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Dilation and curettage (D & C) is a gynecological procedure that may be performed under a variety of circumstances. Contrary to popular belief, the D & C is not often used as an abortion technique, and doctors instead prefer early term vacuum methods. Yet this procedure is sometimes used to end a missed miscarriage or to finish an uncomfortable miscarriage in process, and may also be employed as a treatment for bleeding between periods, polyps removal, or to evaluate endometrial (uterine lining) tissue for problems. As the name suggests, the D & C involves two separate steps: dilation of the cervix to gain access to the uterus, and scraping or sometimes suctioning of the uterine lining.
There are some variations in how dilation and curettage may be performed. Some women undergo a D & C while under general anesthesia. Growing preference is to use local anesthesia instead, but there can be good reason why a general anesthetic is preferred, particularly if the D & C is not planned and must be performed on an emergency basis. Another variance is where a dilation and curettage might be performed; it could occur at a hospital, surgical center, or a suitably equipped doctor’s office.
The actual dilation and curettage procedure does not take long. It involves inserting a series of rods into the cervix opening to dilate it for access to the uterus. Once the opening is large enough, an instrument called a curette is inserted into the uterus via the cervix, and is used to scrape the lining of the uterus. Pieces of this lining are removed to either end a miscarriage or get samples, which can be tested at a lab for anomalies. A curette could also remove polyps present in the uterus, if needed.
Alternately, vacuum extraction of the tissue may be preferred to use of the curette, or the two instruments might both be employed. This may still be called a dilation and curettage. It may be more accurately titled a dilation and extraction (D & E).
Degree of discomfort women may feel with dilation and curettage usually depends on the anesthetic used. With general anesthesia, nothing is felt, but with local anesthetic there may be some pulling and tugging sensations or cramping. If these become too uncomfortable, women should inform their doctors. It’s often possible to have a higher dose of anesthetic before continuing.
Afterwards, women are usually given fairly specific instructions on aftercare. These include reporting any fever, severe pain, bad smelling discharge, or heavy bleeding, abstaining from intercourse for at least two weeks, not using tampons for that time period and following up with doctors at the six week point. Such follow-up is doubly vital if uterine lining is being tested for evidence of any forms of cancer. It’s important to follow all doctor’s instructions after this procedure, and also to not hesitate to contact doctors if unusual symptoms occur or questions exist that aren’t covered by instructions.
The typical complications of the D & C are excessive bleeding and infection. In fact, since the cervix remains somewhat open for a few weeks after the procedure, women remain vulnerable to infection: hence the warning on avoiding insertion of things into the vagina or having intercourse. There is an additional risk that some women should consider.
If the dilation and curettage is for a missed miscarriage or abortion, there will be a quick decline in pregnancy hormones, placing women at risk for postpartum depression. Having strong support may minimize this risk slightly, but women should also pay attention to strong feelings of sadness, hopelessness, isolation, or suicidality. Should these feelings be noted, they should be brought to the attention of a doctor right away for treatment
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