Dilation and Curettage

About Dilation and Curettage

Dilation and curettage, commonly called D and C, is a procedure in which the cervix is gently widened and tissue is removed from the lining of the uterus, either by suction or by scraping with a spoon shaped instrument called a curette. It is used to remove pregnancy tissue after an incomplete miscarriage or retained placenta, to manage heavy or abnormal bleeding, and to obtain tissue for diagnosis of conditions of the endometrium. Suction curettage, also called vacuum aspiration, is preferred for evacuation of the uterus in early pregnancy because it is quicker and causes less blood loss than sharp curettage. For diagnostic purposes, blind curettage has been largely replaced by hysteroscopy, which allows the surgeon to look inside the uterus and take targeted biopsies, and by office endometrial sampling. The procedure can be performed under local anesthesia with a paracervical block, with sedation or under general anesthesia, usually as a day case. Complications are uncommon and include perforation of the uterine wall, tears of the cervix, bleeding, infection of the uterine lining and intrauterine scar tissue known as Asherman syndrome, which is more likely after procedures performed soon after childbirth or miscarriage. For early miscarriage, waiting for natural passage of tissue and medical management are alternatives to surgical evacuation, and the choice depends on clinical circumstances and patient preference. The word curettage derives from the French word for scraping.