Dilation And Curettage

What you should know

• Dilation and curettage (D and C) is a procedure to remove tissue from the lining of your uterus (womb). You may need a D and C if you have symptoms, such as abnormal vaginal bleeding. Abnormal vaginal bleeding occurs when it is not time for your monthly period, or after menopause. If you have heavy vaginal bleeding after giving birth, you may need a D and C. If placental tissue is retained (remains) in your uterus after giving birth, you may need a D and C to remove it. The placenta supplies food and oxygen to your unborn baby inside your uterus during pregnancy. You may also retain tissue in your uterus after a miscarriage (death of an unborn baby). Retained tissue can lead to heavy bleeding and infection. A D and C may be done to abort (end) a pregnancy. A D and C may also be done to remove a growth, or to help diagnose uterine cancer.
  
  
• During a D and C, your cervix (opening of the uterus) is dilated (widened). Your caregiver may remove tissue from your uterus with a curette (sharp tool), vacuum suction, or forceps (grasping tool). If you have a miscarriage after 13 weeks of pregnancy, larger amounts of tissue may need to be removed. Having a D and C may help you and your caregivers learn the cause of your symptoms. A D and C may stop your abnormal or heavy vaginal bleeding. A D and C may prevent you from getting a life-threatening infection from retained tissue in your uterus.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• If you are awake during your D and C, you may have pain while the tissue is removed. Your uterus, cervix, intestines (bowel), or nearby tissue may be torn or damaged. You may have life-threatening blood loss, and need a blood transfusion or another surgery. You may need to have your uterus removed. You may get an infection in your uterus that could spread to your blood and become life-threatening. You may have a reaction to the anesthesia medicines, and you may die.
  
  
• After your D and C, you may have nausea (upset stomach), vomiting (throwing up), dizziness, or a headache. Scar tissue may form in your uterus. You may need another D and C to remove more tissue from your uterus. If cancer caused your abnormal vaginal bleeding, lab tests may not detect the cancer in your uterus. If your D and C was done to end a pregnancy, you have an increased risk for a future miscarriage. You are also at risk for pre-term (early) delivery during a future pregnancy.
  
  
• If you do not have a D and C, your symptoms, such as vaginal bleeding, may continue. Caregivers may not find the cause of your symptoms, and you may not get proper treatment. Retained uterine tissue may cause a life-threatening infection. If you lose too much blood from heavy vaginal bleeding, you may die. Talk with your caregiver if you have questions or concerns about your condition or treatment.

Getting Ready

Before your procedure:

• Ask your caregiver if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
  
  
• Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
  
  
• You may need blood tests before and after your D and C. You may need immune globulin medicine if your blood is Rh-negative, and you had a miscarriage. The medicine helps prevent problems with a future pregnancy. Ask your caregiver for more information about Rh-negative blood and immune globulin medicine.
  
  
• You may need a vaginal swab test before your D and C to check for infection. Caregivers may place medicine in your cervix to help it dilate. The medicine may be inserted 1 to 2 days before your D and C. The medicine may also be inserted the day of your procedure. Ask your caregiver for more information about these and other tests or treatments you may need.

The night before your procedure:

• Ask caregivers about directions for eating and drinking.
  
  

The day of your procedure:

• Write down the correct date, time, and location of your procedure.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  
  
• Caregivers may insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.
  
  
• Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
  
  
• You may have an ultrasound of your uterus before your procedure. During an ultrasound, sound waves show pictures of your uterus on a TV-like screen. This test may help your caregiver see the tissue in your uterus that needs to be removed.

Treatment

What will happen:

• Medicine may be given in your IV to help you relax or make you drowsy. You may be given local or epidural anesthesia medicine to numb your procedure area and decrease discomfort. With local or epidural anesthesia, you will be awake during your procedure. You may be given general anesthesia medicine to keep you asleep and free from pain during your procedure. Caregivers will work with you to decide which anesthesia is best for you. Your caregiver will check your cervix to see if it is dilated. If needed, your caregiver may use tools to dilate your cervix. An ultrasound may be used to guide your caregiver during your D and C.
  
  
• Your caregiver may use a curette to remove tissue from your cervix and uterus. Your caregiver may use suction, instead of a curette, to remove tissue from your uterus. To use suction, your caregiver will insert a thin tube into your uterus. The tube connects to a suction machine or a syringe, and the tissue is removed through the tube. Forceps may be needed to remove larger amounts of tissue from your uterus. Tissue removed during your D and C may be sent to a lab for tests. Medicines may be given to help your uterus tighten, and prevent heavy bleeding after your D and C.

After your procedure:

You will be taken to a room to rest. Do not get out of bed until your caregiver says it is okay. When your caregiver sees that you are not having any problems, you may be able to go home. If you are staying in the hospital, you will be taken to your room.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You have a fever.
  
  
• Your symptoms, such as vaginal bleeding, get worse.
  
  
• You are late or cannot make it to your D and C appointment.

Seek Care Immediately if

• You are urinating very little or not at all.
  
  
• You feel very tired, dizzy, and your skin is pale (lighter in color).
  
  
• You have heavy vaginal bleeding that soaks two pads in one hour, for two hours in a row.
  
  
• You have a fever and strong (very bad) cramps in your abdomen (stomach).

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.