Dilation and curettage (D&C)

What is a D&C?

D&C stands for dilation and curettage. It's a surgical procedure that involves opening (dilating) the cervix and removing tissue from inside the uterus (curettage) with a thin instrument (a curette) or a suction device. It's a surgery sometimes used for early pregnancy complications, such as miscarriage, and also for basic gynecologic problems, such as heavy bleeding.

Your doctor may do a procedure called a hysteroscopy at the same time. This involves putting a small camera through the cervix into the uterus to examine the endometrial cavity directly. The images are shown on a monitor. If a growth such as an endometrial polyp or a uterine fibroid is seen, the doctor can remove it with special instruments.

The terms "suction D&C" or "vacuum aspiration" are typically used to refer to treatment of a first trimester miscarriage or the procedure for a first-trimester pregnancy termination. (Surgically, they're the same procedure.) The term D&E, or dilation and evacuation, is used only for procedures done in the second trimester. It usually involves the use of suction as well as other surgical instruments.

When is a D&C used?

A D&C may be diagnostic or therapeutic, and it may be obstetric or gynecologic.

A diagnostic D& C is done to determine what's causing a medical condition, such as abnormal uterine bleeding or to follow up on abnormal biopsy results. Some tissue is removed and tested.

Often an endometrial biopsy (endometrial sampling) is done first, if you have unusual bleeding or a specific variety of an abnormal Pap test. The endometrial sampling can test for uterine polyps or endometrial cancer or precancer (called endometrial intraepithelial hyperplasia).

Your doctor may do a D&C if they need more information after the endometrial biopsy (a D&C provides a more complete sample). Or your doctor may do a D&C instead of an endometrial biopsy if you're not able to have the biopsy – because you need to be under anesthesia for the procedure, for example. They may also do a D&C to treat the condition after the biopsy or sampling.

A therapeutic D&C removes the contents of the uterus and may be done:

• After a miscarriage, if the pregnancy tissue isn't passed completely or at all
• After childbirth, if pregnancy or placental tissue remains
• For an abortion, to end a pregnancy
• To treat a molar pregnancy, removing the growth that's formed in place of the placenta
• To treat excessive vaginal bleeding that doesn't respond to hormonal treatment
• To remove cervical or uterine (endometrial) polyps
• To treat endometrial intraepithelial hyperplasia, or precancerous changes of the lining of the uterus

Is a D&C a major surgery?

No, a D&C is considered a minor surgery. The procedure may be done in a doctor's office, surgery center, hospital, or clinic, usually on an outpatient basis, so you'll go home the same day.

You'll receive an IV for fluids and medicines. You may have general anesthesia (where you're unconscious and have a tube placed in your lungs to control your breathing), conscious sedation (where you're asleep and won't remember the procedure but are breathing on your own), or local anesthesia (a numbing medicine will be injected into your cervix). The type of anesthesia you receive depends on your needs, medical history, and what the facility is equipped to provide.

The procedure takes about 15 to 30 minutes. How much or little discomfort you have depends on what type of anesthesia you have, but you can expect at least some cramping and pressure if you're awake for the procedure.

Here's how a D&C is done:

1. You'll get comfortable on the operating table, lying down on your back. If conscious sedation or general anesthesia is used, you'll drift off to sleep in this position and be unaware of the rest.
2. Your physician and nurses will help position your legs in supports, similar to during a gynecologic exam.
3. Your doctor will clean the vagina and cervix with an antiseptic solution.
4. They'll insert a speculum into your vagina.
5. The cervix will be held in place with another instrument, called a tenaculum (a type of forceps).
6. To dilate your cervix, a series of rods – each slightly larger than the last – will be passed through the cervical opening, gently stretching the opening. How dilated your cervix needs to be depends on the exact procedure you're having. Most procedures require dilation of only 5 to 10 mm.
7. An instrument called a curette and/or a suction device is used to gently remove the tissue within and lining the uterus.
8. The tissue is sent to a laboratory for analysis. (This is generally done for both diagnostic and therapeutic D&Cs.)

What to expect before your D&C

Your provider will prep you ahead of time, so you know not to eat or drink anything on the day of the procedure.

For second trimester D&E procedures, a slender rod absorbent rod, called a laminaria, is inserted into the cervix several hours or the day before the procedure. The rod expands as it absorbs fluid from the cervix, causing the cervix to dilate. You can walk around and move normally with the laminaria in place.

You may also be given medication (such as misoprostol) to soften the cervix, which will make it easier to dilate. You may take it orally, buccally (dissolving it between your gums and your cheek), or insert it vaginally.

What to expect after your D&C

After your D&C, you'll remain in the hospital or office for some time (between half an hour and a few hours) so you can wake up from anesthesia and be monitored after your procedure. You'll need someone to drive you home.

Any cramping pain is usually mild and usually subsides soon after the procedure, though it may last a day or two. If you're uncomfortable, take a non-aspirin pain reliever, such as acetaminophen or ibuprofen (aspirin may increase bleeding).

You may have light bleeding or spotting for several days.

Avoid strenuous activity for a few days, but you'll otherwise be able to resume most of your normal activities in a day or two. Don't insert anything into your vagina after the procedure, because bacteria from the vagina can get into the uterus and cause infection. Ask your doctor how long you should wait before using tampons or having sex.

Usually you'll have a period in 4 to 6 weeks after a D&C. It may not occur at the normal time, though, as a new lining needs to build up in the uterus, and that can cause your period to be early or late.

Your doctor will call you with lab results, and you may see them for a follow-up appointment in a week or two, though this isn't always necessary for a first trimester D&E.

Call your provider if you have any of the following after a D&C:

• Fever over 100.4 degrees F
• Heavy bleeding (soaking a sanitary pad within an hour more than once) or bleeding that lasts more than 2 weeks
• Abdominal pain that gets worse or cramping that lasts more than 48 hours
• Vaginal discharge that's green or foul smelling
• Dizziness or lightheadedness

D&C risks and complications

D&C is considered a very safe procedure. Potential complications are rare but include:

• Bleeding
• Infection, which would require treatment with antibiotics
• Perforation of the uterus with the tip of an instrument. Most uterine perforations heal on their own without treatment.
• Cervical injury from the curette or from dilations. These can be treated with pressure and/or medications, stitches, or a balloon to keep pressure on the cervix.
• Hemorrhage (extremely rare), which would require a transfusion
• Incomplete procedure
• Anesthesia complications
• Adhesions. Rarely, adhesions (scar tissue) may form inside the uterus after a D&C is performed. These adhesions may cause changes in menstruation and infertility, though the condition (called Asherman syndrome) can often be treated with surgery.

Learn more:

• Should I have an abortion?
• Emergency contraception
• Grieving a miscarriage