Dilation and Curettage (D&C) - Procedure, Risks, Recovery

DnC is a surgery used to remove the foetus and abnormal uterine tissue from the inside of the uterus. The procedure involves two main steps: 

1. Dilation, where the cervix is widened to allow access to the uterus

2. Curettage, in which a surgical instrument (curette) is used to ablate the uterine lining and remove tissue
   

 Anatomy and Physiology of the Uterus

The uterus is a pear-shaped hollow organ within the pelvis between the bladder and the rectum. It has four main parts: 

1. Fundus (the top portion above the openings of the fallopian tubes)

2. Corpus (the central part where the fertilised egg implants)

3. Isthmus (where the uterus starts to narrow)

4. Cervix (the lower section that opens into the vagina)

The uterine wall is made up of three layers:

1. The innermost layer, or endometrium, lines the uterine cavity and sheds during the menstrual cycle.

2. The middle layer, or myometrium, is composed of smooth muscle. It expands during pregnancy to accommodate a growing foetus and contracts during labour.

3. The outermost layer, the perimetrium, covers the exterior of the uterus.

D&C procedure is used to treat a variety of conditions affecting the uterus, providing both diagnostic and therapeutic benefits. The following are some of the reasons for performing dilation and curettage: 

1. Diagnosing causes of abnormal bleeding and removing polyps or fibroids that may be causing the bleeding

2. Clearing out any tissue from the uterus after miscarriage or incomplete abortion to prevent infection or heavy bleeding 

3. Treating significant bleeding after childbirth by clearing out remaining placental fragments from the uterus 

4. Eliminating noncancerous polyps in the cervix or uterus 

5. Treating molar pregnancy (tumours develop inside the uterus instead of the placenta during pregnancy)

DnC as a surgical procedure offers significant benefits for diagnosing and treating various gynaecological conditions. These include: 

1. Quick and Efficient: It is a relatively short procedure, often taking 15 minutes. Moreover, it is usually performed outpatient, minimising the time spent in a medical facility. This allows for a quick return to routine activities.

2. Minimally Invasive: Compared to other surgical alternatives, the D&C procedure involves minimal invasion. It leads to fewer complications and a faster recovery time.

3. Diagnostic Utility: D&C allows for the collection of uterine tissue samples. It can be crucial for diagnosing conditions like uterine cancer or the causes of abnormal uterine bleeding.

4. Therapeutic Benefits: The procedure effectively removes remnants of placental tissue following a miscarriage or abortion. This can prevent complications such as heavy bleeding or infection.

Preparing for a D and C procedure involves understanding the essential steps required before and on the day of the operation. Patients need to follow their doctor’s instructions closely.

Before Dilation and Curettage 

Patients meet their doctor before a DnC to ensure they are prepared for the procedure. They should make sure to ask questions and clear all their doubts. The following is what they can expect: 

On the Day of Dilation and Curettage 

Patients arrive at the hospital or clinic and complete any final paperwork. The following preparations may take place on the day of the procedure: 

DnC is commonly performed in an outpatient clinic or hospital. It is completed within 10 to 15 minutes. The exact procedure can differ based on the patient’s condition. Generally, it involves the following steps: 

1. Preparation: The patient is usually given anaesthesia to ensure comfort during the procedure. This can be:

1. General anaesthesia, where the patient is asleep

2. Spinal or regional anaesthesia, where the patient does not have any feeling from the waist down 

2. Positioning: The patient is made to relax on the operating table in a lithotomy position. They lie on their back with their legs supported in raised stirrups.

3. Cervix Access: A speculum is inserted into the vagina to open the cervix. A clamp is used to help keep the cervix in place. 

4. Dilation: The cervix is gently dilated using multiple rods to allow access to the uterus. This enables the passage of surgical instruments into the uterine cavity.

5. Curettage: The gynaecologist uses a curette, a spoon-shaped instrument, to scrape the lining of the uterus. This removes uterine tissue, which can be sent to a lab for analysis. Alternatively, a suction device may vacuum tissue out of the uterus.  

6. Completion: After the procedure, the instruments are removed, and the speculum is withdrawn. 

It is usual to experience mild cramping and vaginal bleeding for 10-14 days after dilation and curettage. Following the doctor’s instructions in the hospital and at home can help a smooth recovery. 

Recovery in Hospital

Patients can usually return home on the same day as the procedure. Before discharge, they can expect the following in the hospital or clinic: 

1. They spend a few hours in the recovery room under observation. This ensures there are no immediate complications like heavy bleeding or adverse reactions to anaesthesia. 

2. The nurse will monitor their vitals, including blood pressure, pulse, and breathing. 

3. Once their condition stabilises, the patient will be discharged from the hospital. They will need someone to drive them home. 

At-Home Recovery

After D and C surgery, individuals can resume their daily activities within one to two days. However, it is important to follow post-operative care guidelines to ensure a smooth healing process. These include: 

1. Over-the-counter pain medications such as ibuprofen to manage mild discomfort and cramping 

2. Use sanitary pads rather than tampons for bleeding to reduce the risk of infection 

3. Avoid sexual intercourse or douching (washing the inside of the vagina with water or other fluids) for one week after the procedure or until the doctor says it’s safe 

4. Shower instead of bathing and avoid swimming 

Patients may expect a change in their next menstrual period. It may begin earlier or later than usual. 

First Follow-Up Appointment

A follow-up visit is usually scheduled two weeks after the DnC procedure. During this appointment, the doctor ensures proper healing and discusses any further treatment if necessary. They will also perform specific tests to evaluate recovery. These include: 

1. Pelvic exam 

2. Ultrasound 

Dilation and curettageare generally considered safe. However, like all surgical procedures, it carries potential risks and complications. Here are some issues that could arise:

1. Perforation of the uterus (instruments used during the D&C can puncture the uterus)

2. Heavy bleeding 

3. Infection 

4. Asherman’s syndrome (formation of scar tissue in the uterus, which can cause menstrual irregularities and infertility)

When to consult a doctor?

After undergoing a DnC, monitoring for any signs of complications is crucial. Women should contact their doctor if they experience the following symptoms:

1. Changing more than one sanitary pad per hour (extensive bleeding) or passing large blood clots 

2. Fever above 100.4℉

3. Cramps for more than two days

4. Worsening pain 

5. Foul-smelling discharge

The cost of the DnC procedure in India varies in different hospitals depending on several factors. Generally, it ranges between ₹ 8,000 to ₹ 11,000. 

Note: The price mentioned above is approximate. Please consult HexaHealth experts for accurate expenses. 

The factors that can influence the cost of the procedure include: 

1. Type of Facility: Choosing between a public hospital, private clinic, or speciality medical centre can significantly affect the cost. Private facilities generally charge more.

2. Geographic Location: Metropolitan areas have higher expenses due to increased living costs.

3. Type of Anesthesia: The cost can differ depending on whether regional or general anaesthesia is used. General anaesthesia is more expensive than regional anaesthesia.

4. Physician’s Expertise: More experienced gynaecologists or surgeons may charge higher fees for their services.

5. Additional Tests: The expenditure may increase if the D&C is part of a broader diagnostic process requiring further tests like hysteroscopy.

Dilation and curettage (DnC) helps diagnose and treat various uterine conditions. It addresses issues such as excessive bleeding and the removal of tissue after miscarriage. As a minimally invasive option, it minimises recovery time, allowing patients to resume routine activities quickly.

For those seeking information about the D&C procedure, HexaHealth can assist by providing access to a network of qualified gynaecologists. With expert guidance, we ensure patients receive personalised care for their reproductive health. Contact us today to have safe surgery.