What is a D&C?
A woman who has suffered a miscarriage, but who still has parts of the tissues of pregnancy inside the uterus may need a D&C to remove all of what are called “products of conception.” This will then allow the uterus to heal and normal cycles to start up again. Sometimes hysteroscopy can be used instead to see and remove these tissues.
Dilation of the cervix may or may not be needed depending on the specific situation. The cervix is the mouth of the womb, and the inner part of it is usually closed except during labor. If dilation is needed, there are medications in suppository form that can be placed in the outer part of the cervix to help open it.
Uterine scarring is a known complication of a traditional D&C. Ultrasound can be used before and after a D&C to help determine where the problem is and to see if it has been resolved afterwards.
If a woman has just delivered a baby and is bleeding heavily, this can be a medical emergency. In addition to using medication, a D&C may be necessary to stop a woman from bleeding to death.
Traditional curettage is done with a small sharp instrument that goes into the uterus and scrapes off the lining. Now there is often suction attached to a blunt instrument and tissue is removed more by suction than scraping. This by itself is not painful, but most of the time a D&C is done under sedation or general anesthesia.
There are also medicines that can do a “chemical D&C,” most commonly misoprostol (Cytotec).
With the new procedures available, less dilation and sharp curettages are being performed. Often tissue removal is done via hysteroscopy so that the doctor can see exactly what he or she is removing. If curettage of the lining is needed, suction is often used. Suction curettage is less likely to cause scars in the uterus. Uterine scarring is a known complication of a traditional D&C. Ultrasound can be used before and after a D&C to help determine where the problem is and to see if it has been resolved afterwards.
If you need a D&C but you are trying to get pregnant now, or plan to try in the future, you should discuss this with your doctor. The best procedure that causes the least scarring should be done. On the other hand, if you are done having children or near menopause, scarring is less of an issue. Each doctor has his or her own approach, and different procedures are best for different patients.
Many, if not most, women consider having or have had a D&C at some time.