Dilation and curettage (D&C) consists of two types: diagnostic and therapeutic. 

 

Diagnostic D&C 

Diagnostic D&C is primarily used to diagnose conditions such as endometrial cancer and cervical canal cancer. This procedure typically involves obtaining a tissue sample from the endometrium for pathological examination to determine the presence of cancer cells. It assists physicians in making a definitive diagnosis and formulating an appropriate treatment plan. 

 

Therapeutic D&C 

Therapeutic D&C is employed to address various medical conditions. It can be used to manage inevitable miscarriage (spontaneous abortion), incomplete miscarriage (when some embryonic tissue remains), stillbirth, molar pregnancy, and retained placenta after childbirth, which can cause prolonged bleeding. This procedure is generally performed to remove residual tissue from the uterus to help stop bleeding and prevent infection. 

 

Indications for D&C 

Diagnostic D&C 

Individuals suspected of having endometrial or cervical canal cancer. 

Patients requiring a tissue sample from the endometrium for pathological analysis. 

 

Individuals for whom other diagnostic procedures (such as endometrial biopsy or tissue culture) have not provided a definitive diagnosis. 

 

Therapeutic D&C 

• Inevitable Miscarriage: When an embryo cannot be completely expelled during a natural miscarriage, D&C may be performed to remove residual tissue and prevent infection and ongoing bleeding. 

• Incomplete Miscarriage: D&C may be used to completely remove any remaining embryonic tissue when part of it has not been expelled. 

• Stillbirth: In cases of stillbirth, D&C can be performed to remove fetal and placental tissue. 

• Molar Pregnancy: This abnormal pregnancy condition may require D&C to clear abnormal tissue from the uterus. 

• Retained Placenta: If the placenta is not completely expelled after delivery, D&C can be used to remove the remaining tissue to prevent ongoing bleeding and infection. 

 

The Procedure Steps 

1. Anesthesia: The procedure is performed under monitored anesthesia care or general anesthesia, ensuring that the patient does not feel pain or discomfort. An anesthesiologist will monitor the patient throughout the procedure to ensure safety. 

2. Dilation of the Cervix: The physician will use instruments (such as cervical dilators) or medications (like local anesthetics) to dilate the cervix for the procedure. 

3. Endometrial Curettage: Using an instrument called a curette, the physician will gently scrape the endometrial tissue from the uterine cavity. This tissue will be sent for pathological examination for diagnostic or therapeutic assessment. 

4. Removal of Uterine Tissue: If the surgery is therapeutic, the physician may further remove tissue within the uterus, such as embryonic tissue from an incomplete miscarriage or retained placenta. 

 

Before the procedure 

• Fasting Instructions: Patients are generally advised to fast for six hours before surgery. During this fasting period, only small amounts of clear fluids (such as water) may be consumed, with no food intake for two hours prior to the procedure. 

• Preoperative Medications: Patients should take any prescribed preoperative medications as directed. 

• Informed Consent: The physician will explain the reasons for the procedure, the process, and potential complications. After understanding, the patient may sign the consent form. 

• Emptying the Bladder: Patients should ensure they have urinated before the procedure. 

 

After the procedure 

• Rest: Patients should rest and avoid excessive activity after the procedure. Based on the physician's advice, it may be necessary to refrain from heavy lifting and vigorous exercise for a period of time. 

• Medications: Physicians may prescribe medications such as pain relievers or antibiotics. Patients should follow the physician’s instructions for these medications to alleviate pain and prevent infection. 

• Vaginal Discharge: It is normal to experience some blood clots in the days following the procedure. However, if clots are large or occur frequently, patients should contact their physician. 

• Severe Bleeding: If patients experience heavy bleeding or need to change more than one pad or liner, they should seek immediate medical attention. 

• Vaginal Products: Patients should avoid using any intravaginal products aside from sanitary pads for a specified period, following the physician's recommendations. 

 

Follow-up and recovery 

Common Symptoms and Postoperative Care 

• Postoperative Symptoms

Patients may experience common postoperative symptoms such as headache, dizziness, nausea, or irritation at the intravenous (IV) site. These symptoms typically resolve within a few days. Pain relief medications can be administered as needed, and ample rest is recommended during this recovery period. 

  

• Return Home 

Patients may leave the facility once the effects of anesthesia have subsided but must be accompanied by an adult. 

 

• Dietary Restrictions 

Patients should refrain from eating until the effects of anesthesia and sedation have fully worn off to prevent choking. 

  

• Avoid Alcohol and Heavy Machinery 

On the day of the procedure, patients are advised not to consume alcohol, operate heavy machinery, or drive in order to avoid accidents. Additionally, it is recommended to refrain from signing any legal documents for 24 hours post-surgery. 

  

• Postoperative Bleeding 

Mild vaginal bleeding, similar to late menstrual flow, may occur within the week following the procedure. 

  

• Abdominal Discomfort 

Mild abdominal cramping may be experienced in the first 2 to 3 days post-surgery. Patients are advised to avoid strenuous activities during this time. 

  

• Personal Hygiene 

To maintain cleanliness after bowel movements, patients should wipe from front to back and prioritize showering over bathing. 

  

• Activity Restrictions 

Patients should avoid sexual intercourse and vaginal douching for one week post-surgery, or as directed by their physician. Additionally, it is recommended to take precautions to avoid pregnancy during the subsequent three months. 

  

Recovery Process Following Dilation and Curettage (D&C)  

During the recovery phase, patients should be attentive to the following: 

  

• Bleeding and Discharge 

It is normal to experience light bleeding and discharge resembling menstrual flow in the days following the procedure. Patients may use panty liners to manage this discharge but should avoid tampons, as they may increase the risk of infection. 

  

• Abdominal Pain and Discomfort 

Mild abdominal pain and discomfort are common after the procedure. Prescription pain medication can help alleviate these symptoms. If pain worsens or becomes unmanageable, patients should contact the physician promptly. 

  

• Rest and Activity 

Patients should rest for several days following the procedure and avoid strenuous activities or heavy lifting. However, light activity, such as gentle walking or low-impact exercises, may be beneficial for circulation and recovery, as advised by theiryour physician. 

  

• Diet 

Maintaining a balanced diet can support recovery. Patients are encouraged to consume nutrient-rich foods, including vegetables, fruits, whole grains, and proteins, to enhance recovery and immune function. Avoiding greasy, spicy, or irritating foods can help prevent abdominal discomfort. 

  

• Sexual Activity 

To minimize the risk of infection and protect the healing of the endometrium, physicians typically recommend avoiding sexual intercourse during the recovery period. 

  

• Monitoring for Abnormal Symptoms 

Throughout the recovery process, patients should remain vigilant for any abnormal symptoms, such as severe abdominal pain, persistent bleeding, fever, or signs of infection. These may indicate complications that require timely intervention, and patients should contact your physician if such symptoms arise. 

 

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Reference

Mayo Clinic. Dilation and curettage (D&C). Available at : https://www.mayoclinic.org/tests-procedures/dilation-and-curettage/about/pac-20384910

 

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