The term D & C refers to a procedure wherein the internal lining of the uterus is scrapped either for diagnostic or for the therapeutic purposes. The term stands for Dilatation and curettage. In this procedure the cervix is first diluted by passing metal dilators of increasing sizes. Then an instrument called curette is inserted in to the uterus and the internal lining of the uterus is scrapped.
D & C is done as a diagnostic procedure in the following conditions:
- Abnormal bleeding before menopause-Heavy / prolonged bleeding
- inter-menstrual bleeding.
- Any bleeding after menopause
- Heavy menstrual pain
- Abnormal pap smear
D & C is done as a therapeutic procedure in the following cases:
- To clear the uterus of products of conception after a missed or incomplete abortion.
- To remove molar pregnancy
- To treat bleeding after delivery by removing and placenta retained inside the uterus.
- To remove sub mucosal fibroids.
- As a treatment for heavy dysfunctional uterine bleeding.
D & C is generally performed as a outpatient procedure and should not take more than 45 min. During this procedure you are likely to be under either general anesthesia or regional anaesthesia. General anaesthesia is usually administrated through masks and consistants of a mixture of nitrous oxide and oxygen usually. There is usually no requirement for a muscle relaxant during this procedure, since intubation (Putting a tube in the wind pipe) is not necessary.
Regional anaesthesia is administrated as a pudendal block wherein the pudendal nerve supplying the cervix and perineum is anaesthetised by injecting a local anesthetic around the nerve.
Once you are under the effect of the anaesthesia, the surgeon will proceed to examine your uterus and pass a probe through the cervix to assess uterine height. Therein metal dilators of increasing sizes are passed through the cervix seriously and when the cervix is adequately dilated, an instrument called curette is passed in to the uterus and the walls scrapped from all sides.
Some of the tissue from the scrapings is preserved in normal saline and dispatched to the lab for pathological studies. After this the uterus and cervix are inspected for any injuries and then the procedure is over.
D & C is a very safe procedure and strictly has any complications. But the following complications are worth mentioning.
Perforation of the uterus is a serious life threatening complication of D & C. This is more common in pregnant women and women after menopause. Most small perforations will heal on their own but any complication like bleeding will require secondary procedures.
Infection is another major complication of D & C. Infection is rare if the D & C is done under aseptic conditions. Infection is heralded by fever, chills and a foul smelling discharge from the vagina.
Sometimes scar tissue may form after the procedure leading to a condition called Asherman syndrome. This may lead to infertility later on.
Damage to the cervix like a laceration or tear can happen during D & C and is treated by suturing.
The following are the danger signs to look for after the procedure:
- Heavy bleeding or light bleeding thinking more than 2 weeks.
- Heavy cramps
- Foul smelling vaginal discharge
- Severe pain
After the procedure it is advisable not to have sex or use tampons for a period of two weeks. The lining of the uterus will regenerate and you will have periods again within six weeks.
You can read the complete articles on D & C and its associated conditions from my website.
Source by Sriram Ravichandran