Dilation and curettage
Encyclopedia
Dilation and curettage (D&C) refers to the dilation
(widening/opening) of the cervix
and surgical removal of part of the lining of the uterus
and/or contents of the uterus by scraping and scooping (curettage
). It is a diagnostic gynecological procedure.
D&C normally is referred to a procedure involving a curette
, also called sharp curettage. However, some sources use the term D&C to refer more generally to any procedure that involves the processes of dilation and removal of uterine contents, which includes the more common suction curettage procedures of manual and electric vacuum aspiration.
(which cause a prolonged buildup of tissue with no natural period to remove it); to remove tissue in the uterus that may be causing abnormal vaginal bleeding, including postpartum retained placenta; to remove retained tissue (also known as retained POC or retained products of conception) in the case of a missed or incomplete miscarriage
; and as a method of abortion
. D&C remains 'standard care' for missed and incomplete miscarriage in many countries among the options currently used for abortions.
Because medical and non-invasive methods of abortion now exist, and because D&C often involves sedation or general anesthesia, the procedure has been declining as a method of abortion. The World Health Organization
recommends D&C as a method of surgical abortion only when manual vacuum aspiration is unavailable. According to the Centers for Disease Control and Prevention
, D&C only accounted for 2.4% of abortions in the United States
in the year 2002, down from 23.4% in 1972. Suction D&Cs are now considered mainstay to manage pregnancy loss (miscarriage) and to obtain tissue for chromosomal analysis when necessary.
Hysteroscopy
is a valid alternative to D&C for many gynecologic indications from diagnosis of uterine cancer to removal of fibroids and polyps. It can be used to visualize areas of concern when disease is confined to a specific area of the uterus. Hysteroscopy still requires some local and/or IV pain control measures. Oftentimes, hysteroscopy is performed in conjunction with D and C when indicated.
Medical management of miscarriage and medical abortion using drugs such as misoprostol
and mifepristone
are generally safe, non-invasive and alternatives to D&C in specific cases. Medical management for abortion has a higher failure rate when used in early pregnancy.
Another risk is intrauterine adhesions, or Asherman's syndrome
. This risk is extremely low in an uncomplicated setting but when infection exists it may increase the risk.
Cervical dilation
Cervical dilation is the opening of the cervix, the entrance to the uterus, during childbirth, miscarriage, induced abortion, or gynecological surgery...
(widening/opening) of the cervix
Cervix
The cervix is the lower, narrow portion of the uterus where it joins with the top end of the vagina. It is cylindrical or conical in shape and protrudes through the upper anterior vaginal wall...
and surgical removal of part of the lining of the uterus
Uterus
The uterus or womb is a major female hormone-responsive reproductive sex organ of most mammals including humans. One end, the cervix, opens into the vagina, while the other is connected to one or both fallopian tubes, depending on the species...
and/or contents of the uterus by scraping and scooping (curettage
Curettage
Curettage, in medical procedures, is the use of a curette to remove tissue by scraping or scooping.Curettages are also a declining method of abortion. It has been replaced by vacuum aspiration over the last decade....
). It is a diagnostic gynecological procedure.
D&C normally is referred to a procedure involving a curette
Curette
A curette is a surgical instrument designed for scraping biological tissue or debris in a biopsy, excision, or cleaning procedure. In form, the curette is a small hand tool, often similar in shape to a stylus; at the tip of the curette is a small scoop, hook, or gouge...
, also called sharp curettage. However, some sources use the term D&C to refer more generally to any procedure that involves the processes of dilation and removal of uterine contents, which includes the more common suction curettage procedures of manual and electric vacuum aspiration.
Clinical uses
D&Cs are commonly performed for the diagnosis of gynecological conditions leading to 'abnormal uterine bleeding'; to resolve abnormal uterine bleeding (too much, too often or too heavy a menstrual flow); to remove the excess uterine lining in women who have conditions such as polycystic ovary syndromePolycystic ovary syndrome
Polycystic ovary syndrome is one of the most common female endocrine disorders. PCOS is a complex, heterogeneous disorder of uncertain aetiology, but there is strong evidence that it can to a large degree be classified as a genetic disease....
(which cause a prolonged buildup of tissue with no natural period to remove it); to remove tissue in the uterus that may be causing abnormal vaginal bleeding, including postpartum retained placenta; to remove retained tissue (also known as retained POC or retained products of conception) in the case of a missed or incomplete miscarriage
Miscarriage
Miscarriage or spontaneous abortion is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, generally defined in humans at prior to 20 weeks of gestation...
; and as a method of abortion
Abortion
Abortion is defined as the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. An abortion can occur spontaneously, in which case it is usually called a miscarriage, or it can be purposely induced...
. D&C remains 'standard care' for missed and incomplete miscarriage in many countries among the options currently used for abortions.
Because medical and non-invasive methods of abortion now exist, and because D&C often involves sedation or general anesthesia, the procedure has been declining as a method of abortion. The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
recommends D&C as a method of surgical abortion only when manual vacuum aspiration is unavailable. According to the Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
, D&C only accounted for 2.4% of abortions in the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
in the year 2002, down from 23.4% in 1972. Suction D&Cs are now considered mainstay to manage pregnancy loss (miscarriage) and to obtain tissue for chromosomal analysis when necessary.
Hysteroscopy
Hysteroscopy
Hysteroscopy is the inspection of the uterine cavity by endoscopy with access through the cervix. It allows for the diagnosis of intrauterine pathology and serves as a method for surgical intervention .-Method:...
is a valid alternative to D&C for many gynecologic indications from diagnosis of uterine cancer to removal of fibroids and polyps. It can be used to visualize areas of concern when disease is confined to a specific area of the uterus. Hysteroscopy still requires some local and/or IV pain control measures. Oftentimes, hysteroscopy is performed in conjunction with D and C when indicated.
Medical management of miscarriage and medical abortion using drugs such as misoprostol
Misoprostol
Misoprostol is a drug that is used for the prevention of non steroidal anti inflammatory drug induced gastric ulcers, for early abortion, to treat missed miscarriage, and to induce labor. The latter use is controversial in the United States. Misoprostol was invented and marketed by G.D...
and mifepristone
Mifepristone
Mifepristone is a synthetic steroid compound used as a pharmaceutical. It is a progesterone receptor antagonist used as an abortifacient in the first months of pregnancy, and in smaller doses as an emergency contraceptive. During early trials, it was known as RU-38486 or simply RU-486, its...
are generally safe, non-invasive and alternatives to D&C in specific cases. Medical management for abortion has a higher failure rate when used in early pregnancy.
Complications
Any intrauterine procedure (hysteroscopy or D and C) carries with it a risk of infection, bleeding or uterine perforation. These complications are quite low and should not dissuade a patient from undergoing such procedures when necessary.Another risk is intrauterine adhesions, or Asherman's syndrome
Asherman's syndrome
Asherman's syndrome , also called "uterine synechiae" or intrauterine adhesions , presents a condition characterized by the presence of adhesions and/or fibrosis within the uterine cavity due to scars...
. This risk is extremely low in an uncomplicated setting but when infection exists it may increase the risk.