DilationandCurettage (D&C) by EditorialStaffandContributors EnEspañol(SpanishVersion) Definition Dilationisdonetoopenandwidenthecervix.Thecervixistheentrancetotheuterus. Curettageisusedtosampletheliningoftheuterus.Theliningisknownastheendometrium. PartsoftheBodyInvolved Vagina Cervix Uterus DilationandCurettage ©2008NucleusMedicalArt,Inc. ReasonsforProcedure Indications/Contraindications AD&Cisindicatedtodetermineconditionsthatcauseabnormalbleeding: Miscarriage Irregularitiesinmenstrualbleeding Postmenopausalbleeding Page1of4 Copyright©2008EBSCOPublishing.Allrightsreserved. Endometrialpolyps Endometrialhyperplasia Endometrialcancer AD&Ciscontraindicated(ie,notadvised)in: Infectionoftheuterus Infectionofthefallopiantubes RiskFactorsforComplicationsDuringtheProcedure Pre-existinginfection Pre-existingheartorothermedicalcondition WhattoExpect PriortoProcedure Inthedaysleadinguptotheprocedure,arrangeforaridetoandfromtheprocedure. Anesthesia General orlocalanesthesia DescriptionoftheProcedure Apelvicexamisdonetofindoutthesizeandlocationoftheuterus.Thevaginaandcervixiscleanedwithan antisepticsolution.Aspeculumisplacedinthevagina.Aninstrumentcalledacervicaldilatorisplacedintothe cervicalcanal.Ascoop-shapedinstrument,calledacurette,isinserted.Itisusedtoscrapetheuterineliningand removetissuethroughthevagina.Aftersamplingtheendometrium,theinstrumentisremovedfromthecervix. AfterProcedure Thetissueisevaluatedinalab. HowLongWillItTake? About10minutes WillItHurt? GeneralanesthesiawillpreventpainduringtheD&C.Withlocalanesthetic,mostreportfeelingsomecramping andbackpain.Itmaylastforadayaftertheprocedure.Over-the-counterpainmedicationsoramildprescription drugareallthatisusuallyneededtorelieveminordiscomfort. PossibleComplications Complicationsrelatedtotheanesthetic Injurytothecervixwithcervicallaceration Scarringofendometriallining Infectionoftheuterusorfallopiantubes Uterineperforation(holeintheuterus)leadingtopossiblebowelperforationorsignificantamountof bleedingintotheuterus Hemorrhagethatmayrequirea bloodtransfusion Page2of4 Copyright©2008EBSCOPublishing.Allrightsreserved. Damagetobowelomentum,mesentery,ureter,bladder,andfallopiantube Punctureoftheuterus Incaseofsignificantinjuryorbleeding,possibleneedtoopentheabdomenandhavetheuterinewound sutured Possibleneedtoremovetheuterus( hysterectomy ) AverageHospitalStay None PostoperativeCare Aftertheprocedure,youwillbetakentotherecoveryarea.Afterashortperiodoftimeyoucanleave. Planonhavinganescortfortransport. Theremaybesomenauseafromtheanesthesia. Milduterinecrampingmaybeexperienced.Thedoctormaygivepainmedicationforthisdiscomfort. Itisnotuncommontoexperiencevaginalbleedinganddischargeforsometime. Mostcommonly,normalactivitymaybestartedafterafewdays. Refrainfromplacinganythinginsidethevaginauntilinstructedbythedoctorbecausethecervixhasbeen openedandthismayallowbacteriatopassupintotheuterus. Theendometriumwillbuildupwithinthenextmonth.Thenextmenstrualcyclemaynotberegular.Itmay belateorearly. Outcome Itgenerallytakesacoupleofdaysforyourdoctortoreceivethelabreport.Atyourfollow-upvisit,yourdoctor willmakerecommendationsforanyadditionaltreatment.Patientscanusuallyreturntononstrenuousworkafter twoorthreedays. CallYourDoctorIfAnyoftheFollowingOccurs Fever Increasingabdominalpain Heavyvaginalbleeding(greaterthanapadperhour) Foulsmellingvaginaldischarge RESOURCES: TheAmericanCollegeofObstetriciansandGynecologists http://www.acog.org/ Womenshealth.gov http://www.4woman.gov/ CANADIANRESOURCES: TheSocietyofObstetriciansandGynaecologistsofCanada http://www.sogc.org/ Women'sHealthMatters http://www.womenshealthmatters.ca/ Page3of4 Copyright©2008EBSCOPublishing.Allrightsreserved. REFERENCES: AmericanCollegeofEmergencyPhysicianswebsite.Availableat:http://www.acep.org/webportal.Accessed October14,2005. D&Cforuterinebleeding.AmericanCollegeofSurgeonswebsite.Availableat:http://www.facs.org/.Accessed July28,2008. LastreviewedJanuary2008by JeffAndrews,MD AllEBSCOPublishingproprietary,consumerhealthandmedicalinformationfoundonthissiteis accreditedby URAC .URAC'sHealthWebSiteAccreditationProgramrequirescompliancewith53rigorousstandardsof qualityandaccountability,verifiedbyindependentaudits. TosendcommentsorfeedbacktoourEditorialTeamregardingthecontentpleaseemailusat [email protected] . Page4of4 Copyright©2008EBSCOPublishing.Allrightsreserved..