Dilation and curettage (D&C) is a relatively quick surgical procedure in which the cervix is dilated and a special instrument (curette) is used to scrape the uterine lining. The latest technological advances in the way D&C is performed has made this procedure safer than ever, whether it is used for therapeutic or diagnostic purposes.
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 breathe 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 will be sent to the lab to be examined, or for therapeutic purposes, which means it is used 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 reach a diagnosis. It is 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
- The removal of placental and/or fetal tissue that remains in the uterus after a miscarriage, planned pregnancy termination, or preterm/term delivery
- Uterine hemorrhage
- Evaluation of gestational trophoblastic disease
- Bleeding not responsive to hormone therapy
How to Prepare for the D&C
The procedure is usually done either in an outpatient clinic, your doctor’s office or in a hospital setting. Your Forest Hills, Queens gynecologist will performs a D&C hysteroscopy when there is a reason to visualize, or remove tissue from, your uterus. Your doctor will explain 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 will determine whether you will have general 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 will be asked to lay in the usual position used for your routine gynecological exam with your feet in the stirrups. After your vulva is cleaned, your doctor places a speculum in the vagina to visualize the cervix. Dilation involves widening the opening of the lower part of the uterus (the cervix) to allow insertion of an instrument. 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 the tissue out. The doctor may also use a cannula to suction any remaining contents from the uterus.
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, your doctor will give you the detailed instructions. Do not drive home until you are 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 will 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 Forest Hills, Queens gynecologist has extensive experience with this procedure. It’s a new technology that is used in removal of polyps, called hysteroscopy with polypectomy. Even though D&C with suction was already a common procedure, MyoSure combines the curetting and suction functions while allowing for good visualization. The MyoSure procedure is designed to allow your doctor to remove any growths in your uterus, while preserving uterine function and form. This is especially important if you want to have children in the future.
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 contraindications can be either resolved or managed. These relative contraindications 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 adhesions
- Complications from anesthesia
The best gynecologists in Queens, NYC who are part of the Forest Hills Medical Services team will discuss the findings with you immediately or at a later date. If it is a therapeutic procedure, you can expect a follow-up to look for complications and to assess the success of the procedure. If it is 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.
Forest Hills Medical Services is a comprehensive clinical practice. In our office we believe that how you are treated is just as important as the medical care we provide. We are dedicated to providing the highest quality obstetrics and gynecology with warmth and compassion. Our physicians are easy to talk to and our entire staff is friendly and attentive to your needs.
Our gynecologists are renowned for their extensive skills in performing the most technologically advanced D&C procedures.
We will listen to all your concerns and together we will come up with the treatment plan that works for you and your unique circumstances.
Call FHMS to meet our staff in our state-of-the-art offices and be heard.
Gynecologists Dr. James Gohar (OBGYN Doctor), Dr Nithya Gopal and Maris Huffman, NP
Forest Hills Medical Services
108-16 63rd Rd
Forest Hills, NY 11375
☎ (718) 897-5331