Dilation and Curettage (D&C) Procedure, Indications, Anesthesia

What is a D&C?

Dilatation and curettage (D&C) is a minor surgical procedure used for the diagnosis and treatment of certain conditions causing abnormal bleeding from the uterus. A D&C is one of the most common forms of surgery performed on a woman. It is a short procedure, usually performed under general anesthesia (GA). The cervix of the uterus is dilated or opened and the inner wall of the uterus (endometrium) is scraped by means of an instrument called a curette.

Why is a D&C done?

Reasons for a D&C (Indications)

  1. Diagnosis and treatment of dysfunctional uterine bleeding (DUB), including heavy and prolonged menstruation or bleeding in between periods. Refer to Abnormal Vaginal Bleeding.
  2. Management of miscarriage (incomplete or missed abortion).
  3. For inducing abortion.
  4. Cancer of the uterus – endometrial cancer can give rise to abnormal bleeding. Both cancerous and pre-cancerous stage diagnosis may be done.
  5. To determine the cause of infertility.
  6. To determine the cause of severe menstrual pain (dysmenorrhea) or abnormal vaginal blood clots.
  7. Treatment of cervical stenosis – the passageway through the cervix (from the vagina to the main body of the uterus) may be abnormally narrow or closed.

Types of Anesthesia Used for D & C

  • General anesthesia (GA) is used most frequently since a D&C is a short procedure and GA can be reversed quickly. With GA, the patient will be unconscious and will not be aware of anything and in most cases,  the patient can be discharged from the hospital on the same day with no need for an overnight stay.
  • Epidural or spinal anesthesia may be given through a needle placed in the lower back.  The patient will be awake throughout the procedure but will not have any sensation in the lower part of her body, usually from the level of the umbilicus. The effect usually wears off in 1 to 3 hours.
  • Rarely, the procedure is performed under local anesthesia with or without intravenous pain medication or ‘twilight sleep’, if the patient so wishes. Local anesthesia is injected into the cervix on either side, which helps to relieve pain from the dilating cervix. This is called a paracervical block. It does not have any effect on the rest of the body. The patient will be awake and may feel pelvic cramping or a tugging sensation in the abdomen during the procedure.

Dilation and Curettage (D & C) Procedure

Before

A patient should have fasted for 8 hours (regional or local anesthesia) or 12 hours (general anesthesia). The procedure needs to be done on an empty stomach.  If the doctor prefers to start dilating the cervix before surgery (this may be necessary in cervical stenosis) a narrow rod or laminaria tents (made from a type of seaweed) is inserted into the opening of the cervix and left in place for several hours. The rod absorbs fluid from the cervix, causing the cervix to swell and the opening to enlarge. The cervix may also be softened and dilated by means of medications (misoprostol) prior to surgery.

During

The procedure may be done in a hospital, outpatient clinic, surgery center or a doctor’s office. An overnight stay is not necessary. The actual procedure takes only a few minutes.

  • Anesthesia is administered.
  • The patient lies on her back, with her legs up in stirrups.
  • The vagina and cervix are cleansed with an antibacterial scrub and then draped.
  • A vaginal examination is done to check the size and location of the uterus.
  • A speculum is inserted into the vagina to expand the vagina and allow access to the cervix.
  • The anterior lip of the cervix is grasped with a tenaculum and a blunt-tipped probe or uterine sound is passed through the cervix to measure the length of the uterus.
  • A series of progressively larger metal rods or dilators are used to gradually dilate or open the cervix.
  • When the cervix has been sufficiently dilated, a spoon-shaped instrument with a sharp edge called a curette is inserted into the uterus.
  • Gentle curetting is done to scrape out the lining of the uterus.
  • Another method of obtaining a sample of the endometrium is by applying suction through a narrow tube. The tissue that is removed is sent to the laboratory for analysis.

In case of D & C being done for miscarriage or abortion, gentle curetting is done till a gritty sensation is felt. Suction is usually applied to remove all the products of conception.

After

After the procedure is done, the patient is moved to a recovery area and kept under observations for a few hours till the effects of anesthesia have worn off. If there are no complications and the patient is feeling fit to go home, she will be discharged on the same day. Slight nausea or vomiting may occur due to the effects of GA. Some amount of pain or discomfort may be present following surgery. Analgesics (painkillers) and other medication may be prescribed if necessary. Recovery is quick and the patient can return to normal activities within a few days.