Dilatation and Curettage (D&C) & Suction Evacuation
Welcome to the guide to understanding D&C. So, what exactly is D&C? Though most women have heard of the term D&C they are not really aware of what exactly it means.
D&C in common parlance is also known as curetting, cleaning of uterus. The actual full form of D & C is “dilatation and curettage.” D&C is a common, safe, and a short procedure used to diagnose certain gynecological conditions. At times, D&C is advised in order to treat and stop excessive bleeding. The procedure comprises of dilatation which means that the mouth of the uterus (cervix) is first dilated. Then follows the curettage which means the lining of the uterus is scraped or curetted by using a thin spoon shaped instrument called curette. Alternatively suction can be used to suck out the contents of the uterus. This is especially done by some doctors in cases of pregnant uterus which is to be emptied of its contents.
The next question that might come to your mind – ‘When does a person undergo D&C?
A gynecologist generally advices a D&C in case of heavy bleeding. D&C helps to find the reason for abnormal bleeding and even helps to stop bleeding. The scrapping may be sent for laboratory examination. The sample is screened under the microscope to find abnormal cells, cancerous cells if any.
D&C may also be done to clean up the uterus and remove the unwanted contents as in case of miscarriage.
D&C can also be combined with hysteroscopy. The hysteroscope is a thin telescope which is used to view inner lining of uterus. D&C is also combined with laparoscopy in treating certain conditions.
Now that you know about D&C, you need to know about the procedure and the precautions to be taken before and after the procedure. There may be certain measures to be followed before D&C since the procedure is carried out under anesthesia. Doctor may ask you to avoid certain medicines or give instructions to keep your stomach empty before the procedure. Please take necessary instructions about these issues from your doctor.
Your doctor may ask for some routine tests like blood or urine before the procedure. Your doctor may want to soften your cervix before the procedure.
If so, the doctor may ask you or your nurse to insert certain tablets/cream in your vaginal passage few hours before the surgery.
Let us now go through the procedure that your doctor follows to perform a D&C.
A D&C is a simple procedure which can be done in an outpatient clinic, or a hospital. This procedure is done under anaesthesia, usually short general anaesthesia or local anaesthesia. The choice of anaesthesia can be decided in consultation with the doctor. With general anaesthesia, you will not be awake during the procedure. You will receive medication through an intravenous (IV) line. Whereas with local anaesthesia, only the area around the cervix will be numbed with medication and you will be awake throughout the procedure.
You will be asked to lie on your back and your legs will be placed in stirrups. The actual procedure will be done under anaesthesia. After inserting speculum which retracts the wall of vagina, the doctor will steady the mouth of uterus with instrument called as vulsellum. The doctor then passes a thin instrument called uterine sound to determine the length and angle of the uterus.
Dilators are used to open the cervix further. The doctor then inserts the curette and scrapes the uterine wall. Some doctors may use a suction curette which sucks out the contents of the uterus.
After the procedure, you will soon regain consciousness, if the procedure is done under general anaesthesia. One may experience cramps from an hour to more than a day. There may be some light bleeding for several days and patients are advised to avoid intercourse for few days. After D&C, a new lining will build up in the uterus and therefore your next menstrual period may not occur at the regular time.
Return to work is possible the very next day. You must go back for follow up visit to the doctor as scheduled. If you have very heavy bleeding, fever, pain in the abdomen and foul-smelling discharge from the vagina, you must go to the doctor immediately.
One must keep in mind that D&C is a blind procedure where doctor does not get the view inside the uterus. Due to this limitation, occasional cases of injury to abdominal structures such as urinary bladder or intestines are reported. Being a blind procedure, some times a particular abnormal area may not get picked up by the curette. Possibility of infection has become much less as compared to earlier.
In all, D&C is minor surgical procedure with very few complications. It is day care procedure.
Should you have any other doubts please clarify them with the doctor before you consent for the procedure.
