D and C Complications, Contraindications, Recovery, Alternatives

Contraindications for D&C

• Pregnancy. Unless a D&C is done for inducing an abortion or in a case of miscarriage.
• Severe arthritis of the hips. If the legs cannot be moved apart for performing the procedure.
• If the patient is too ill for surgery.
• Pelvic infection. To prevent infection from the vagina and cervix being carried to the uterus during the procedure. Infected tissue is more prone to injury therefore a D& C should be avoided if any infection is present.
• Blood disorders. Women with certain blood clotting disorders may bleed excessively after this procedure.
• Certain medical problems such as heart or lung conditions where general anesthesia (GA) or other forms of anesthesia may become risky.
• Uncontrolled hypertension or diabetes.

Complications of D & C

Serious complications are rare following a D&C procedure. Some common complications may include :

• Pain or cramping may be present for a few days after the procedure. It can usually be relieved by pain medication such as nonsteroidal anti-inflammatory drugs (NSAIDs) and other analgesics.
• Infection is rare and may be controlled by oral antibiotics.
• Some amount of vaginal bleeding is normal for a few days after a D & C and it usually resolves on its own. Excessive bleeding requires immediate medical attention.
• Perforation of the uterus (accidental). This may occur if excessive force is applied while dilating the uterus or while using the sharp edge of the curette. Perforation of the uterus is more likely to occur if the uterus is soft (as during pregnancy), in case of previous uterine surgery like a Cesarean section or myomectomy, or due to infection. Cervical stenosis requiring extra force while applying the dilators or abnormal anatomy of the uterus may also result in uterine perforation.
• Cervical injury. Injury to the cervix can usually be managed by application of pressure and stitches are rarely necessary.
• Over-aggressive scraping with a curette during a D&C can lead to extensive scarring of the uterus, known as Asherman’s syndrome, causing light or absent periods, infertility and recurrent abortions. In most cases, these adhesions within the uterus can be removed with surgery.
• Persistent dilated cervix may lead to cervical incompetence and chances of spontaneous miscarriage in future pregnancies.
• Adverse reaction to anesthesia and other complications of anesthesia.
• Two or more abortions done by using the sharp curette in D & C may reduce chances of future pregnancy.

Follow up and Recovery

• The patient may be asked to come in for a follow up consultation after 2 to 6 weeks.
• Further management may need to be discussed depending upon the result of the tissue samples.
• Avoid using of tampons or a vaginal douche and refrain from sexual activity for 2 weeks following D&C . This will help to prevent an infection.
• The next menstrual period may come a little early or late.
• If there is a small perforation of the uterus, it may not require further treatment and may heal on its own.

Dilation and Curettage (D&C) Alternatives

Previously a D&C was conducted as a diagnostic procedure more than it is these days. With modern imaging techniques and investigative procedures, a D&C may not always be necessary.

• Since only a part of the endometrial cavity is scraped during a D & C, there is a fair chance of missing a disease unless a hysteroscopy is done along with it.
• Ultrasound and other imaging techniques such as a hysteroscopy are preferred to D & C for diagnosis of many uterine conditions.
• Endometrial sampling (biopsy) is increasingly being done as an in-office procedure by means of a thin plastic suction curette. This method is both quick and simple and the slight pain associated with this procedure can be handled by using oral painkillers.

In terms of treating abnormal uterine bleeding, modern drugs may be more effective that a D&C.