November 29th, 2023 | 10 min. read
There are many reasons a dilation and curettage (D&C) procedure may be recommended by your doctor, including after miscarriage, to diagnose and/or treat conditions like abnormal uterine bleeding, or following childbirth. Here's what to know, straight from a fertility nurse.
In this article:
What is Dilation & Curettage (D&C)?
A dilation and curettage (often abbreviated as D&C) is a minor surgical procedure typically performed in a doctor's office, a women's health clinic, a day surgery center, or a hospital. Here at Illume Fertility, our surgeons are able to perform the procedure onsite in our fully-equipped Norwalk surgical suite.
During a D&C, the cervix is slowly dilated (the cervix serves as a gateway to the uterus). Once the cervix has opened, a specialized instrument known as a curette, which resembles a spoon in shape, is used by the surgeon to clear tissue from the inner lining of the uterus.
In some cases, a hysteroscopy may be performed at the same time.
Purpose of D&C Procedure
There are a variety of situations where a D&C may be recommended:
- To remove retained tissue in the womb after miscarriage or childbirth
- To determine a cause for heavy bleeding during or between menstrual periods
- To remove infected tissue caused by pelvic inflammatory disease (PID)
- To remove an intrauterine device (IUD)
- To remove tumors or fibroids
- To perform an elective abortion
Depending on the reason for your D&C, tissue removed from the uterus may be sent to a laboratory for further analysis. After a miscarriage, a D&C may make it easier to collect a usable tissue sample for patients who want to pursue chromosomal testing on the fetus.
Note: If the purpose of the D&C is to remove potentially cancerous tissue, you’ll get a report from your doctor’s office on the laboratory findings.
D&C for Early Miscarriage
A dilation and curettage procedure is performed in around 50% of pregnancy losses, when a physician and patient both agree that it is the best course of action. The procedure ensures that products of conception that are unable to pass naturally (or with the help of medication) are not retained, as this can cause serious complications.
Some patients may choose to have a D&C so they do not have to wait to miscarry naturally (in the case of a missed miscarriage). Waiting an unknown length of time for the body to begin this process can be emotionally painful for many.
If a miscarriage occurs before 10 weeks of pregnancy, it will most likely happen on its own and not cause any problems. After the 10th week of pregnancy, there’s a higher risk of having what is called an "incomplete" miscarriage.
Preparing for a D&C
Your doctor or nurse will provide you with written instructions on preparing for your D&C. Always follow these instructions exactly. Let's go over what to do before your procedure, and how to set yourself up for a smooth recovery afterwards.
- Arrange to take one or two days off from work or school if possible
- Make sure you have someone to drive you home after the procedure
- The night before, do not to eat or drink anything (even medications like Tylenol)
- Try to relax and rest prior to your surgery
- If you’re feeling crampy, use a heating pad to help relieve discomfort
Feeling anxious?
It’s normal to feel a wide range of emotions (including anxiety) before any surgery. If you take medications for chronic anxiety, like Zoloft, Prozac, Lexapro, we recommend that you DO take these at your regular time with a small sip of water.
However, we suggest that you skip medications like Xanax or Ativan, as they can cause exacerbated drowsiness in addition to the anesthesia you’ll be receiving during your procedure.
Will someone need to drive me to/from my D&C?
Yes, because of anesthesia used during the procedure, you will need to arrange for a family member or friend to drive you home. You will not be permitted to drive yourself or leave in an Uber, taxi, or bus, so please plan ahead to ensure a safe journey.
Are there any risks to a D&C?
There are always risks to be considered in any surgery. The complications that can occur in a D&C include infection, a perforated uterus, and retained products of conception. However, these complications are unlikely and great care is taken to ensure they do not occur.
The Day of Your D&C Procedure
If you and your doctor have determined that a D&C is the best course of action, you will be scheduled for the procedure at our Norwalk office. Your Care Team will walk you through any paperwork and answer your questions prior to surgery day.
Upon arrival at Illume's Norwalk office, you’ll check in with our front desk team. Once you’re all signed in, you’ll be escorted back to our surgical suite.
Note: We ask that you arrive 1 hour prior to your scheduled surgery to allow enough time for us to complete your pre-op check-in.
In your own private surgical bay, you’ll be asked to remove everything from the waist down and put on one of our sterile surgical gowns. There will be a surgical stretcher (like a bed) with a warm blanket, where you will rest until your scheduled surgery time.
What to Expect During Your D&C
The procedure itself takes about 20-30 minutes. You can anticipate being at Illume Fertility for approximately 2 hours. This time frame includes pre-op, the procedure, and a monitored recovery of at least 30 minutes.
A D&C does not hurt. You will be anesthetized during your procedure; you will be breathing on your own, but unaware of the procedure occurring and not feeling any pain.
The procedure physician scheduled for the day of your surgery will be performing the D&C. This may or may not be your primary physician, as our team operates on a surgical rotation schedule.
Two medical assistants, an anesthesia provider, and your assigned surgeon will be in the room with you during the procedure. You will be monitored by one of our nurses in recovery.
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What happens after my D&C?
After your D&C, you will be instructed to take the oral antibiotics prescribed within 2-3 hours afterward. This is considered prophylactic (with the goal of preventing potential infection). We will always call you the day after your procedure to see how you’re doing.
We also offer counseling referrals for mental health support, and can work together to create a network of appropriate for you. Always ask for help if you are struggling.
Note: You will most likely need a saline sonogram after your D&C. Your Care Team will work with you to determine the best time to schedule this.
Recovering From Your D&C
The recovery period following a D&C typically lasts around 1-2 weeks, though some patients may need more time to recover fully. During the first few days after the procedure, it is common to experience mild to moderate cramping, spotting, and light bleeding.
For most, this is comparable to menstrual cramps, and is usually managed with over-the-counter remedies and a heating pad. Pain relief medications may be prescribed to manage more significant levels of discomfort.
When to contact us: If your pain has become intolerable, or you notice that you are bleeding through a standard size maxi pad in 1 hour or less, please contact your Care Team so we can address these concerns right away.
Frequently Asked Questions About D&C
We've covered a lot here, and it's completely normal to feel a bit overwhelmed by all the information you're receiving. Likewise, you may have some lingering concerns or questions that we haven't addressed yet.
Let's tackle some of the most common ones together:
How will I know if the D&C procedure worked?
After your D&C, your Care Team will schedule a follow-up saline sonogram. This will ensure there are no retained products of conception or other abnormalities in your uterus.
Why are my HCG levels still high after a miscarriage?
This can be one of the toughest parts of pregnancy loss (especially on your mental health) - allowing your body time to "recognize" the loss has occurred. You may feel eager to begin another treatment cycle and move forward, or feel unable to grieve the loss because you're still seeing signs that remind you of pregnancy.
After a loss, it can take one month or more for bHCG levels to return to normal. How far along you were in your pregnancy will often determine the amount of time before your hormones are back to baseline.
When can I resume fertility treatment after a D&C?
Once your bHCG has returned to baseline and we've confirmed your saline sonogram results are within normal limits, your Care Team will discuss resuming fertility treatments with you.
If you need to take a break from treatment or reassess your family-building plan, your team will support you through this as well. It's all on your own timeline, and there is no rush to "get back" to treatment when you're not ready yet.
Why was a D&C recommended instead of medication?
Unfortunately, when a loss occurs at a later stage in pregnancy, medication (such as misoprostol) taken to help the body process a miscarriage may be ineffective.
Retained products of conception have the potential to cause serious illness, and when deemed by a physician that the benefits of a D&C outweigh the potential risks of a failed medication-managed miscarriage, it is the best course of action.
Is a D&C considered an abortion?
While a D&C may be used in some elective abortions, having this procedure does not necessarily mean you are having an abortion. D&Cs are frequently used in situations where a miscarriage has already occurred (i.e. the pregnancy has ceased to progress, or a fetal heartbeat has stopped) to help clear the uterus.
Note: The medical term for a miscarriage is "spontaneous abortion." We know that when you are experiencing a pregnancy loss, seeing this language can be painful. Know that if you see this note on any paperwork or test results, it is simply terminology used by medical professionals - not necessarily a reflection of what you're going through.
You Are Not Alone
Here's a shocking statistic: 25% of recognized pregnancies end in miscarriage. So while pregnancy loss is a heartbreaking experience, it is also incredibly common. I can confidently say that everyone knows someone that has experienced a loss.
Another important thing to remember? Just because you've had a pregnancy loss does not mean that you won't be able to have a healthy pregnancy in the future. In fact, most people do go on to successfully conceive again.
If you're struggling emotionally as you navigate pregnancy loss or have additional questions about the D&C process, please reach out to your Care Team. We are here to support you the entire way.
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