Uterine Curettage: Purpose, Risks, and Post-Surgery Care

Many women have heard of Dilation and Curettage (D&C) but may not fully understand its purpose. What is it used for? Who needs it? Is it dangerous? How should you prepare and care for yourself before and after the procedure? What are the potential risks and side effects? Here’s everything you need to know.

Dilation and Curettage (D&C) is a procedure used to remove tissue from the uterus for diagnosis or treatment of abnormalities. It is commonly performed after a miscarriage to remove any remaining placental tissue, clean the uterus, and prevent excessive bleeding. The doctor will use specialized instruments to gently open the cervix and scrape or suction out the uterine lining.

1. Dilation and Curettage (D&C) for Diagnosis

When abnormalities occur in the uterus, doctors may need to diagnose the condition by examining endometrial cells. D&C is one method used to identify various health issues, such as:

• Diagnosing postmenopausal bleeding

• Investigating causes of infertility

• Examining abnormal endometrial cells

• Detecting uterine polyps

• Identifying endometrial hyperplasia

• Diagnosing endometrial cancer

D&C for diagnostic purposes involves removing a small sample of tissue for analysis rather than scraping out large amounts or eliminating foreign matter, distinguishing it from D&C performed for treatment.

2. Dilation and Curettage (D&C) for Treatment

D&C is also used as a treatment method, particularly for conditions involving abnormalities or foreign matter in the uterus. For example, in cases of miscarriage—whether from natural pregnancy or ectopic pregnancy—D&C may be necessary to remove remaining tissue and help restore the uterus to its normal state.

Additionally, D&C is sometimes performed as part of an abortion procedure when pregnancy complications occur, and other termination methods are not feasible.

Preparation Before a Dilation and Curettage (D&C) Procedure

1. Fasting: Avoid food and drink for 6-8 hours before the procedure to reduce the risk of aspiration during anesthesia.

2. No makeup or nail polish: Refrain from wearing makeup, lipstick, or nail polish to help doctors assess circulation and blood loss.

3. Remove jewelry and accessories: Do not wear rings, necklaces, or other valuables to prevent loss, and remove dentures or contact lenses before surgery.

4. Have a companion: Bring a relative or friend to assist you and accompany you home after the procedure.

5. Prepare sanitary pads: Bring sanitary pads for use after the procedure.

6. Follow doctor’s instructions: If you have any underlying health conditions, follow your doctor’s specific guidelines regarding medication and care.

Steps of Dilation and Curettage (D&C) Procedure

1. The doctor cleans the cervix with an antiseptic solution and may use a hysteroscope to examine the uterine lining before starting the procedure.

2. A speculum is inserted into the vagina to open the vaginal walls and access the cervix.

3. After dilating the cervix, a curette (a spoon-shaped surgical instrument) is inserted to scrape the uterine lining and remove tissue.

4. If the curette cannot remove all the tissue, suction may be used to extract any remaining tissue.

5. Once the required tissue sample is obtained or no residual tissue remains, the doctor removes the instruments and sends the collected sample for laboratory analysis.

Post-D&C (Dilation and Curettage) Self-Care

• Get at least 8 hours of rest daily.

• Avoid heavy work or strenuous activities for 1-2 weeks after the procedure.

• You may experience side effects like nausea or vomiting from anesthesia, but you can resume normal eating habits afterward.

• Refrain from sexual intercourse for at least 2 weeks to prevent infection.

• Light vaginal bleeding may occur but should gradually decrease and typically resolve within 2 weeks.

• Do not use tampons after the procedure; opt for sanitary pads instead.

• Avoid douching to prevent infections in the uterus.

• Take prescribed medications, such as pain relievers, to ease uterine cramps.

• Attend follow-up appointments as scheduled to review pathology results and plan further treatment if necessary.

• High fever

• Increasing and persistent lower abdominal pain for more than 48 hours

• Heavy vaginal bleeding

• Foul-smelling discharge from the vagina

Uterine infection (Endometritis)
Some tissue may remain in the uterus after the procedure, which the body can naturally expel without harm. However, if an infection develops or excessive vaginal bleeding occurs, a repeat D&C may be necessary.

Cervical injury
If the cervix tears or sustains damage during the procedure, the doctor may apply pressure or stitch the wound to stop the bleeding.

Intrauterine adhesions (Asherman’s syndrome)
This condition often occurs after a D&C following childbirth or miscarriage. It can lead to missed periods, severe menstrual pain, infertility, or an increased risk of miscarriage in future pregnancies.

Uterine perforation
In rare cases, the uterus may be perforated due to surgical instruments used during the procedure.

After a D&C, the uterine lining becomes very thin, which may prevent embryo implantation or cause the placenta to implant too deeply, increasing the risk of retained placenta during childbirth. Therefore, doctors usually recommend avoiding sexual intercourse for at least one month and postponing pregnancy for at least three months to allow the uterine lining to regain sufficient thickness for embryo implantation.

D&C for Diagnosis:
The primary purpose of a dilation and curettage (D&C) procedure is to diagnose abnormalities such as unexplained uterine bleeding or potential endometrial cell irregularities. It helps detect conditions like endometrial cancer, abnormal thickening of the uterine lining, polyps, or fibroids in the uterus.

D&C for Treatment:
Besides diagnosis, a D&C is also performed for treatment. It is used in cases such as molar pregnancies (abnormal growth of placental tissue), legal abortion procedures, or when a miscarriage occurs to ensure no tissue remains inside the uterus.

Is a Dilation and Curettage (D&C) Dangerous?
A D&C procedure is generally safe and not life-threatening. However, like any medical procedure, it carries potential side effects that vary from person to person, such as light bleeding, lower abdominal pain, or fever. To minimize risks, the procedure should be performed by a specialized and experienced doctor. If any unusual symptoms occur after the procedure, seeking medical attention immediately is advised.

How Long is the Recovery Period After a D&C?
After the procedure, patients typically need to rest in the hospital for about 2-3 hours for monitoring. This allows doctors to observe for any complications or side effects from anesthesia before discharging the patient.

Is General Anesthesia Used for a D&C?
A D&C can be performed under general anesthesia, local anesthesia, or sedation, depending on the case. Patients do not feel pain during the procedure, but mild cramping may occur once the anesthesia wears off. The procedure usually takes around 30 minutes.

Dilation and Curettage (D&C) is a procedure used to remove tissue from the uterus for diagnostic or treatment purposes. It is commonly performed for cases of miscarriage, abnormal vaginal bleeding, postmenopausal bleeding, abnormal endometrial cells, ectopic pregnancy, and postpartum hemorrhage.

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