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Dilatation and Curettage

Dilatation and curettage

Definition

Dilatation and curettage (D & C) is a gynecological procedure in which the cervix is dilated (expanded) and the lining of the uterus (endometrium) is scraped away.


Purpose

D & C is used to diagnose and treat heavy or irregular bleeding from the uterus. Possible reasons for abnormal uterine bleeding include:

  • Hormonal imbalance. Often women with abnormal bleeding are first treated with hormones in an attempt to normalize bleeding. D & C may be used to determine the cause of bleeding if hormone treatment is ineffective.
  • Endometrial polyps. Polyps are benign growths that may protrude from the uterus by a stem or stalk, usually to the endometrium or cervix. D & C may be used to diagnose polyps or to remove them.
  • Uterine fibroids. Also called leiomyomas, fibroids are benign growths in the smooth muscle of the uterus. Abnormal bleeding is often the only symptom of fibroids. D & C is often used to diagnose fibroids and may be used to scrape away small tumors; additional surgery may be needed to remove more extensive growths.
  • Endometrial hyperplasia (EH). EH is a condition where the endometrium grows excessively, becoming too thick and causing abnormal bleeding. Tissue samples procured during D & C can be assessed for early signs of cancer.
  • Cancer. D & C may be used to obtain tissue for microscopic evaluation to rule out cancer. Women over the age of 40 are at an increased risk of developing endometrial cancer.
  • Miscarriage, incomplete abortion, or childbirth. Abnormal bleeding may result if some of the products of pregnancy remain in the uterus after a miscarriage or induced abortion, or if parts of the placenta are not expelled naturally after childbirth. These retained products can be scraped out by D & C.

Description

D & C is usually performed under general anesthesia, although local or epidural anesthesia can also be used. Local anesthesia lessens risk and costs, but the woman will feel cramping during the procedure. The type of anesthesia used often depends upon the reason for the D & C.

During the procedure (which takes only minutes to perform), the doctor inserts an instrument called a speculum to hold open the vaginal walls, and then stretches the opening of the uterus (the cervix) by inserting a series of tapering rods, each thicker than the previous one, or by using other specialized instruments. This process of opening the cervix is called dilation.

Once the cervix is dilated, the physician inserts a spoon-shaped surgical device called a curette into the uterus. The curette is used to scrape away the uterine lining. One or more small tissue samples from the lining of the uterus or the cervical canal are sent for analysis by microscope to check for abnormal cells.

Although simpler, less expensive techniques such as a vacuum aspiration are quickly replacing the D & C as a diagnostic method, it is still often used to diagnose and treat a number of conditions.

Diagnosis/Preparation

If general anesthesia will be used, the patient will be instructed to refrain from eating and drinking for at least eight hours before the procedure. The doctor may order blood and/or urine tests to scan for certain abnormalities. Because opening the cervix can be painful, sedatives may be given before the procedure begins. Deep breathing and other relaxation techniques may help ease cramping during cervical dilation.


Aftercare

A woman who has had a D & C performed in a hospital can usually go home the same day or the next day. Many women experience backache and mild cramps after the procedure, and may pass small blood clots for a day or so. Vaginal staining or bleeding may continue for several weeks.

Most women can resume normal activities almost immediately. Patients should avoid sexual intercourse, douching, and tampon use for at least two weeks to prevent infection while the cervix is closing and to allow the endometrium to heal completely.


Risks

The primary risk after the procedure is infection. If a woman experiences any of the following symptoms, she should report them immediately to her doctor, who can treat the infection with antibiotics:

  • fever
  • heavy bleeding
  • severe cramps
  • foul-smelling vaginal discharge

D & C is a surgical operation that has certain risks associated with general anesthesia such as pulmonary aspiration and failed intubation. Rare complications include perforation of the uterus (which usually heals on its own) or puncture of the bowel or bladder (which requires further surgery to repair).

Extensive scarring of the uterus may occur after over-aggressive scraping during D & C, leading to a condition called Asherman's syndrome. The major symptoms of Asherman's syndrome are light or absent menstrual periods, infertility, and recurrent miscarriages. Scar tissue can be removed with surgery in most women, although approximately 2030% of women will remain infertile after treatment.


Normal results

Removal of the uterine lining will normally cause no side effects, and may be beneficial if the lining has thickened so much that it causes heavy periods. The uterine lining soon grows again normally, as part of the menstrual cycle.

Morbidity and mortality rates

D & C has been associated with a 410% rate of postoperative complications.


Alternatives

There are a number of alternatives to D & C, depending on the reason for doing the procedure. The following are some examples of procedures that allow doctors alternative ways of evaluating, sampling, or treating disorders of the inner lining of the uterus:

  • Expectant management of spontaneous abortion. D & C is the most commonly used method of treatment for incomplete abortion; one study showed that over 90% of women who visited hospital emergency rooms for incomplete spontaneous abortion were treated by D & C. Recent studies, however, have shown that expectant management (i.e., no active intervention) is a viable option for women who do not wish to undergo surgery and who are in otherwise good health. Up to 72% of women indicated that that expectant management of incomplete abortion was preferable to medical or surgical intervention.
  • Endometrial biopsy. This procedure is similar to D & C in that a curette is used to obtain a sample of endometrial tissue. Little or no cervical dilation is necessary, however, because the curette used in endometrial biopsy is narrower. The cervix is numbed with a local anesthetic but the patient will still experience cramping.
  • Vacuum scraping. A thin plastic tube attached to a suction machine is passed through the cervix and scraped along the endometrium. Vacuum scraping has been shown to have similar success in diagnosing uterine cancer as D & C. Local anesthesia is also used for this procedure.
  • Hysteroscopy. A thin telescope called a hysteroscope is inserted through the cervix and used to view the inside of the uterus after it has been expanded with a liquid or gas. The view afforded by the hysteroscope can help to diagnose abnormal growths, accumulation of scar tissue, or other conditions.
  • Hysterectomy . A total hysterectomy permanently removes the uterus and cervix. This procedure is generally recommended only if a woman no longer desires to have children and no other forms of treatment have been successful. Most hysterectomies are done to treat uterine fibroids and endometriosis (a condition in which the endometrium grows outside of the uterus).

Resources

periodicals

Geyman, John, Lynn Oliver, and Sean Sullivan. "Expectant, Medical, or Surgical Treatment of Spontaneous Abortion in First Trimester of Pregnancy?" Journal of the American Board of Family Practice 12, no. 1 (1999): 5564.

Molnar, Alexandra, Lynn Oliver, and John Geyman. "Patient Preferences for Management of First-Trimester Incomplete Spontaneous Abortion." Journal of the American Board of Family Practice 13, no. 5 (2000): 333337.

organizations

American College of Obstetricians and Gynecologists. 409 12th St., SW, PO Box 96920, Washington, DC 20090-6920. <http://www.acog.org>

other

"Asherman's Syndrome." International Adhesions Society. April 24, 2002 [cited February 24, 2003]. <http://www.adhesions.org/relatedconditions/asherman.htm>.

"Dilatation and Curettage." eTenet. 2001 [cited February 24, 2003]. <http://www.etenet.com/Apps/Library/Corporate.asp?ID=713>.

"Dilatation and Curettage." Patient Education Institute. December 21, 2001 [cited February 24, 2003]. <http://www.nlm.nih.gov/medlineplus/tutorials/dilationandcurettage/og059101.html>.

"Dysfunctional Uterine Bleeding." WomenOne.org. 2001 [cited February 24, 2003. <http://www.womenone.org/health04.htm>.

"Endometrial Hyperplasia." American College of Obstetricians and Gynecologists. 2001 [cited February 24, 2003]. <http://www.medem.com/MedLB/article_detaillb.cfm? article_ID=ZZZ7Z2GWQMC&sub_cat=9>.

"Hysterectomy." American College of Obstetricians and Gynecologists. 2001 [cited February 24, 2003]. <http://www.medem.com/search/article_display.cfm?path=n:&mstr=/ZZZ MULQGSWC.html&soc=ACS&srch_typ=NAV_SERCH>.

"Hysteroscopy." American College of Obstetricians and Gynecologists. 2001 [cited February 24, 2003]. <http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZ AXX8MA7C&sub_cat=8>.

Williams, Carmine. "Dilation and Curettage." eMedicine. April 26, 2001 [cited February 24, 2003]. <http://www.e medicine.com/aaem/topic156.htm>.


Carol A. Turkington Stephanie Dionne Sherk

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


D & C is generally performed by an obstetrician/gynecologist, a medical doctor who has completed specialized training in the areas of women's general health, pregnancy, labor and childbirth, prenatal testing, and genetics. Samples of the uterine lining may be sent to a pathologist for analysis. A pathologist is a medical doctor who has completed specialized training in the diagnosis of diseases from microscopic analysis of cells and tissues.

The health of the patient and the type of anesthesia used determines where a D & C is performed. The procedure is generally done in a hospital on an outpatient setting.

QUESTIONS TO ASK THE DOCTOR


  • Why is D & C recommended for my condition?
  • Where will the procedure be performed?
  • What alternative therapies are available to me?
  • What are my options in terms of anesthesia during the procedure?
  • What risks are involved with the procedure?

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"Dilatation and Curettage." Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers. . Encyclopedia.com. 19 Aug. 2017 <http://www.encyclopedia.com>.

"Dilatation and Curettage." Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers. . Encyclopedia.com. (August 19, 2017). http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/dilatation-and-curettage-1

"Dilatation and Curettage." Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers. . Retrieved August 19, 2017 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/dilatation-and-curettage-1

Dilatation and Curettage

Dilatation and curettage

Definition

Dilatation and curettage (D&C) is a gynecological procedure in which the lining of the uterus (endometrium) is scraped away.

Purpose

D&C is commonly used to obtain tissue for microscopic evaluation to rule out cancer. The procedure may also be used to diagnose and treat heavy menstrual bleeding and to diagnose endometrial polyps and uterine fibroids. D&C can be used to remove pregnancy tissue after a miscarriage, incomplete abortion, or childbirth, or as an early abortion technique up to 16 weeks. Endometrial polyps may be removed, and sometimes benign uterine tumors (fibroids) may be scraped away.

Description

D&C is usually performed under general anesthesia, although local or epidural anesthesia can also be used. Using local anesthesia reduces risk and costs, but the patient will feel cramping during the procedure. The type of anesthesia used often depends upon the reason for the D&C.

To begin the procedure (which takes only minutes to perform), the doctor inserts an instrument to hold open the vaginal walls, and then stretches the opening of the uterus to the vagina (the cervix). This is done by inserting a series of tapering rods, each thicker than the previous one, or by using other specialized instruments. The process of opening the cervix is called dilation.

Once the cervix is dilated, the physician inserts a spoon-shaped surgical device called a curette into the uterus. The curette is used to scrape away the uterine lining. One or more small tissue samples from the lining of the uterus or the cervical canal are sent for analysis by microscope to check for abnormal cells.

Although simpler, less expensive techniques such as a vacuum aspiration are quickly replacing the D&C as a diagnostic method, it is still often used to diagnose and treat a number of conditions, especially when cancer is suspected.

Preparation

Because opening the cervix can be painful, sedatives may be given before the procedure begins. Deep breathing and other relaxation techniques may help ease cramping during cervical dilation.

Aftercare

A woman who has had a D&C performed in a hospital can usually go home the same day or the next day. Many women experience backache and mild cramps after the procedure, and may pass small blood clots for a day or so. Vaginal staining or bleeding may continue for several weeks.

Most women can resume normal activities almost immediately. Patients should avoid sexual intercourse, douching, and tampon use for at least two weeks to prevent infection while the cervix is closing and to allow the endometrium to heal completely.

Risks

The primary risk after the procedure is infection. Signs of infection include:

  • fever
  • heavy bleeding
  • severe cramps
  • foul-smelling vaginal discharge

A woman should report any of these symptoms to her doctor, who can treat the infection with antibiotics before it becomes serious.

D&C is a surgical operation, which carries certain risks associated with general anesthesia. Rare complications include puncture of the uterus (which usually heals on its own) or puncture of the bowel or bladder (which requires further surgery to repair).

Normal results

Results are considered normal if no unusual thickening, growths, or cancers are found. Removal of the uterine lining causes no side effects, and may be beneficial if the lining has thickened so much that it causes heavy periods. The uterine lining soon grows again normally, as part of the menstrual cycle.

Abnormal results

Some types of uterine thickening, called hyperplasia, are considered abnormal. Simple hyperplasia is a benign condition in which the uterine lining becomes thicker and with more endometrial glands. In complex hyperplasia, another condition where the uterine lining has thickened, the endometrial glands are crowded together. In 80% of cases these conditions will improve, and there is little risk of cancer. Only 1% of simple hyperplasia and 3% of complex hyperplasia will become cancerous.

Atypical hyperplasia is a more serious finding. In this type of endometrial thickening, the cells are abnormal. Twenty-nine percent of women with atypical hyper-plasia develop cancer. In fact, in 17% to 25% of women with atypical hyperplasia who have a hysterectomy within one month of diagnosis, a carcinoma is found elsewhere in the endometrium.

A D&C is not a fool-proof procedure because only a portion of the uterine lining is sampled. Therefore, it is possible for a cancer to be missed. Because of this, patients with atypical hyperplasia must have another D&C in three or four months. Combining a hysteroscopy (a procedure where a physician can see the lining of the uterus using a special tool) with D&C may increase the accuracy of the diagnosis in some cases. However, this combination is not recommended when endometrial carcinoma is suspected because of the possibility that the hysteroscopy itself can aid in the spread of cancer through the fallopian tubes.

See Also Biopsy; Endometrial cancer; Gynecologic cancers

Resources

BOOKS

Berman, Michael L. and Michael T. McHale. "Uterus." In Cancer Treatment, 5th ed., edited by Charles M. Haskell. Philadelphia: W.B. Saunders, 2001, pp. 951-55.

Byers, Lowell J. et al. "Uterus." In Clinical Oncology, 2nd ed., edited by Abeloff, Martin D. et al. Philadelphia: Churchill Livingstone, 2000, pp. 1987-97.

Carlson, Karen J., Stephanie A. Eisenstat, and Terra Ziporyn. The Harvard Guide to Women's Health. Cambridge: Harvard University Press, 1996.

ORGANIZATIONS

American College of Obstetricians and Gynecologists. 409 12th St. SW, PO Box 96920, Washington, DC 20090-6920. <http://www.acog.org>.

Carol A.Turkington

KEY TERMS

Endomerial hyperplasia

Thickening of the uterine lining. The types of hyperplasia include: simple, complex, and atypical.

Endometrial polyps

A growth in the lining of the uterus (endometrium) that may cause bleeding and can develop into cancer.

Epidural anesthesia

A type of anesthesia that is injected into the epidural space of the spinal cord to numb the nerves leading to the lower half of the body.

Hysteroscopy

A procedure in which the doctor can see the uterine lining with a tube and viewing system. This is sometimes done with a D&C.

Uterine fibroid

A noncancerous tumor of the uterus that can range from the size of a pea to the size of a grapefruit. Small fibroids require no treatment, but those causing serious symptoms may need to be removed.

QUESTIONS TO ASK THE DOCTOR

  • What are you looking for in the D&C?
  • Do you recommend any special preparation before the procedure?
  • How long will the procedure take?
  • What is the risk of finding cancer in my case?
  • What action will be taken if cancer is found?
  • Will a repeat D& C be necessary?

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"Dilatation and Curettage." Gale Encyclopedia of Cancer. . Encyclopedia.com. 19 Aug. 2017 <http://www.encyclopedia.com>.

"Dilatation and Curettage." Gale Encyclopedia of Cancer. . Encyclopedia.com. (August 19, 2017). http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/dilatation-and-curettage-0

"Dilatation and Curettage." Gale Encyclopedia of Cancer. . Retrieved August 19, 2017 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/dilatation-and-curettage-0

Dilatation and Curettage

Dilatation and Curettage

Definition

Dilatation and curettage (D & C) is a gynecological procedure in which the lining of the uterus (endometrium) is scraped away.

Purpose

D & C is commonly used to obtain tissue for microscopic evaluation to rule out cancer. D & C may also be used to diagnose and treat heavy menstrual bleeding, and to diagnose endometrial polyps and uterine fibroids. A D & C can be used as a treatment as well, to remove pregnancy tissue after a miscarriage, incomplete abortion, or childbirth. Endometrial polyps may be removed, and sometimes benign uterine tumors (fibroids) may be scraped away. D & C can also be used as an early abortion technique up to 16 weeks.

Description

D & C is usually performed under general anesthesia, although local or epidural anesthesia can also be used. A local lessens risk and costs, but the woman will feel cramping during the procedure. The type of anesthesia used often depends upon the reason for the D & C.

In the procedure (which takes only minutes to perform), the doctor inserts an instrument to hold open the vaginal walls, and then stretches the opening of the uterus to the vagina (the cervix) by inserting a series of tapering rods, each thicker than the previous one, or by using other specialized instruments. This process of opening the cervix is called dilation.

Once the cervix is dilated, the physician inserts a spoon-shaped surgical device called a curette into the uterus. The curette is used to scrape away the uterine lining. One or more small tissue samples from the lining of the uterus or the cervical canal are sent for analysis by microscope to check for abnormal cells.

Although simpler, less expensive techniques such as a vacuum aspiration are quickly replacing the D & C as a diagnostic method, it is still often used to diagnose and treat a number of conditions.

Preparation

Because opening the cervix can be painful, sedatives may be given before the procedure begins. Deep breathing and other relaxation techniques may help ease cramping during cervical dilation.

Aftercare

A woman who has had a D & C performed in a hospital can usually go home the same day or the next day. Many women experience backache and mild cramps after the procedure, and may pass small blood clots for a day or so. Vaginal staining or bleeding may continue for several weeks.

Most women can resume normal activities almost immediately. Patients should avoid sexual intercourse, douching, and tampon use for at least two weeks to prevent infection while the cervix is closing and to allow the endometrium to heal completely.

Risks

The primary risk after the procedure is infection. Signs of infection include:

  • fever
  • heavy bleeding
  • severe cramps
  • foul-smelling vaginal discharge

A woman should report any of these symptoms to her doctor, who can treat the infection with antibiotics before it becomes serious.

D & C is a surgical operation, which carries certain risks associated with general anesthesia. Rare complications include puncture of the uterus (which usually heals on its own) or puncture of the bowel or bladder (which require further surgery to repair).

Normal results

Removal of the uterine lining causes no side effects, and may be beneficial if the lining has thickened so much that it causes heavy periods. The uterine lining soon grows again normally, as part of the menstrual cycle.

KEY TERMS

Endometrial polyps A growth in the lining of the uterus (endometrium) that may cause bleeding and can develop into cancer.

Epidural anesthesia A type of anesthesia that is injected into the epidural space of the spinal cord to numb the nerves leading to the lower half of the body.

Uterine fibroid A noncancerous tumor of the uterus that can range from the size of a pea to the size of a grapefruit. Small fibroids require no treatment, but those causing serious symptoms may need to be removed.

Resources

BOOKS

Carlson, Karen J., Stephanie A. Eisenstat, and Terra Ziporyn. The Harvard Guide to Women's Health. Cambridge, MA: Harvard University Press, 1996.

Cite this article
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"Dilatation and Curettage." Gale Encyclopedia of Medicine, 3rd ed.. . Encyclopedia.com. 19 Aug. 2017 <http://www.encyclopedia.com>.

"Dilatation and Curettage." Gale Encyclopedia of Medicine, 3rd ed.. . Encyclopedia.com. (August 19, 2017). http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/dilatation-and-curettage

"Dilatation and Curettage." Gale Encyclopedia of Medicine, 3rd ed.. . Retrieved August 19, 2017 from Encyclopedia.com: http://www.encyclopedia.com/medicine/encyclopedias-almanacs-transcripts-and-maps/dilatation-and-curettage

dilatation and curettage

dilatation and curettage (D and C) n. an operation in which the cervix (neck) of the uterus is dilated, using a dilator, and the lining (endometrium) of the uterus is lightly scraped off with a manual curette (see curettage) or removed by suction using an aspirator. It is performed for a variety of reasons, including removal of any material remaining after miscarriage and obtaining an endometrial biopsy for histological examination.

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"dilatation and curettage." A Dictionary of Nursing. . Retrieved August 19, 2017 from Encyclopedia.com: http://www.encyclopedia.com/caregiving/dictionaries-thesauruses-pictures-and-press-releases/dilatation-and-curettage