Dilatation and curettage

Dilatation and curettage (D & C) is a gynecological procedure in which the lining of the womb (endometrium) is scraped away. It is commonly used to obtain tissue for microscopic evaluation to rule out cancer. D & C may alsobe used to diagnose and treat heavy menstrual bleeding, and to diagnose growths such as endometrial polyps and uterine fibroids. A D & C can be used as a treatment as well, to remove pregnancy tissue after a miscarriage, incomplete abortion, or childbirth. Endometrial polyps may be removed, and sometimes non-threatening uterine tumors (fibroids) may be scrapedaway. D & C can also be used as an early abortion technique, up to 16 weeks.

D & C is usually performed under general anesthesia, although local or epidural anesthesia can also be used. A local anesthetic lessens risk and costs, but the woman will experience cramping during the procedure. The type of anesthesia used often depends on the reason for the D & C.

In the procedure (which takes only minutes to perform), the doctor inserts aninstrument to hold open the vaginal walls, and then stretches the opening ofthe uterus to the vagina (the cervix) by inserting a series of tapering rods, each thicker than the previous one, or by using other specialized instruments. This process of opening the cervix is called dilation.

Once the cervix is dilated, the physician inserts a spoon-shaped surgical device called a curette into the womb. The curette is used to scrape away the uterine lining. One or more small tissue samples from the lining of the uterusor the cervical canal are sent for analysis by microscope to check for abnormal cells.

Although simpler, less expensive techniques such as a vacuum aspiration are quickly replacing the D & C as a diagnostic method, it is still often usedto diagnose and treat a number of conditions.

Because opening the cervix can be painful, sedatives may be given before theprocedure begins. Deep breathing and other relaxation techniques may help ease cramping during cervical dilation.

A woman who has had a D & C performed in a hospital can usually go home the same day or the next day. Many women experience backache and mild cramps after the procedure, and may pass small blood clots for a day or so. Vaginal staining or bleeding may continue for several weeks.

Most women can resume normal activities almost immediately. Patients should avoid sexual intercourse, douching, and tampon use for at least two weeks to prevent infection while the cervix is closing and to allow the endometrium toheal completely.

The primary risk after the procedure is infection. Signs of infection includeheavy bleeding, severe cramps, and foul-smelling vaginal discharge. A womanshould report any of these symptoms to her doctor, who can treat the infection with antibiotics before it becomes serious.

D & C is a surgical operation, which carries certain risks associated with general anesthesia. Rare complications include puncture of the uterus (which usually heals on its own) or puncture of the bowel or bladder (which require further surgery to repair).

Removal of the uterine lining causes no side effects, and may be beneficial if the lining has thickened so much that it causes heavy periods. The uterinelining soon grows again normally, as part of the menstrual cycle.

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