Dilation and curettage (D&C) has made technological advances so that it’s safer than ever for both therapeutic and diagnostic purposes. You’re still advised to avoid sex after D&C and may have complications if you terminate pregnancy after D&C. But advancements such as D&C hysteroscopy make risks such as bleeding after D&C rarer than ever before.
Dilation and Curettage (D&C) Procedure
The words dilation and curettage, more commonly referred to as a D&C, still make some women shudder. Not only was it previously performed in a hospital setting for first trimester abortions, but this procedure used to be done blind. Now, women can take a sigh of relief. A D&C has a variety of uses and now it has the benefit of being safer and simpler, especially when performed by a top OB/GYN in Queens, NYC.
In a dilation and curettage, your cervix — the small opening connecting your uterus and vagina — is temporarily enlarged or dilated so an instrument called a curette can be used to remove tissue from your uterus. The tissue removed is either for diagnostic purposes, which means it’ll be sent to the lab to be examined, or for therapeutic purposes, which means it’s to remove abnormal tissue.
Why Gynecologists Still Rely on D&Cs
Even though newer imaging procedures exist today, D&Cs are still done when advanced technology is unavailable or when they’re inconclusive in helping your doctor come to a diagnosis. It’s also appropriate for removing abnormal uterine growths and getting tissue samples for a pathological diagnosis of malignancy without a highly invasive procedure or removal of the entire uterus.
The original purpose for this procedure was to detect abnormalities in the endometrium, or uterine lining. It also was meant to help manage abnormal uterine bleeding. With the invention of smaller and more flexible cameras and the emergence of scopes, a D&C with hysteroscopy has a variety of uses. The diagnostic or elective reasons to do a D&C hysteroscopy include:
- Endometrial sampling
- Suspected malignancy
- Termination of pregnancy
The therapeutic indications for a D&C hysteroscopy include:
- Abnormal or irregular uterine bleeding (such as menorrhagia, post-menopausal bleeding or spotting)
- Removal of fluid or products retained in the uterus that were found on imaging
- Removal of abnormal uterine tissue such as polyps and small fibroids
- Cervical stenosis
- Retained products of conception (after miscarriage or termination)
- Uterine hemorrhage
- Evaluation of gestational trophoblastic disease
- Bleeding not responsive to hormone therapy
The procedure is done either in an outpatient clinic, your doctor’s office or in a hospital setting. Your Forest Hills, Queens gynecologist performs a D&C hysteroscopy when there’s a reason to visualize, or remove tissue from, your uterus. He explains the reasons for doing the procedure and provide specific instructions, like whether you should eat or not beforehand.
Arrange for someone to be with you or clear your day so that you can completely recover from anesthesia before you drive home. Even though most women are able to go home the same day, it depends on the procedure and your reaction to the anesthesia.
What to Expect
Your gynecologist guides you to have general anesthesia or local anesthesia; it depends on the procedure and your medical history. Your doctor may start the dilation process a few days before with specific medication to make the manual dilation easier in situations like more involved D&C procedures or the termination of pregnancy.
You’re asked to dress down and lay in a lithotomy position in stirrups — the usual position when you go for your routine gynecological exam. After your vulva is cleaned, your doctor places a speculum in the vagina to visualize the cervix. Manual dilation of your cervix is done by inserting rods that gradually increase in diameter. When this procedure is performed without a scope, the next step is to insert the curette, a very long, very tiny, spoon, into your uterus and scrape tissue out.
You can expect some bleeding after D&C, along with minor cramping or discomfort. You should refrain from using tampons and having sex after D&C for about two weeks. Don’t drive home until you’re fully recovered from the anesthesia.
Special Types of D&C
With D&C hysteroscopy, before the curette is introduced, a hysteroscope, which is a very thin telescope camera, is inserted into your uterus. Then the uterus is filled with fluid, usually saline, so that the doctor can see the uterine lining. He’ll look around for any abnormalities then introduce the curette to get a sample.
The D&C hysteroscopy technique is always advancing. Hysteroscopy D&C with MyoSure is an advanced procedure. The instrument makes viewing and removing tissue easier. Your Rego Park, Queens gyno has extensive experience with this procedure. It’s a new technology that’s used in removal of polyps, called hysteroscopy with polypectomy. It doesn’t do much damage to the normal uterine tissue and is a safer option if you’re concerned about fertility.
Even though D&C with suction was already a common procedure, MyoSure combines the curetting and suction functions while allowing for good visualization. Pregnancy after D&C is also more feasible after this procedure because of the reduced risk of damage.
Be Informed; Be Aware
A D&C procedure is relatively safe, but there are certain reasons not to get one. Absolute contra-indications — like being pregnant, having an obstructed vagina, or the doctor being unable to see the cervical opening — mean you should not have this procedure. Some contra-indications can be either resolved or managed. These relative contra-indications include:
- Severe cervical stenosis or narrowing of your cervix
- An obstructive cervical lesion
- Cervical or uterine structural abnormalities
- Prior endometrial ablation
- A bleeding disorder
- Acute pelvic infection
Even though there are risks to every procedure, technological advancements have removed many of the risks of a D&C. There are still some risks associated with this procedure, however, including:
- Bleeding or hemorrhage
- Cervical laceration
- Uterine perforation
- Intrauterine synechiae or adhesions
- Complications from anesthesia
The best gynecologist in Queens, NYC discusses the findings with you immediately or at a later date. If it’s a therapeutic procedure, you can expect a follow-up to look for complications and to assess the success of the procedure. If it’s done for diagnostic purposes, your doctor reviews the results when the pathology report is ready.
With the advancements of technology, more compassionate patient care, and patient awareness, procedures that used to be risky have become beneficial. Now, the rewards far outweighing the risks. The newer, safer, D&C techniques maybe a better solution for many women.
As a best in class gynecologist in Queens, Dr. James Gohar provides highly personalized and comprehensive care. His philosophy regarding the doctor/patient relationship is based on trust and has earned him one of the most respected reputations in Queens NY.
For more information about the Dilation and Curettage (D&C) procedure, treatment options or to schedule a consultation with the (gynecologist) OBGYN doctor, the best rated Dilation and Curettage (D&C) procedure specialist, Dr. James Gohar, please contact our Queens office.
Gynecologist Dr. James Gohar (OBGYN Doctor)
Forest Hills Medical Services
108-16 63rd Rd
Forest Hills, NY 11375
☎ (718) 897-5331