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).

Do You Need a D&C After a Miscarriage?

The procedure is done to:

  • Remove tissue in the uterus during or after a miscarriage or abortion or to remove small pieces of placenta after childbirth. This helps prevent infection or heavy bleeding.
  • Diagnose or treat abnormal uterine bleeding. A D&C may help diagnose or treat growths such as fibroids, polyps, hormonal imbalances, or uterine cancer. A sample of uterine tissue is viewed under a microscope to check for abnormal cells.

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 healthcare provider.
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 start upon 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 Performed?

You can have a D&C in your doctor’s office, an outpatient clinic, or the hospital. It usually takes only 10 to 15 minutes, but you may stay in the office, clinic, or hospital for up to five hours.
Your doctor will need your complete medical history and a signed consent form. Be sure to tell the doctor if:

  • You suspect you are pregnant
  • You are sensitive or allergic to any medications, iodine, or latex
  • You have a history of bleeding disorders or are taking any blood-thinning drugs

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.

  1. You may be given antibiotics intravenously or orally to help prevent infection.
  2. 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.
  3. 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.
  4. The tissue removed during the procedure may be sent off to a pathology lab for testing.
  5. 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.

Are There Risks and Complications?

  • 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 a D&C

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 the Doctor

Most women experience few complications after a D&C procedure after miscarriage, 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
  • Chills
  • Foul smelling discharge

Want to Know More?

 

Compiled using information from the following sources:

1. Managing Complications in Pregnancy and Childbirth, World Health Organization

https://www.who.int/

2. 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

https://www.nlm.nih.gov/medlineplus/ency/article/002914.htm

3. Women’s Health Care: 20 Common Problems. Smith, Mindy, et al, Ch. 15, 2000.

4. William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 9.

5. Danforth Obstetrics and Gynecology Ninth Ed. Scott, James. Gibbs, et al, Ch. 9