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.