What Are the Risks and Complications of Dilation and Curettage (D&C)?
The dilation and curettage procedure (D&C) involves dilating the uterine cervix so that the lining tissue of the uterus can be removed by scraping or suction. It is a safe, minor procedure that is performed for a variety of reasons in a hospital or ambulatory surgery center or clinic.
In general, a dilation and curettage are used to help determine the health of the uterine lining or to remove abnormal tissue. Occasionally, the procedure can correct some of the problems in the uterus such as polyps, scar tissue, or tissue overgrowth.
The D&C procedure has a low risk of serious complications. It is normal to experience vaginal bleeding and/or pelvic cramping (similar to menstrual cramping) for a few days following the procedure. Typically, over-the-counter pain medications are sufficient for pain control.
Some other risks include the following.
Hemorrhage: Heavy bleeding is rare, but it can happen if an instrument injures the walls of the uterus or if an undetected fibroid is cut during curettage.
Infection: There is always a slight possibility of infection once instruments are inserted into the uterus. Most infections can be easily cured with antibiotics.
Perforated uterus: This complication, though rare, is more common in women who have a uterine infection at the time of the procedure, in elderly postmenopausal women, and if the procedure is being done for a miscarriage.
Asherman syndrome: This complication is rare and involves the formation of scar tissue in the uterus, caused by aggressive scraping or abnormal reaction to the scraping. Thick scars can result, which can fill up the uterus completely and lead to infertility and cessation of menstrual periods.
Missed disease: Since the procedure cannot completely remove all the endometrium (lining tissue of the uterus), there is a chance that disease could go undetected. This is why the procedure is seldom done without an examination of the uterine lining using an instrument that allows direct visualization.
During the Dilation and Curettage Procedure
Prior to the procedure the patients will be given either local, spinal or general anesthesia.
Step #1 Dilation: While grasping the cervix with a clamp, the doctor will pass a thin, flexible piece of metal called a sound to determine the depth and angle of the uterus. These measurements allow the doctor to know how far into the uterus the curette can be safely inserted. This process takes about 10 minutes is repeated until the cervix has expanded to about the width of a finger.
Step #2 Hysteroscopy and curettage: After dilation, the doctor holds the vagina open again with the speculum. The doctor may also reach into the cervix with a tiny spoon to obtain a specimen of the cervical lining. At this point, the hysteroscope is usually inserted into the uterus so that the doctor may look at the inside of the uterus. The doctor may see fibroids, polyps, or overgrowths of the endometrium. At that time, instruments may be inserted through the hysteroscope and biopsy, or removal, of the fibroids, polyps, or endometrial overgrowths may be accomplished.
The entire procedure, including curettage takes about 20 minutes. At the end, the patient may have cramps that may last about 30 minutes; however, some women experience cramps for a much longer period of time.
What Follow-up is Needed for Dilation and Curettage?
Following the surgery, the patient is cared for in a post-anesthesia care unit during recovery from the anesthesia. Most patients can return to normal activities within a few days. Non-steroidal anti-inflammatory medications may be recommended to relieve the mild pain and cramping that may follow.
If you are curious about whether the dilation and curettage procedure can help with a medical issue you are experiencing, call our office today to schedule a consultation and let’s discuss your goals and options.