What is Dilation & Curettage / ERPOC
A D&C or Evacuation of retained products of conception is a common surgical procedure that may be necessary after a miscarriage or sometimes after birth
Dilation and curettage, most commonly called D&C, is a surgical procedure to scrape the lining of the uterus to remove tissue. Technically a D&C refers only to the procedure whereby the uterus lining is scraped with a curette, but it is often used interchangeably with an evacuation of retained products (ERPOC), which uses suction rather than scraping. This minor surgery is nowadays considered both routine and safe and is usually a day-patient procedure. A D&C is most often diagnostic (tissue from the uterus is removed to be analysed for diseases and other problems) but for pregnant women and new mothers a D&C is usually performed as a treatment to clear out pregnancy tissues from the womb.
Why might I need a D&C?
After birth or miscarriage, a D&C is recommended after an ultrasound has shown that tissues from the pregnancy remain in the womb.
- An incomplete miscarriage happens when you suffer a miscarriage but the womb doesn't expel all of the pregnancy tissues. This may cause bleeding and discomfort or pain.
- If you suffer a missed miscarriage in the first three months of pregnancy then you will usually have the choice of waiting for a natural miscarriage to complete, having a D&C to remove the fetus, or taking a drug that acts to empty the womb.
- For women who have already given birth but are diagnosed with retained placental tissue, a D&C clears the womb of any residual traces of placenta. This is important to stop abnormal postnatal bleeding and prevent infection.
For non-pregnant women, a gynaecological D&C is often used to investigate the causes of very heavy or irregular periods, or post-menopausal vaginal bleeding.
What happens?
A D&C can be performed under a spinal epidural or local epidural but is usually performed under general anaesthetic. Before the procedure you'll be given a surgical robe to wear rather than any of your own clothes for hygiene reasons. You'll be taken to the operating room - usually on a trolley, which can seem very odd when you don't feel ill - and then be given your anaesthetic by injection. You might also be given a drug to relax you and stop you producing too much saliva prior to the anaesthetic. The injection of anaesthetic takes near-immediate effect and you will lose consciousness until you are in the recovery room.
Once the anaesthetic has taken effect, your legs will be put up in stirrups so that the gynaecologist can best access the vagina. The gynaecologist first dilates (opens) the cervix with special instruments and then inserts either a curette, a metal instrument with a loop at one end, a little like a spoon, to gently scrape the womb lining. With an evacuation of retained products (ERPOC) a fine, hollow tube is inserted into the uterus and the pregnancy tissue is cleared with suction. An ERPOC is the method usually preferred after early pregnancy failure. The whole procedure is very quick and you'll be coming round from the anaesthetic within twenty minutes to half-an-hour.
After you come round from the anaesthetic you'll usually be kept in the recovery room for a while where they'll monitor your vital signs until you're properly awake.
How should I prepare for a D&C?
Your anaesthetist and/or gynaecologist will talk you through any preparations you need to make before your D&C. These usually include not eating for at least 6 hours before your admission to the clinic, avoiding drugs and alcohol in the days before surgery, and scheduling or not taking any regular medication you may use.
The day before the operation you may be administered with medication on the cervix to soften it in preparation.
How fast will I recover?
Physical recovery after a D&C is very fast. Because of the general anaesthetic you'll need to stay in hospital under observation for a few hours after the procedure, but you may be allowed to go after as little as two hours. You'll be given some toast and a drink on the ward and will need to pass urine before being allowed home (you won't be able to drive). You'll then need to be watched by a family member or friend for 24 hours after the operation as a precautionary measure, and you shouldn't drive for 48 hours. You also shouldn't use tampons or have sexual intercourse until you have recovered (or about a week), and you should avoid heavy lifting for a few days.
You might experience cramps, like period pain, for half-an-hour to an hour after the D&C, and some women have cramps for the rest of the day. Your usual pain relief medication, such as paracetemol or ibruprofen should take care of this. You will probably also have light bleeding or spotting.
Physically you'll need at least one day off work afterwards to recover, perhaps a couple, but if the reason for a D&C was miscarriage then you are likely to need more time.
You should seek medical help right away if you experience any of the following:
- Abdominal pain (more than period-like cramps) or painful cramps that persist beyond a couple of days and aren't helped by painkillers
- Heavy or increased vaginal bleeding, or clots in the blood
- A discharge from your vagina with an unpleasant odour
- Fever
What are the risks involved?
D&C is considered a very safe procedure, however, it is not entirely risk-free. The very low risks from the procedure include:
- The possibility of uterine perforation - Because the wall of the womb is softer than usual during and immediately after pregnancy, there is a higher, but still very small, chance that the gynaecologist could make a hole in the uterine wall and could result in a haemorrhage.
- Asherman's syndrome - This is a very rare complication following a D&C where the scraping leads to the formation of scar tissue which can then expand to fill the uterus and affect your fertility.
- The introduction of instruments into the womb carries a small risk of infection.
- There are the usual risks involved with any procedure involving a general anaesthetic.
Discuss this story
hi ya to anyone who reads these comments   I suffered a second trimester missed misscarriage in late oct 2007. for any one who does'nt know what that is!! it is when the baby dies and you dont know it because there are no signs except that you gradually loose the pregnancy feelings like the breast swellings and morning sickness... I had no bleeding just a tiny bit of spotting and was told by my GP it was probably nothing to worry about and to wait for my scan. That was when I was told the baby had no heart beat and after a discusion and a second scan a week later they said i could wait and see if i would miscarry naturally or i could have the D&C straight away...i waited another five weeks and nothing happened so i had to have the opp anyway. ive just had my third cycle since and im still hoping for another chance but its a slim one cause of my age...any support or comment welcome please!!! thinking on you guys who have the same problems
Posted: 05/02/2008 11:52
oh , dear , do not be abset , do not be sad , i know how do you feel , you need to think positively. and try to enjoiy and do do your best good luck
Posted: 05/02/2008 15:49
Hi Emma, i'm glad someone read what i said, i was a bit scared to write at first...thought it might sound absurd that i should be so upset even now five months later. My problem is that ive had other children all of which have been ok; in a previous relationship that all went wrong, finally just when i thought no man could be trusted i met someone ,fell pregnant on the pill totally unplanned at 40yrs old...i knew he would'nt turn his back on me even though we had only been together 5/6months but he thinks it probably went wrong because of my age and is not keen to try again, i would love to have had that baby for him as well as me but it was'nt to be and i know there are so many others out there with similar problems...i just wonder if there is anything to improve my chances without going to the dr only to be told its my age or something like that...many thanks hun hope your really happy with your new baby
Posted: 05/02/2008 21:43
hi all, Hi Katherine, You can't say for sure that it was your age. The hosp I was at say they have at least two women who come in for the d&c everyday. I had mc at 25 so anyone can have one. There are lots of things you can do. I took pregnacare before I conceived my daughter and it made my feel reassured that she was getting the vitamins she needed,etc. Tried to eat more oily fish and took omega tablets also from the pregnacare range in the third trimester. You may not be thinking or trying again or wish to wait a little longer but just to let you know incase you are interested the most ferrtile period for women is around two weeks after first day of your period so there are just two to three days for conception to really take place each month. My hubbie and I were just letting nature take it's course and then I was preg in June and mc in Aug/Sept. Then I was sort of really wanting a baby like never before. I was worried that I couldn't carry a baby & feelings like this were going on. If you need any advice just ask. Thank you for your story Emma. Very uplifting to read. I also lost at 11 weeks. I'm waiting a few years before no2 as I want my daughter to be past the terrible two's stage! Also want to enjoy watching her growing up a bit. Are you having anymore or is 3 enough.sx
Posted: 06/02/2008 14:44
Hi Katherine. Really sorry to hear about your miscarriage, it must have been really terrible. Of course the miscarriage might well have had nothing to do with your age at all, and I completely understand that you want to have another baby. I think your partner's attitude is understandable though, he was prepared to stand by you in the pregnancy, but he wasn't expecting it, and it's a very different situation to positively try to have a baby rather than to accept that one is on its way. And now you've both just had the distress of losing the baby. Why don't you give him a little time and agree to discuss it again in a month or two? The other option is to both agree to come off the pill and let nature take its course, but resisting the temptation to really try for a baby, which could add stress that neither of you needs.
Posted: 07/02/2008 13:38
Hi Katherine - I'm full of sympathy for you, miscarriages are a horrible thing to go through. I agree with Suzie, that it was probably just 'one of those things', and not age related. My first pregnancy ended in miscarriage at 11 weeks, and I was 25 at the time. My second pregnancy also ended in miscarriage, but this time at 5 weeks (I was 26). Third pregnancy resulted in a healthy baby boy named Tyler who was born in 2003, fourth pregnancy resulted in healthy baby girl named Paige (2005), and fifth in a healthy baby boy named Dylan (2007). My husband and I would like a fourth child so we would like to start trying later on this year, but I always dread the 1st trimester and can never relax properly until about the 30th week of pregnancy. I'm sure if you guys decide to try again, you will be fine. Maybe your partner was just scared because he couldn't help share the pain, but if you really want a baby with him then I think it's worth sitting him down and explaining that although there is a slightly higher risk of things going wrong as a womans age increases, things like this happen to women of any age. Going to stop waffling now, but hope some of what I said helps, Good luck
Posted: 11/02/2008 19:38
hi Dee - thank you so much for your reply... ive not been on here for a day or two as my pc crashed and ive had to put a few things right with it. I am so sorry to hear that you went through those two m/c but very pleased to hear that you have had sucess at last with the other pregnancies that resulted in three healthy babies. I have just been told that my baby is still at the hospital awaiting the burial arrangements.. so im going through it all again now as we speak.... really difficult time at the moment and to top it all my partner has to go in to hospital on sunday for a major opp on his leg which means he will on crutches for three to six months. I would have loved to talk it over with him but now is not the right time (obviously) and i feel that by the time he has healed and ive got the courage to ask it will be too late to try again, but talking things through does help me XX many thanks Dee hope to hear back from you.
Posted: 13/02/2008 21:39
Hi Dee B & Pooky just got bk on here again after a long time of pain and trauma possibly good news ...I found out last week im pregnant again but worried sick that it going to be a repeat of last year...hope you are ok and still around to chat. thinking of you all xxx
Posted: 12/11/2008 09:12
Hi Emma I hope you are well the last time we spoke you had not long had your baby and that was feb 08 thinking of you and if you around on here some time would love to talk. your advice was sound and i have just found out im expecting again but dreading a repeat of before will be six wks tomorrow!!! xxx kat
Posted: 12/11/2008 09:23
Hi ya many thanks for your reply and congratulations on being pregnant again, not sure what number baby this is for you but im sure your looking forward to it as i have with mine... and im very happy for you. Im just praying its all going to be ok this time as i had very little warning that things were not right last time, im even dreading going to the dr to let him know in case that tempts fate how daft is that lol Not sure if id get booked in and a scan date this side of christmas anyway, its all so different now with the way they do things goin to finish rabbiting now... great to here from you take care too and good luck  xxx will let you know how i get on when i get the courage lol
Posted: 12/11/2008 23:55
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