DESCRIPTION

Dilation and curettage is a procedure used for opening the cervix and removing the lining (endometrium) and contents of the uterus. The D&C is often both a diagnostic and a therapeutic procedure.



This procedure is often used to diagnose or treat abnormal uterine bleeding. The D&C is one of the most common surgical procedures performed on women. Dilation and Curettage also provides important information about whether uterine cancer is present.

The uterus is a pear-shaped, muscular organ that sits in the lower abdomen. The top of the uterus is wide and it narrows like the neck of a bottle at the bottom. The lower third portion of the uterus is its neck which is called the cervix. The cervix is round and has a small opening called the Os. During your exam your health care provider can see the cervix by using a speculum - an instrument used to separate the walls of the vagina.

The inner wall of the uterus is lined by endometrial tissues. The endometrial tissues thicken during the first part of your menstrual cycle. Once ovulation occurs progesterone acts to stop this thickening, and changes the endometrial lining so that it is ready to accept a pregnancy should it occur. If pregnancy does not occur, hormone production ceases and the endometrium breaks up and is shed as menstrual blood.

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REASONS FOR PROCEDURE

Diagnosis of abnormal bleeding. Thickening of the uterus (endometrial hyperplasia). A D&C may be required to diagnosed and/or treat a problem such as heavy or prolonged menstruation, as well as unexplained bleeding between periods. There are many possible causes for these menstrual abnormalities, one of the most common being a hormonal imbalance. Hormonal imbalance causes a thickening of the endometrium which sometimes causes irregular or prolonged menstrual cycles. Although this can happen at any age it most commonly occurs in young women just starting menstruation and in older pre-menopausal women.

Uterine Fibroids. Abnormal uterine bleeding is also a warning of various types of growths, which are most often non-cancerous. One of these benign growths are polyps which attach either by a stem or a stalk most often to the lining of the uterus or the cervix. Polyps inside the uterus can usually be removed by D&C. Fibroid tumors are another common benign growth that occurs in the uterus. Fibroids can be silent causing no symptoms, or they can cause heavy bleeding and painful cramping. Although fibroid tumors are sometimes detected during dilation and curettage, another surgical procedure is necessary to remove them.

cancer inside the uterus. Abnormal bleeding is sometimes a sign of endometrial cancer, particularly in women over 40. Women over 40, especially those past menopause, may have a D&C or another procedure called an endometrial biopsy. Occasionally a hysteroscopy is performed at the same time as a D&C, allowing the health care provider a better view of inside the cervix, vagina, and uterus.

Incomplete spontaneous miscarriage (spontaneous abortion). Dilation and curettage is also commonly performed following miscarriage or abortion in cases where the uterus fails to fully empty its content. Abortions induced before the 12th week of pregnancy are performed in a manner which is similar to the D&C.

Treatment of minor diseases of the uterus.

Embedded intrauterine device (IUD) used for contraception.

Investigation of infertility.

Elective abortion during early pregnancy. Because medical and non-invasive methods of abortion now exist, and because D&C requires heavy sedation or general anesthesia and has higher risks of complication, the procedure has been declining as a method of abortion. The World Health Organization recommends D&C as a method of abortion only when manual vacuum aspiration is unavailable. According to the Centers for Disease Control and Prevention, D&C only accounted for 2.4 percent of abortions in the United States in the year 2002, down from 23.4 percent in 1972.

Removal of membranes and placenta after childbirth in cases where they fail to deliver spontaneously (retained placenta).

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RISK INCREASES WITH

Obesity.

Smoking.

Cervical infection or ongoing uterine infection.

Excess alcohol consumption.

Recent or chronic illness, including anemia, diabetes mellitus, and heart or lung disease.

Use of drugs, such as antihypertensives; cortisone; diuretics; or insulin.

Use of mind-altering drugs, including narcotics; psychedelics; hallucinogens; marijuana; sedatives; hypnotics; or cocaine.

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DESCRIPTION OF PROCEDURE

It is normally performed in a hospital or a surgery center. Where your D&C takes place depends on individual factors about your health. It can be performed in a hospital setting using general anesthesia or in your health care provider's office using a local anesthetic. An injection around the cervix will minimize pain or discomfort from the procedure and produce numbness in the area.

Do not eat or drink anything before surgery for a time period to be determined by your health care provider.

A general anesthetic, local anesthetic, or both will be administered.

The vagina and cervix and the skin around the vagina are cleansed with an antiseptic solution.

The health care provider inspects the pelvic reproductive organs for any abnormal changes.

A speculum is inserted into the vagina to open the walls so the health care provider can see the cervix.

The cervix is carefully opened with dilators (tapered rods of increasing widths) by inserting them into the cervical opening (os).

A curette is inserted into the uterus. The curette can be a suction device through a narrow tube or a looped knife.

The curette is used to scrape the endometrium from the uterine wall. The tissue may be removed for microscopic examination and diagnosis, or for treatment of heavy or irregular uterine bleeding.

Occasionally, ultrasound can be used for guidance of the instruments.

The instruments are removed.

You may have some discomfort from general anesthesia which can include nausea, vomiting, and a sore throat that can last a few days. Many women will notice mild cramping for a few days following D&C, as well as spotting or slight bleeding for up to a week. Your next period may be early or late.

You will need a friend or family member to accompany you home a few hours after your D&C. The affects of anesthesia wear off at different rates for each individual; however you should be able to drive and return to normal activities within a few days.

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EXPECTED OUTCOME

Tissue obtained successfully without complications in virtually all cases. Allow about 4 to 6 weeks for recovery from surgery.

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POSSIBLE COMPLICATIONS

Anesthesia complications include reactions to medications and problems with breathing.

Surgical-wound infection with pain and fever.

Excessive bleeding.

Inadvertent injury to the uterus. Perforation of the uterine wall caused by the tip of the surgical instrument. This injury rarely requires treatment and additional surgery and heals on its own. Uterine lining (endometrium) scarring.

Laceration (tear) of the cervix.

Having two or more sharp curettage procedures may increase the risk of complications in future pregnancies, such as ectopic pregnancy, miscarriage, and placenta previa.

TREATMENT

GENERAL MEASURES

To prevent bacteria from entering the cervix following a D&C, you should refrain from sexual intercourse, tampon use and douches for at least a week.

Do not douche unless your health care provider recommends it.

Wear cotton underpants and pantyhose with a cotton crotch. Avoid underpants made from nylon, polyester, silk or other non-ventilating materials.

Expect slight vaginal bleeding during recovery from surgery. Use a sanitary pad to protect clothing. Avoid tampons temporarily; they may lead to infection.

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MEDICATION

Antibiotics are often given during, or following, the procedure to help prevent any infections.

Prescription pain medication should generally only be required for 2 to 7 days following the procedure.

You may use non-prescription drugs, such as acetaminophen, for minor pain.

Hormones, if necessary to correct an imbalance.

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ACTIVITY

Resume driving in 1 or 2 days.

To help recovery and aid your well-being, resume daily activities, including work, as soon as you are able.

Resume sexual relations when spotting ceases.

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DIET

No special diet. However, you should follow a healthy, balanced nutritional program for a healthy immune system and to assist in a rapid recovery from your surgery.

MoonDragon's Nutrition Information, Guidelines, Dietary Recommendations



NOTIFY YOUR HEALTH CARE PROVIDER IF...

Vaginal discharge increases or smells unpleasant.

You experience pain that simple pain medication does not relieve quickly.

Unusual vaginal swelling or bleeding develops.

You develop signs of infection: general ill feeling and fever, headache, muscle aches or dizziness.

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