Results vs Risks ofDilation and curettage

D&C is a very common procedure.

Results

D&C has been performed for over 100 years. It’s an effective way to take tissue samples from inside your uterus, treat an incomplete miscarriage, terminate a pregnancy and treat bleeding after childbirth.

In an emergency, it can also be used to temporarily reduce excessive vaginal bleeding.

Sometimes endometrial pipelle biopsy, ultrasound and other imaging techniques are done instead of D&C. Hysteroscopy, a procedure which uses an instrument with a light and camera, enables your surgeon to see the cavity of your uterus. For incomplete miscarriage, termination of pregnancy, or bleeding after childbirth a D&C may still be your best treatment option. Similarly, for suspicion of uterine cancer or heavy bleeding that hasn’t responded to other treatments, a D&C is still regarded as the diagnostic gold standard.

D&Cs are usually performed under general anaesthesia or IV sedation. While not particularly painful, you can expect some pain and cramping afterwards. Pain is usually managed with over-the-counter painkillers.

Risks

As with any medical procedure, there are some potential risks. The chance of complications depends on the underlying condition being diagnosed or treated, as well as other factors such as age, pregnancy status, anatomic variations and your overall general health.

Haemorrhage

This is rare, but can happen if an instrument injures the walls of your uterus, the uterus fails to contract following evacuation of products of pregnancy or due to an underlying bleeding disorder.

Infection

There’s always a slight possibility of infection when instruments are inserted into your uterus. Most infections can be easily treated with antibiotics. Most women don’t require post-operative antibiotics.

Perforated uterus

This is a significant, though rare, complication. It’s more common in women who are pregnant, post-menopausal, have a uterine infection at the time of the procedure, or if there is any pre-existing anatomical variation. As long as no internal organs or large blood vessels are damaged, the hole in the uterus will almost always heal itself without further surgery. If your surgeon suspects that your uterus has been perforated, you may be asked to stay in hospital for observation or require further surgery. Repair to other organs may require laparoscopic (key-hole) or open abdominal surgery.

Asherman’s syndrome

This is a rare complication where damage is done to the underlying muscle layer of the uterus and scar tissue forms. The thick scars can completely fill the cavity of the uterus. This can lead to infertility and end of menstrual periods.

Missed abnormalities

A D&C is regarded as a “blind” procedure performed by “feel”.  During the procedure, it’s impossible to completely sample the entire cavity of your uterus. So if an abnormality is small, or localised, there’s a chance that it could go undetected. This is why the procedure is now often done in conjunction with hysteroscopy, where the entire uterine cavity is seen, and the surgeon can then target sampling to abnormal areas.

Increased risk of premature birth

Women who have D&C for incomplete miscarriage or pregnancy termination have small increased risk of subsequent premature birth. The risk is higher for women who’ve had multiple D&C procedures.

Damage to the cervix

If your cervix is damaged during D&C, you may need stitches to repair it. This cervical damage can lead to a weakened cervix, which can be a cause of miscarriage or premature birth.