Dilation and Curettage (D&C)
Dilation and curettage (or D&C for short) is a very common gynaecological procedure that has a number of uses. The name gives a good indication of what the procedure involves: dilation of the cervix (the opening of the uterus) and scraping (curettage) of the contents or the lining of the uterus. This procedure is known in Maltese as raxkament.
D&C is usually considered a minor procedure and can be performed under local anesthesia, with light sedation, or under a general anaesthetic. The first step is to visualise the cervix through the vagina using a speculum, and then the cervix is dilated (enlarged) by inserting dilators of increasing size. This allows the curette - a surgical instrument with a sharp loop at one end and a handle at the other end - to be inserted into the uterus. Sometimes a curette with suction is used. The lining or the contents of the uterus are then gently scraped, collected, and sent to a pathology lab for further analysis. Sometimes a scope with a camera at the end (hysteroscopy) is also inserted to allow the doctors to see the inside of the uterus.
Indications for a D&C
D&C can be used either to diagnose problems with the uterus, or as a treatment.
In pregnant women, D&C is used in early pregnancy to remove an incomplete miscarriage or perform a surgical abortion.
In women who have just given birth, D&C can be used to remove retained placental tissue.
In women who are not pregnant, D&C is often used as part of the investigations of post-menopausal bleeding. D&C allows doctors to obtain samples of the lining of the uterus which are then sent to a pathology lab for analysis. The lab scientists and pathologists examine the samples under the microscope and can identify problems such as endometrial cancer. D&C also allows doctors to remove some of the causes of abnormal bleeding, such as uterine polyps and certain types of uterine fibroids.
Like any other surgical procedure, there are possible complications that can occur during or after D&C.
Infection is the most common complication, especially when D&C is performed on pregnant women. This is treated with antibiotics.
A perforation of the uterus is uncommon but can occur, especially when D&C is performed after a miscarriage. Very rarely, organs around the uterus could also be damaged.
Adhesions inside the uterus after a D&C may rarely occur. These may be a problem if the woman becomes pregnant in the future, and they may cause pregnancy complications like ectopic pregnancy, miscarriage, or abnormal placentation.
There can also be complications related to the anaesthesia that is used during the procedure. Your doctor will explain this in more detail.