D and C (Dilation & Curettage) After a Miscarriage/Abortion

Dilation and Curettage (D and C) is a surgical procedure through which a physician explores the uterine lining and the inside of the uterus. The recovery phase is short. However, there are some risks which a patient may have to face, but they are rare.

What are Dilation and Curettage?

Dilation refers to the widening or opening of the cervix and Curettage refers to the procedure when the lining of the uterus or the contents of the uterus are scraped and scooped out. The D and C surgery is performed after a miscarriage in the first trimester or in case of an abortion.

Why You Need a D and C Surgery?

A ‘D and C’ procedure is carried out to diagnose the gynaecological reasons which cause heavy, abnormal uterine bleeding. It is also used to understand and identify the presence of cancer or to analyze the reasons behind a woman’s infertility. The procedure is also used to remove the excess uterine lining in women who suffer from polycystic ovary syndrome.

It is also done in case of a missed or incomplete miscarriage. A ‘D and C’ procedure for miscarriage uses suction to remove the uterine contents. It is used after a miscarriage to pull out the fetus and the other tissues in case the contents have not come out on their own. For healing after a miscarriage

Reasons for Not Performing Dilation and Curettage?

A ‘D and C’ is performed to ward off infections in the uterus and for gynaecological conditions. Although, it should not be done under the following conditions listed below:

• A person who is too sick to undergo surgery should not undergo this procedure.
• It should not be done on people suffering from severe arthritis who may be unable to move their legs apart to allow a speculum inside.
• In case a person is pregnant or assumes that she is pregnant, D and C should not be carried out. It can only be done in case the woman wants to abort the baby, or she has had a miscarriage.

Preparation Needed for Dilation and Curettage

Follow exactly the way your doctor asks you to. However, there are few things you need to do on your own like –

• One should avoid drinking and should not eat anything on the day of the surgery.
• Before getting the procedure done, you should get yourself thoroughly examined.
• To start opening your cervix get the gel applied a day before the procedure by your doctor.
• Do get someone with you to drive you back home after the procedure.

Which Type of Anaesthesia is Required for D and C?

There are different types of anaesthesia that can be used during D and C. However, it is up to the patient and the anaesthetist what they want to choose.

1. General Anaesthesia

It is a medically induced coma. It can be administered as an inhaled gas or through an injection. This is the most common among all types of anaesthesia in a D and C procedure.

2. Spinal Anaesthesia

Spinal anaesthesia is a type of regional anaesthesia into the subarachnoid space through an injection. The drug is injected with the help of a very fine needle. The best part about spinal anaesthesia is that though the patient is wide awake, she does not have any sensation down below the waist.
Another form of spinal anaesthesia is the epidural anaesthesia. In this type, the drug is injected at a slightly different place in the spine. It eases the pain keeping the lower limbs active.

3. Local Anaesthesia

Here a small part of the body where the incision is to be made is made numb. The drug is injected into the part of the body where the incision is to be made. This form of anaesthesia is rare in a D and C procedure.

What Happens during D And C Procedure?

A ‘D and C’ procedure is a minor surgery in which a patient can go home on the same day after the surgery. The following are the steps to the procedure.

1. On Reaching the Hospital

Once you reach the hospital, the first thing you will be asked to do is empty your bladder and wear the hospital gown.

2. Anaesthesia

The nurse will then ask you to lie down, and the doctor will start administering the anaesthesia.

• In case of local anaesthesia, the doctor will insert the speculum into the vagina and clean the inner as well as the outer vagina including the cervix with an anti-bacterial cleaning solution. Then on getting the cervix steady with a clamp, he will administer the drug on both the sides of it.
• If the patient is being administered spinal anaesthesia, the drug is injected into the spinal fluid through the back.
• The patient will not be aware of anything if administered general anaesthesia. In this case, the patient will be made to lie down and given an intravenous anaesthetic drug which will make the patient fall asleep immediately. The breathing will be monitored throughout the procedure.

3. Dilation

During this procedure, the doctor first tries to understand the depth and the angle of the uterus. He does so by inserting a thin flexible piece of metal. Then he inserts a speculum; an instrument used to hold open the vaginal walls. Then he inserts a series of tapering rods, each thicker than the previous one to stretch the opening of the uterus.

4. Curettage and Hyteroscope

Once the cervix is dilated, a spoon-shaped device called a Curette is inserted into the uterus. After scraping a little of the cervical lining, the doctor will then insert a hysteroscope. Through this instrument, the doctor can get to see the inside of the uterus to look for overgrowths in the endometrium. If in case, there are polyps or fibroids, the doctor can remove it then. Hysteroscopy in D and C is usually done to evaluate the cause of the abnormal uterine bleeding and even to rule out malignancy in menopausal patients.

The procedure takes less than 30 minutes only and the recovery time is about 24 hours maximum.

D and C Side-Effects & Risks

D and C is usually a very safe procedure. However, on rare occasions, patients may experience few side-effects and risks.

• In case a patient is administered general anaesthesia, he may feel a bit disoriented after getting back to his senses.
• The patient may experience cramping for the next few days after undergoing a D and C surgery. This is due to the uterus being scraped and suction applied to pull out the tissues and the uterine contents.
• Haemorrhage or heavy bleeding may occur rarely in cases of injury in the uterine wall by the instruments, or in case an unknown fibroid is cut during curettage.
• While conducting the procedure, the uterus may be injured.
• The Asherman’s syndrome may occur in very rare cases. In such a case there will be the formation of scar tissues in the uterus. Normal mensuration may be affected, and it may also cause problems in conceiving.
• Infections can occur since instruments are inserted into the uterus.
• Uterine perforation may be a case if the patient is suffering from an infection in the uterus during the procedure. This is usually very rare. It also occurs in elderly post-menopausal women and patients who have had a miscarriage.
• At times when the procedure is not done using a hysteroscope, a polyp or a fibroid may go undetected.

Recovery After Dilation and Curettage

The minor surgery takes about 15-20 minutes and D and C recovery time are also less, unlike other surgeries. You may have to stay for a few hours after the surgery for observation. Only in rare cases, the patient may have to be hospitalized. You may experience lightheadedness for a day or cramping for few days after the D and C procedure. Therefore, you have to have someone to drive you back home from the hospital. The patient may experience light bleeding or spots. You could also suffer from Anaemia due to excessive blood loss during the procedure. Anaemia could cause weakness and heavy breathing. This can be cured by taking iron tablets. All in all, the patient can start her normal routine of doing household chores or going to work in a couple of days. Some may even start as early as the day after the surgery.

How to Take Care of Yourself At Home?

Taking care of yourself after a ‘D and C’ procedure is imperative. Here are 7 tips on how to do so:

• Taking adequate rest and getting enough sleep will help you recover soon.
• Avoid strenuous activities like lifting heavy weights, running, cycling etc. until your doctor gives the nod.
• Eat a nutritious and normal diet until you have been asked by your doctor not to.
• Do not use tampons until your doctor allows you to. Instead, use a sanitary napkin in case of bleeding.
• Stay away from intercourse for at least 2 weeks after the surgery.
• Do not conceive till your doctor says you can.
• Drink plenty of fluids.
• Take painkillers as prescribed by your doctor.
• Take a full course of the anti-biotic as have been prescribed by your doctor. Do not stop taking them just because you have started feeling better.
• In case of any discomfort, be sure to consult the doctor immediately.

When to Seek Medical Help?

You should call for medical help anytime you feel uncomfortable. However, here is a list of signs you should look out for after a D and C surgery.

• You have chest pain or trouble breathing.
• You cough up blood.
• You experience heavy vaginal bleeding and may have to change one or more than one pad in an hour.
• You have a vaginal discharge with a foul smell.
• When even a painkiller does not relieve the pain.
• You are sick to your stomach and unable to drink any kind of fluid.
• You have signs of infection like pus draining from the area, severe pain, swelling and warmth in the area.
• You have symptoms of blood clot in your leg like a pain in your calf, back of the knee, thigh or groin and swelling.

FAQs

Here are a few frequently asked questions of people which may help you to get an answer to your queries.

1. What If My Bleeding After D And C Stopped And Then Started Again?

Bleeding for some time and then not and then bleeding again for the first four weeks after D and C is perfectly normal. It is just your hormone trying to regulate itself. Moreover, even after scrapping and scooping in the D and C procedure, a lot of uterine lining is still there to be shed which comes out through the bleeding.

2. Can I Get Pregnant After D and C?

Yes, it is absolutely possible to get pregnant after a D and C. However, it is wise to wait for your body to heal before you try to conceive again.

3. When Will I Have My First Period After a D And C Procedure?

It takes about 4 to 6 weeks to get your first periods after a D and C procedure. The first flow after the D and C is different for different people. However, it is usually heavier than usual but nothing to be worried about.

Advances in the field of medicine have provided an alternative treatment to the traditional method of D and C. However not all doctors are trained or equipped to try out these alternatives. Therefore, the D and C procedure will continue to be the standard diagnostic or therapeutic method for gynaecological conditions.