Dilation and Curettage

by Sharon Hopkins

A D&C or dilation and curettage procedure involves the dilation of the cervix to enable to removal of the endometrial tissue that lines the uterus. Scraping or suction is used for removal. Dilation and curettage is considered a safe procedure and is usually performed in a clinic or hospital. It is often carried out in conjunction with other procedures such as a hysteroscopy or polypectomy. The CPT code for a dilation and curettage is 59812.

What is a D&C?

Prior to the procedure it is advisable to avoid unnecessary medication and not eat or drink for 8 to 12 hours depending on the type of anesthesia being used. Routine medical tests such as blood and urine tests are usually prescribed before the procedure as well to ensure that no medical conditions have been ignored.

The dilation and curettage procedure begins with anesthesia. This could include local, spinal or general anesthesia depending on your doctor and the extent of the procedure. The first step of a dilation and curettage of the uterus is the dilation. Using a special clamp and measurement tools, the doctor will determine the size of the uterus. Dilation is usually carried out using a thin metal rod or laminaria tents (special dried seaweed in the shape of thin cigarettes). The laminaria is inserted up to 20 hours prior to the procedure and slowly swells up and dilates the cervix. This is often regarded as less painful than metal dilators. During a dilation and curettage hysteroscopy, a tiny speculum is inserted to remove a small sample of the uterine lining. A hysteroscope is then used to view the insides of the uterus and check for abnormal growths such as fibroids or polyps. At this point in the procedure, small growths can be removed easily as well.

Finally, a curette will be placed into the uterus and with steady strokes; the uterine wall will be scraped or suctioned off. This endometrial tissue will then be sent to the lab for further investigation and testing. The entire D&C procedure can take up to 20 minutes in total. Post the D&C, the patient may feel cramps and pain but these can be relieved with painkillers. Light bleeding post the procedure is also common. Recovery after a D&C is usually quick and patients can return to their normal routine within 24 to 48 hours.

Why a D&C?

Considered a diagnostic rather than therapeutic procedure, there are many reasons why a dilation and curettage may be carried out. These include:

  • Excessive bleeding and irregular periods – a closer examination of the uterine lining removed during a D&C can help determine the cause of any abnormal bleeding such as fibroids, polyps or endometrial cancer.
  • An incomplete miscarriage may require a D&C to remove left over fetal tissue.
  • A full term delivery that does not expel all placental matter may also require a D&C to prevent excessive bleeding and complications later on.
  • Unless absolutely essential, a D&C is rarely used to diagnose or treat conditions such as a pelvic infection, cervical infections and abnormal blood clots

Thanks to advancements in science and diagnostic tools, the dilation and curettage procedure is no longer as common as it was before. Today, alternatives such as ultrasounds and hormonal treatments provide safer, less invasive methods of treating various gynecological conditions.

Risks of a D&C

Though minimal, there are still risks attached to a dilation and curettage procedure such as:

  • Hemorrhage or excessive bleeding caused by injury to the internal walls of the uterus during the procedure.
  • Anytime instruments are inserted into the body, there is a slight chance of infection. However this can be cured with antibiotics.
  • If the patients has a uterine infection at the time of the procedure or is post-menopausal, there is a higher risk of uterine perforation. In such cases a longer hospital stay and closer observation may be necessary.
  • Formation of scar tissue in the uterus caused by aggressive scraping is a possibility. Known as Asherman syndrome, if not treated properly, can lead to infertility and menstrual problems.

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