Dilation and curettage (D&C) is a procedure in which the opening to the uterus, the cervix, is dilated or stretched and tissue that lines the uterus is curetted (scraped or removed). This minor surgical procedure can be used to diagnose conditions, such as cancer of the uterus, and to treat and diagnose the source of conditions such as abnormal uterine bleeding. It is also a treatment for certain types of abnormal growths (e.g., polyps). D&C can also be used to remove tissue that remains in the uterus after a miscarriage and to perform an elective abortion beyond the first trimester (dilation and evacuation).  

During D&C the uterine opening, the cervix,  is widened (dilated) using instruments called dilators. Then, the physician removes selected tissue by suction or sharp curettage (scraping). In some cases, a long metal instrument with a loop on the end (curette) will be used to scrape the walls of the uterus after suctioning, a process known as curettage. Both techniques may be used simultaneously for certain cases.

D&C can be performed in a physician’s office, clinic or hospital. The health of the patient, the reason for the procedure and the type of anesthesia to be used determine the most appropriate setting. D&C is typically an outpatient procedure that can be completed in less than an hour. It is generally very safe, and in most cases patients can resume their normal activities within a few days.

Dilation and curettage (D&C) is a surgical procedure in which the cervix is widened (dilated) and a physician gently suctions (aspirates) tissue from inside the uterus. In some cases, a long metal instrument with a loop on the end (curette) will be used to scrape the walls of the uterus after suctioning, a process known as curettage. This helps ensure that no tissue is left behind in the uterus. For some D&Cs, a lighted tube called a hysteroscope is also used so the uterus can be viewed during the procedure.

A D&C can be performed either to diagnose or treat various gynecological conditions including:

• Treatment of abnormal uterine bleeding. This is the most common reason that D&C is performed. If a woman is of reproductive age and experiences abnormal bleeding a physician has several options for treatment. Initially, a physician is most likely to prescribe hormone medications to stabilize the uterine lining and to keep it from bleeding abnormally. However, if this is not successful, an operation may be recommended to help determine the cause of the uterine bleeding and plan effective treatment. This procedure may be performed along with a hysteroscopy so the curettage can be viewed directly. This helps make diagnosis and/or treatment more accurate.
  
  
• Removal of tissue after miscarriage or childbirth. D&C is often used to remove fetal or placental tissue that can remain inside the uterus after a miscarriage or childbirth.
  
  
• Removal of abnormal growths and cancer. Abnormal growths, known as polyps, can develop in the lining of the uterus or cervix and may cause bleeding. A cervical polyp may cause irritation during sexual intercourse whereas a uterine polyp may cause abnormal bleeding. In other cases, the growth may be a fibroid, which forms from the cells that make up uterine muscle. A fibroid can cause abnormal bleeding if it protrudes into the uterine cavity. During D&C, these growths can be scraped from the lining of the uterus. The tissue will then be sent to a laboratory to determine if the growths are cancerous. Most growths – especially fibroids – are noncancerous.
  
  
• Performing an induced abortion beyond the first trimester. Dilation and curettage is the most common method of induced abortion used beyond the first trimester (12 weeks). It usually involves suction and use of forceps to remove the fetus. In some cases, the uterus may be gently scraped to ensure that all tissue has been removed. D&C has several advantages over other second trimester procedures (such as induction of uterine contractions). These include greater convenience, lack of need for hospitalization and lower cost.
  
  
• Treatment of endometrial hyperplasia. D&C can be used to thin the lining of the uterus in women who have endometrial hyperplasia, a condition in which the uterine lining has become too thick. This thickening may occur as the result of hormonal changes, medications or other factors.
  
  
• Diagnosis of other disorders. D&C samples may be analyzed when trying to diagnose conditions such as the source of severe menstrual pain or infertility problems. A hysteroscopy is often also performed. 

Prior to dilation and curettage (D&C), patients should follow all preparatory steps recommended by their physician. These may include dietary restrictions or medication changes. If the patient's pregnancy status is unknown, a pregnancy test may be performed.

The procedure can be performed in a physician’s office, outpatient clinic or hospital. The health of the patient, the reason for the D&C and the type of anesthesia to be used determine the most appropriate setting.

Some patients may be given a sedative before the procedure, and intravenous (I.V.) fluids may be administered before or after the D&C. Just prior to the procedure, the vaginal area will be gently washed.

The patient will be positioned on her back with her knees bent and her feet propped up in stirrups. Tools known as dilators will be inserted into the vagina and cervix to gradually open the muscles of the cervix, which are strongly contracted.

After the cervix is sufficiently dilated, the physician inserts a thin, spoon-shaped instrument (curette) into the patient’s uterus to scrape its lining (endometrium). Depending on the patient’s underlying health condition, the physician will either remove:

• A sample of the endometrium for testing
  
  
• The portion of the endometrium causing excessive bleeding
  
  
• The remaining fetal or placental tissue (in the case of miscarriage)
  
  
• The fetus (in the case of abortion)

After the procedure has been completed, a sanitary napkin (pad) is placed over the vagina. The entire procedure usually can be completed in less than an hour. 

D&C is typically a “blind” procedure, meaning that the physician cannot see into the patient’s uterus during the procedure. In some cases D&C may be accompanied by other procedures such as hysteroscopy, in which a small, lighted telescope is used to view the inside of the uterus.

Following the dilation and curettage (D&C) procedure, patients usually spend about 30 minutes in the recovery room. In some cases, patients may be required to stay overnight at the hospital. This is usually a precaution for women who have another health condition, such as heart disease or diabetes. Patients may be required to remain in the hospital if complications related to the surgery arise.

In most cases, the patient is allowed to return home within a few hours of the procedure. Patients should arrange to have someone drive them home from the hospital or clinic. Patients can usually return to their regular activities within a day or two, including their jobs as long as they do not involve physical labor. However, women should refrain from sexual intercourse and the use of tampons for at least seven days. Sanitary napkins (pads) can be used during this time for discharge that occurs from the procedure. Douches should also be avoided for two weeks following the procedure to prevent exposure to bacteria that may cause infection or inflammation.

Patients may receive oral medication to treat any postoperative pain, such as severe cramps and back pain. Pain usually disappears within 24 hours. Patients may also receive antibiotics to prevent infection. It is not unusual for patients to experience slight bleeding or staining for 5 to 14 days following the procedure.

In most cases, the results of any laboratory analysis of tissues are available within several days. The physician will discuss the results with the patient and recommend additional tests or treatment if necessary. Following D&C, new tissue will replace any tissue that was removed from the uterus. A woman’s next menstrual period may be either early or late. The D&C procedure leaves no scar as it is performed through the opening of the cervix.

There are normal risks with dilation and curettage (D&C) that are associated with all surgeries, including bleeding, infection and complications from anesthesia. In rare cases of D&C, there is also the risk of a puncture of the uterus, laceration (tearing) of the cervix and scarring of the endometrium.

If the procedure needs to be performed when the cervix is still thick and firm, stretching can cause cervical incompetence. This may interfere with the success of subsequent pregnancies. In rare circumstances, scarring of the uterine wall can also impact future fertility.