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Dilatation and Curettage (D & C)

Introduction

A dilatation and curettage (D&C) is a procedure in which the cervix is dilated (enlarged). This is done so that tissue samples can be taken. Samples are taken from the uterine lining with an instrument called a curette. A D&C provides information about the lining of the uterus. It is a common procedure. The most common reason for having a D&C is to find out the cause of abnormal uterine bleeding. It may also be used to remove growths such as polyps. It is helpful in the early diagnosis of endometrial carcinoma. This is cancer of the lining of the uterus. A D&C may also be done:

  • After a miscarriage. It is done to remove tissue this is still in the uterus.
  • To stop heavy bleeding after delivering a baby.
  • To perform an abortion.
  • To remove an imbedded intrauterine device (IUD).
  • To help determine the cause of infertility.

A D&C may be done with a hysteroscopy. This is a procedure that involves inserting a thin scope through the cervix. This allows the doctor to see the uterine lining.

Why the D&C Is Performed

It is done to help the doctor find out the cause of abnormal uterine bleeding. Abnormal bleeding can be caused by cancer in the uterine lining. Early diagnosis of cancer improves the chance that treatment will work. Most cases of abnormal uterine bleeding fall into these categories:

  • Bleeding between periods - It is important to keep a record of the dates of your menstrual cycle. This will help you figure out when and if unusual bleeding occurs.
  • Bleeding after intercourse - Light spots of blood after intercourse.
  • Heavy and prolonged periods - This may be due to abnormal buildup of cells in the uterine lining. It could also be due to polyps or fibroids.
  • Bleeding during or after menopause - Irregular or heavy bleeding, or a sudden onset of bleeding after a year or longer without getting a period. It may be a sign of abnormal changes in the uterine lining. It may also be related to normal hormonal changes.

What the D&C Can Reveal

A D&C can provide information about the following:

  • Endometrial cancer - Cancer of the endometrium. This is the lining of the uterus. Your doctor will discuss your treatment options.
  • Fibroids - Tumors that are made up of connective tissue and muscle fiber. They grow out from the uterine wall and may cause bleeding. Fibroids are usually benign (noncancerous). But, if they grow very quickly, it can sometimes mean the tumor is a cancer.
  • Polyps - Tumors that grow on stalks and are usually benign. They can bleed without any reason. If a polyp goes into the cervix, it can bleed during intercourse. Since polyps are often removed during a D&C, bleeding may be stopped by the surgery.
  • Hyperplasia - An abnormal growth of the uterine lining. This can be caused by hormonal changes that happen with menopause. These changes can also happen before or after menopause. Some forms are considered precancerous. But, most are benign. Your doctor may recommend surgery to treat this.

The Day Before the D&C

A staff member will call you the day before the procedure to confirm your appointment time. He or she will also answer any questions you may have. On the night before your D&C, do not eat or drink anything after midnight. You may brush your teeth and rinse your mouth, but do not swallow the water. Ask your doctor if you should take the medication(s) you usually take.

Procedure for a D&C

  • Go to the Admissions Center at 1275 York Avenue. Be sure to get there at your appointed time.
  • You will be shown to a dressing room and asked to remove all clothing, jewelry, dentures, and contact lenses. You will be given a hospital gown to put on.
  • You will be bought into the operating room by a nurse. He or she will assist you onto the operating bed. Warm blankets are available if you feel cold.
  • A member of the anesthesia team will put an intravenous (IV) needle into a vein. This is done so that you can get medicine and fluids during the procedure.
  • You will be given anesthesia. This is the medicine that will put you to sleep. Once it has taken effect, your doctor will perform the D&C.
  • When the procedure is completed, you will be brought into a recovery room. You will stay there until you recover from your anesthesia. A nurse will be checking your blood pressure, pulse, and breathing. You may or may not receive oxygen while you are sleeping.
  • When you are fully awake, you will be brought to the second recovery area. You will be able to drink some tea or juice, have crackers, and see your family.
  • You may have some dull cramping in your lower abdomen. Ask the nurses for medicine to relieve any pain.

Discharge

  • Once you are feeling well enough to walk, you may go home. Your nurse will give you instructions on what to do at home.
  • A care partner must be with you for you to be released from the hospital.

Recovery and Follow-Up Care

  • You may feel drowsy from the effects of the medicine. It is important to have someone with you for the first 24 hours after surgery.
  • For two weeks after your D&C, or as instructed by your doctor, do not:
    • Douche.
    • Use tampons.
    • Have intercourse.
  • You may take showers. Ask your doctor when you can take a bath.
  • You may have some cramping and vaginal bleeding similar to a menstrual period. This may last for a few days after the surgery.

Call Your Doctor or Nurse If You Have:

  • A fever of 101° F (38.3° C) or above.
  • Vaginal bleeding that is heavier than your normal menstrual flow.
  • Pain not relieved by the medicine your doctor ordered.
  • Swelling in your abdomen.
  • Foul-smelling vaginal discharge.
  • Any questions or concerns.

Call your doctor for a follow-up appointment as instructed.