Dilatation and curettage

A dilatation and curettage (D&C) is an operation performed on women to scrape away the womb lining. The cervix (neck) of the uterus (womb) is dilated using an instrument called a dilator. The endometrium (lining of the womb) is then lightly scraped off using a curette. This spoon-shaped instrument can be used to remove diseased tissue, treat abnormal bleeding or to obtain a specimen for diagnostic purposes.

Problems that may require D&C
D&C can be used as a diagnostic test or as a form of treatment for a range of conditions. Some of the problems that may require D&C include:

• A history of abnormal menstrual bleeding, such as heavy bleeding (menorrhagia) or bleeding between periods
• Polyps (small growths protruding from the mucous membrane of the uterus)
• Uterine infection
• Incomplete abortion (miscarriage)
• Surgical abortion
• Heavy bleeding after childbirth
• Suspicion of uterine cancer
• Investigations of female infertility.

• Once you are anaesthetised, your uterus is examined to determine its size and position.
• The walls of the vagina are held apart by an instrument called a speculum (the same instrument used during a Pap test).
• If you aren’t having general anaesthetic, an instrument is inserted to both position the cervix and administer local anaesthetic.
• Rods (dilators) that increase in size are introduced into the cervix, one at a time, to gently widen the entrance of the cervix (os) to the right diameter.
• The spoon-shaped curette is inserted through the dilated cervix and into the uterus.
• The lining of the uterus (endometrium) is scraped off using the curette.
• What happens next depends on the condition. For example, the scraping procedure concludes the surgical abortion, while tissue samples will be prepared and taken to a laboratory for investigation if the D&C was needed to help diagnose suspected uterine cancer.

• Nurses to record your vital signs such as temperature, pulse and blood pressure.
• You are observed for any vaginal bleeding.
• You shouldn’t need pain relief after the operation, although some patients experience mild abdominal cramps. A light pain killing tablet may be suggested.
• You should be able to get out of bed within a few hours and often are allowed home four to six hours after the operation if there is no vaginal bleeding.
• If you have lost a lot of blood before the operation, you might be required to stay in hospital overnight.
• Make arrangements for someone to come and collect you from the surgery or hospital, as you should not drive at least until the next day.

• Reactions to the medications used, such as allergic reactions to the general anaesthesia
• Cervical damage due to dilation or the passage of instruments
• Haemorrhage (bleeding)
• Infection of the uterus or other pelvic organs
• Scar tissue within the uterus, if the scraping was too vigorous
• Puncture of the uterus.

• Some cramping or mild abdominal discomfort is considered usual after a D&C. See your doctor if you are concerned or in pain.
• You should take any medication as ordered by your doctor.
• If you are taking antibiotics, make sure to take the whole course, even if you feel well.
• You should not have sexual intercourse for a week or so if possible.
• Avoid putting anything into your vagina, including tampons or douches, for at least one week or preferably two.
• If you experience any signs of infection (such as fever, pain or discharge) see your doctor immediately.

• Using a catheter (thin hollow tube) to take a sample of endometrial tissue for diagnostic purposes.
• A hysteroscope (a type of slender telescopic device) is generally advised for taking tissue samples from older women.
• Another diagnostic test is the vaginal ultrasound. This involves introducing a slender device into the vagina to take ‘sound pictures’ of the uterus.
• The oral contraceptive pill can be used to treat menorrhagia.
• An intrauterine device (IUD) that’s impregnated with the hormone progesterone can reduce heavy menstrual flow in some cases.

• Your doctor
• The Jean Hailes Foundation Tel. 1800 151 441
• Australasian Menopause Society Tel. (03) 4642 1603
• Women's Health Information Centre Information line Tel. (03) 8345 3045, TTY (03) 9344 2849, Country callers Tel. 1800 442 007
• Family Planning Victoria Inc. Tel. (03) 9257 0100

• A dilatation and curettage (D&C) is an operation performed on women to scrape away the womb lining.
• D&C is a form of treatment for a range of conditions including incomplete miscarriage, polyps or unwanted pregnancy.
• D&C can be used as a diagnostic test if, for example, cancer of the uterus is suspected.

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