What is the difference between MTP and D&C?

MTP or Medical Termination of Pregnancy uses medications to end a pregnancy. Pregnancy can be terminated using medicines if it is between seven and nine weeks long; otherwise, surgery is required to terminate it. In India, Medical Termination of Pregnancy is permitted if the pregnancy period does not exceed 24 weeks.

Medical abortion is performed using two medicines. The doctor will prescribe a Mifepristone pill to stop the pregnancy, and another medication called Misoprostol to cause uterine contractions.

Misoprostol is taken about 24-48 hours after Mifepristone. In some time, you will experience stomach cramps and vaginal bleeding, resulting in the termination of pregnancy. But you may need follow-up visits with your doctor. 

MTP may be performed for various medical, social, and personal reasons. Some of these reasons include:

1. Completion of a miscarriage
2. Risk to the mother’s physical or mental health during pregnancy
3. Pregnancy caused by rape or sexual abuse
4. Contraception failure
5. Foetal anomalies (congenital disabilities, physical or mental abnormalities)
6. A poor socioeconomic status may affect the health of the mother or baby

A D&C is a surgical treatment that involves cleaning the uterine lining with a surgical instrument. It is an outpatient procedure performed in a hospital or clinic.

Before the procedure, your doctor will provide instructions about eating and drinking. It is carried out in an operating room after administering local anaesthesia. D&C follows an MTP usually. 

A D&C has two steps, as its name suggests:

1. Dilatation:  It involves dilating the cervix to allow the insertion of a surgical instrument. It includes:
   1. The doctor will insert a speculum (a duck’s bill-shaped device) into your vagina to examine the cervix. 
   2.  A clamp is used to hold the cervix in place. 
   3. Next, the doctor will insert slender rods (laminaria) into your cervix to ensure it is sufficiently dilated.
       
2. Curettage: It involves clearing the uterine lining and removing uterine tissue. It includes:
   1. The doctor will remove the dilating rods. 
   2. They will insert a curette (a spoon-shaped instrument with a sharp edge or suction device at the end) to remove the foetal tissue from your uterus.

The medical process for ending a pregnancy depends on how far along a woman is in her pregnancy. There are several stages of MTP, including the first, second, and third trimesters.

A woman can choose between a medical or surgical abortion method during the first trimester. A surgical abortion method called Dilation and Curettage (D&C) terminates the pregnancy up to or within 16 weeks of gestation. The difference between MTP and D&C are:

An MTP is only possible up to nine weeks into a pregnancy.  It is among the safest ways to end an unintended pregnancy. The advantages of MTP are:

1. For very early pregnancies, medical abortion is an efficient and secure procedure
2. Unless it fails, it does not use anaesthesia, surgery, or vacuum aspiration
3. It is carried out confidentially without revealing any private details of the woman
4. It is a non-invasive process

The minimally painful and uncomfortable D&C technique is a standard surgical treatment. It lessens the agony and anguish, the danger of infections, and the requirement for more procedures; it is frequently advised following a miscarriage. The benefits of the procedure are:

1. A relatively safe procedure: D&C is usually considered a safe procedure that does not affect your future fertility. However, there are some rare complications of D&C, which can be treated. 
2. Eliminates the waiting time: For an incomplete abortion, instead of allowing the abortion to proceed at its own pace, you can schedule D&C to eliminate the waiting time. D&C helps shorten the physical process of abortion for women going through pregnancy loss. 
3. Involves minimal physical pain: D&C is generally performed under local anaesthesia. Due to this, you may feel little to no pain during the procedure. Though you may have mild cramps or discomfort after the procedure, you can usually return to normal activities within a day or two. 
4. Reduces emotional distress: While going through a pregnancy loss, it can be traumatic to witness all the blood and tissue expelled from the uterus after miscarriage or abortion. During D&C, you will be under anaesthesia, unaware of the removed tissue. 

MTP and D&C are usually safe procedures. However, like any other procedure, there are some risks involved, which are rare. The risks include:

1. Perforation of the uterus: Uterus perforation (a hole in the uterus due to the insertion of an intrauterine device) is a common complication during an MTP procedure.
   In most cases, the perforation heals itself. However, if a blood vessel or organ is damaged, it may require a second procedure for repair. 
2. Infections: During or after the D&C procedure, bacteria can transfer from your vagina to the uterus, causing infections. The symptoms of infections include fever, pain, uterine cramping, and vaginal discharge.
   These infections generally do not cause long-term complications if treated promptly. However, the infection may sometimes scar your ovaries, uterus, or fallopian tubes, making future pregnancies difficult. 
3. Damage to the cervix: D&C can cause a tear in the cervix. The doctor may apply medicine or pressure on the cervix to stop bleeding or close the wound with stitches. 
4. Damage to the uterine wall: During D&C, there is a risk of too much or too little scraping of the uterine wall. If it is scraped too little, the remains of the embryo will remain in the uterus, requiring a second D&C procedure.
   When D&C is delayed, the risk of excessive bleeding and infections increases. 
5. Asherman’s Syndrome: If the uterine wall gets scraped too much, its lining can become damaged, resulting in the development of scar tissue in the uterus.
   This condition, known as Asherman’s Syndrome, can lead to missed or painful menstrual cycles, future miscarriages, and infertility. Mostly, it can be treated with surgery. 

D&C is a relatively safe procedure in which the risk of complications is rare. Consult your doctor to discuss if and when a D&C procedure following MTP is the right choice for you. Though a difficult decision, it may help you get through the physical process of abortion, enabling you to focus on processing your emotions. 

You can contact an HexaHealth expert for a more detailed discussion about your choices. Our team of experienced gynaecologists and counsellors can help you with safe medical termination of pregnancy, offering utmost care from guidance to recovery.