D&C Surgery – Dilation & Curettage : Everything You Need To Know

Dilation and curettage surgery, also known as D&C surgery, is a procedure done by gynecologists or obstetricians. It is used for both treatment and diagnosis. During the surgery, the doctor removes parts of the tissue lining the uterus, called the endometrium.

To do this, the doctor expands the cervix, which is the lower part of the uterus, and uses a special tool to scrape away the necessary tissue. D&C surgery is commonly done when there is a miscarriage, unexplained bleeding between periods, or leftover tissue after childbirth or abortion. It can also be used to check the health of the uterus and fertility, as part of a hysteroscopy procedure, or to treat heavy bleeding.

Most of the time, D&C surgery is done as an outpatient procedure, which means you can go home on the same day. You usually don’t need to be completely asleep for D&C surgery. Local anesthesia to numb the area is often enough, although some patients may have the option of general anesthesia or spinal epidural if necessary.

What Is Dilation and Curettage – D&C surgery ?

Dilation and Curettage (D&C) is a surgical procedure commonly performed on an outpatient basis, meaning the patient doesn’t have to stay overnight in the hospital. The procedure causes minimal damage to actual tissues and doesn’t require any incisions to access the uterus. In most cases, localized anesthesia is used, so general anesthesia, which puts the patient to sleep, is not needed, allowing the patient to remain awake during the procedure.

During the D&C surgery, a speculum is used to open the folds of the vagina, providing access to the cervix. The healthcare provider gradually dilates the cervix by gently pushing it open with a series of rods of increasing size. This dilation process allows the healthcare provider to reach the inside of the uterus.

Once the lining of the uterus is accessible, a specialized tool called a curette is used. The curette, which looks like a stylus with a spoon-like scraper at its end, carefully scrapes small portions of the endometrium, which is the tissue lining the uterus.

In some cases, suction is utilized, where a tube is used to remove or evaluate tissue (this variant is sometimes referred to as “dilation and evacuation” or D&E). D&C surgery is typically a planned or scheduled procedure carried out for specific medical purposes.

Contraindications

Just like with any surgery, there are certain conditions that make it unsuitable to undergo a D&C procedure. These include:

Pregnancy: If you are currently pregnant or think you might be, D&C surgery is not recommended. It is crucial to inform your healthcare provider if you suspect you are pregnant.
Allergy: Individuals who have known allergies to anesthetic drugs may be at risk during the procedure, making it unsuitable for them.
Excessive Bleeding Problems: If you have a history of issues with excessive bleeding, this procedure may not be safe for you. It is essential to inform your healthcare provider about any bleeding problems you have experienced.

Potential Risks associated with D&C surgery

While D&C surgery is generally considered a minor procedure, it does carry certain risks:

Heavy bleeding:

There is a possibility of experiencing heavy bleeding as a result of the D&C surgery, especially if there is unintended perforation of the uterine lining.

Infection:

Infection can occur at the surgical site or if the uterine lining has been perforated during the D&C surgery. It is important to follow post-operative care instructions to minimize the risk of infection.

Asherman’s syndrome:

This is a rarer complication that can occur when D&C surgery is performed after a miscarriage. It involves the formation of scar tissue on the uterine lining. Although it is treatable, Asherman’s syndrome can impact fertility and the normal flow of menstrual blood.

Purpose of D&C surgery

D&C surgery serves both diagnostic and therapeutic purposes for various health conditions. It is recommended in the following cases:

Uterine bleeding:

Excessive bleeding between periods requires assessment and treatment with D&C.
Causes may include uterine polyps, fibroids, hormonal imbalances, menopause, or certain cancers.

Infertility testing:

D&C surgery may be used as part of the diagnostic process to assess suspected infertility.
It complements blood tests and other assessments.

Cancer screening:

D&C surgery is employed to collect samples of the uterine lining for screening in cases of uterine cancer.
This includes endometrial cancer (lining of the uterus) and cancer of the uterus itself.

Following miscarriage or abortion:

D&C surgery is used to remove retained placenta or other gestational material after a miscarriage or abortion.

Following vaginal birth:

D&C may be performed to remove excess placenta tissue from the uterine lining after vaginal birth.
This helps prevent infection and promote healing.

Ending a pregnancy:

D&C surgery is utilized as part of the procedure known as vacuum aspiration for performing an abortion.
It’s important to note that there may be other cases where D&C is recommended, and your gynecologist or obstetrician will explain the specific reasons based on your individual situation.

Preparation for D&C surgery : To-Do list

Preparing for D&C surgery involves several steps to ensure a smooth and safe procedure. Here’s what you can expect:

Choose a Location:

D&C surgery can be performed in a hospital, healthcare provider’s office, or outpatient clinic.
Overnight stays are typically not required for recovery.

Operating Theater:

In the operating theater, certain arrangements and equipment will be in place.
Surgical lights will be positioned to provide optimal visibility for the surgical team.
You will be asked to lie down on the operating table once you are ready for surgery.
Tables of instruments, including the curette, speculum, and forceps, will be arranged for efficient use.

Monitoring Devices:

Monitoring devices will be used to track important vital signs during the procedure.
Your heart rate, blood pressure, breathing, and blood oxygen levels will be monitored.
Monitors will display this information for the healthcare team.

An intravenous (IV):

An intravenous (IV) line may be inserted into your arm to deliver medications, including anesthetic.
Preparing for a D&C surgery ensures that the surgical environment is ready and equipped to provide the necessary care and monitoring during the procedure.

Preparing for D&C surgery: What You Need to Know

What to Wear:

As D&C surgery is an outpatient procedure, no extra clothing is required.
During the surgery, you will be provided with a gown to wear.
Choose loose-fitting clothing for comfort.
Opt for comfortable, easy-to-slip-on shoes.
Avoid wearing acrylic nails or any nail polish.
Leave your jewelry at home.

Food and Drink:

There are few restrictions on eating or drinking before the procedure.
If you opt for general anesthesia or spinal epidural, you will be asked to refrain from eating or drinking for at least eight hours before the appointment.
Limited water intake is usually allowed.
It is advised to abstain from alcohol for at least 24 hours prior to the procedure.

Medications:

Certain medications may increase the risk of complications.
You may need to adjust dosages or temporarily stop taking specific medications, including anticoagulants (blood thinners), aspirin, NSAIDs, certain herbal supplements, and diabetes medications.
Discuss your medication regimen with your healthcare provider for guidance.

What to Bring:

Bring your insurance information.
Make a list of medications and supplements you are currently taking.
Carry an extra sanitary pad for use after the procedure.
Arrange for a driver or transportation for the ride home.

Pre-Op Lifestyle Changes:

Making some lifestyle changes before the surgery can help reduce complications.
Consider quitting tobacco use.
Moderate or abstain from alcohol consumption.
Engage in regular exercise, ideally on a daily basis.
Maintain a healthy diet.
Manage excess weight.
By following these guidelines and discussing any concerns with your healthcare provider, you can ensure a smoother and safer experience before and during the D&C procedure.

What to Expect on the Day of D&C Surgery

⦁ Before the D&C surgery:

The day of the surgery will involve careful preparation and assessments.
Your overall health status will be evaluated, including vital sign checks.
You will be asked about the medications you’re currently taking and any existing health conditions.
This is a good time to ask your gynecologist or obstetrician any remaining questions about which you have concern.
You can discuss your pain management preferences with the anesthesiologist.

During the D&C surgery:

During the D&C surgery, you will be taken to the operating theater, whether it’s in a hospital, clinic, or office setting. Here’s what you can expect during the procedure:

Staging and positioning:

You will change into a hospital gown and lie back on the operating table with your legs and feet in footrests for better access to the pelvic area.

Medication and monitoring:

Monitoring devices will be connected to you, and an intravenous (IV) line will deliver medications and fluids. You may receive drugs to help reduce anxiety.

Catheterization and cleaning:

A urinary catheter will be inserted into your urethra, and a speculum will be placed inside your vagina to visualize the cervix and clean it.

Anesthesia:

Depending on the type of anesthesia chosen, you will either receive general anesthesia or regional anesthesia via a facemask or a local anesthesia injection near the cervix to numb the area.

Measuring the uterus:

The length of the uterus will be measured using a thin, tube-shaped device called a uterine sound. This may cause cramping if you have localized anesthesia. The healthcare provider may use a curette to scrape small portions of cervical tissue, if deemed necessary, during the process of assessing and expanding the cervix.

Scraping and/or suction:

Once the cervix is sufficiently dilated, the healthcare provider will use a curette to access the uterus and scrape tissue from the lining. If suction is used, a tube will be positioned and employed to remove the tissue.

Testing:

After gathering enough tissue samples and ensuring stability, the tools will be removed, and the collected samples will be sent to the laboratory for further testing.

Throughout the surgery, the healthcare team will closely monitor your vital signs and ensure your comfort and safety. It’s important to communicate any discomfort or concerns you may have during the procedure.

After the D&C surgery :

After the D&C surgery, the medical team will usually discharge most patients within two to three hours, as it is typically performed on an outpatient basis. However, if complications arise, an overnight stay may be necessary.
If you received general anesthesia, you will be taken to a post-anesthesia care unit (PACU) for recovery, where the medical staff will monitor your vital signs as you regain consciousness.
Once you are fully awake, they may transfer you to a general recovery area and offer you drinks and snacks. You will be encouraged to get out of bed and walk around to prevent the formation of blood clots.
Once the medical team confirms your stability and the success of the procedure, you will be allowed to return home. Before changing back into your clothes, it is advisable to use a pad as there may be some additional bleeding.

If you were given general anesthesia or anxiety medication, it is important to have a friend or family member drive you home, as the effects of the medication may still be present. The medical team will provide you with post-operative instructions and guidance for a smooth recovery.

By understanding what to expect on the day of D&C surgery and communicating any concerns or questions with your healthcare team, you can approach the procedure with confidence and ensure a smoother experience.

Healing after D&C surgery

Taking care of the cervix and uterus during the healing process is relatively simple. Showering is generally safe, but it is recommended to seek approval from your healthcare provider before taking a bath.

Knowing when to contact your healthcare provider is crucial for a smooth recovery. Be attentive to the following signs:

High fever of 101°F (38.3°C)
Chills
Increased bleeding during menstruation
Persistent or worsening pain despite medication
Abdominal swelling
Foul-smelling vaginal discharge

Possible Future Surgeries after D&C surgery

In some cases, additional surgeries or procedures may be required following D&C, depending on the diagnosis or complications that arise. These may include:

Uterus repair:

If the uterine lining is inadvertently perforated during the procedure, excessive bleeding may occur. Surgical repair may be necessary to suture and mend any tears or ruptures in the uterus.

Hysterectomy:

In cases of severe uterine damage, ongoing fibroid or polyp growth, or the detection of cancer, surgical removal of the uterus (hysterectomy) may be recommended. It is important to note that while this procedure can effectively address the underlying issues, it results in infertility.

Regular communication and follow-up with your healthcare provider will guide you through the recovery process and any subsequent treatments that may be required.

Also Read : D&C – Dilation and Curettage : A Patient’s Guide

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