester miscarriages, expectant management should be a reasonable option.
For some women, the emotional toll of waiting to miscarry naturally is too unpredictable and too much to handle in an already challenging situation. Healing for them may only start once having a D&C procedure. A D&C may be recommended for women who miscarry later than 10-12 weeks, have had any complications, or have medical conditions in which emergency care could be needed.
How is a D&C procedure performed?
A D&C procedure may be performed as an outpatient or inpatient procedure in a hospital or other type of surgical center. A sedative is usually given first to help you relax. Most often, general anesthesia is used, but IV anesthesia or paracervical anesthesia may also be used. You should be prepared to have someone drive you home after the procedure if general or IV anesthesia is used.
- You may be given antibiotics intravenously or orally to help prevent infection.
- The cervix will be examined to determine if it is open. If the cervix is closed, dilators (narrow instruments in varying sizes) will be inserted to open the cervix to allow the surgical instruments to pass through. A speculum will be placed to keep the cervix open.
- The vacuum aspiration (also called suction curettage) procedure uses a plastic cannula (a flexible tube) attached to a suction device to remove the contents of the uterus. The cannula is approximately the diameter in millimeters as the number of weeks gestation the pregnancy is. For example, a 7mm cannula would be used for a pregnancy that is 7 weeks gestation. The use of a curette (sharp-edged loop) to scrape the lining of the uterus may also be used, but this is often not necessary.
- The tissue removed during the procedure may be sent off to a pathology lab for testing.
- Once the health care provider has seen that the uterus has become firm and the bleeding has stopped or is minimal, the speculum will be removed and you will be sent to recovery.
What are the possible risks and complications of a D&C procedure?
- Risks associated with anesthesia such as an adverse reaction to medication and breathing problems
- Hemorrhage or heavy bleeding
- Infection in the uterus or other pelvic organs
- Perforation or puncture to the uterus
- Laceration or weakening of the cervix
- Scarring of the uterus or cervix, which may require further treatment
- Incomplete procedure that requires another procedure to be performed
What to expect after the D&C Procedure:
Most women are discharged from the surgical center or hospital within a few hours of the procedure. If there are complications or you have other medical conditions, you may need to stay longer. You will more than likely be given an antibiotic to help prevent infection and possibly some pain medication to help with the initial cramping after the procedure.
Things to know about taking care of yourself at home:
- Most women can return to normal activities within a few days, and some feel good enough to return to normal non-strenuous activity within 24 hours.
- You may experience some painful cramping initially, but this should not last longer than 24 hours.
- Light cramping and bleeding can be expected from a few days to up to 2 weeks. Ibuprofen is usually suggested for treating cramps.
- You should not insert anything into the vaginal area (including using a douche or having sexual intercourse) for at least 2 weeks or until the bleeding stops. Your health care provider should give you specific instruction for when intercourse can resume.
- Tampons should not be used until you start your next regular period, which could be anywhere from 2-6 weeks after the D&C procedure.
- It is unknown when ovulation will return, so once sexual intercourse is allowed, you should use a method of contraception until your health care provider says it is okay to try to get pregnant again.
- Make sure to attend your follow up appointment.
When to contact your health care provider:
Most women experience few complications after a D&C procedure, but you should be aware of symptoms that could signal a possible problem.
Your health care provider should give you specific instructions on what to expect, but contact them as soon as possible if you experience any of the following:
- Dizziness or fainting
- Prolonged bleeding (over 2 weeks)
- Prolonged cramping (over 2 weeks)
- Bleeding heavier than a menstrual period, or filling more than one pad per hour
- Severe or increased pain
- Fever over 100.4 °F
- Foul smelling discharge
Compiled using information from the following sources:
Managing Complications in Pregnancy and Childbirth, World Health Organization http://www.who.int/ D & C for Miscarriage, Medem Medical Library A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; ©2005. D and C; [updated 2004 Apr 14; cited 2006 Jul 12]; [about 2 p.]. Available from: http://www.nlm.nih.gov/medlineplus/ency/article/002914.htm Women’s Health Care: 20 Common Problems. Smith, Mindy, et al, Ch. 15, 2000. William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 9. Danforth Obstetrics and Gynecology Ninth Ed. Scott, James. Gibbs, et al, Ch. 9