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Dilation and Curettage
What is dilation and curettage? Dilation and Curettage, more known as D&C, is a gynecologic procedure which involves expanding or enlarging the cervix (lower part/neck) of a womans uterus using a dilator, so that a spoon-shaped metal instrument, called a curette, can lightly scrape or suction away the lining of the uterus for tissue sampling. Purpose of dilation and curettage D&C is most commonly performed to:
Candidates for dilation and curettage A D&C is often indicated for following conditions:
Your consultation Before a D&C, the same general rules for other outpatient procedures apply. Your doctor will most likely see you at least the day before the surgery to discuss the procedure and its potential risks and complications in greater detail. A complete medical history and a physical exam will be done. Pre-operative instructions will also be given before the scheduled operation.
The procedure Dilation and curettage is performed under general anesthesia, although local or epidural anesthesia may be used. Local anesthesia lessens risks and costs, but you will feel cramping during the procedure. The type of anesthesia used will depend upon the reason for the D&C. During the procedure, which takes only minutes to perform, you will be positioned on your back and your legs will be placed in stirrups. The doctor will then insert a speculum into your vagina as is done with a pelvic exam to hold open the vaginal walls, and then stretches the opening of the uterus to the vagina by inserting a series of tapering rods, or by using other specialized instruments. This is called dilation. After dilation, the physician inserts a spoon-shaped surgical device called a curette into the uterus to scrape away the uterine lining. One or more small tissue samples are sent for microscopic analysis to check for abnormal cells. Often, the doctor uses a viewing instrument to examine the uterus visually (hysteroscopy) prior to the D&C to make the procedure more complete. The entire procedure, including curettage takes about 20-30 minutes. Recovery After the procedure, you will be cared for in a recovery or post-anesthesia care unit for a few hours to monitor for excessive vaginal bleeding or other complications. This also allows time for recovery from the anesthesia. The procedure is normally very short and the general anesthetic can quickly wear off. You may experience nausea and vomiting, which can be treated with medications. You will be allowed to go home after a few hours. Most hospitals and outpatient clinics will keep you in until you become fully awake. You will need to arrange for a ride home. It is advised that you do not drive for at least 24 hours after anesthesia. This is recommended even after a sedative/local anesthesia because these drugs can temporarily impair your coordination and response time. You may experience backache and mild cramps after the procedure, and may pass small blood clots for a day or so. Pain relievers are usually given for the cramping and the pain, and vaginal staining or bleeding may continue for several weeks. Your next period may be early or late, and may occur within 4 to 6 weeks of the procedure. You can resume normal activities almost immediately, but 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 and complications D&C is a commonly performed procedure that is usually very safe and uncomplicated. Yet as with any operation, complications may occur. Rare complications include puncture of the uterus (which usually heals on its own), puncture of the bowel or bladder (which require further surgery to repair), cervical injuries (from lacerations to the cervix during dilation or curettage), or Asherman Syndrome (formation of scar tissues in the uterus which can cause cessation of menstrual periods and infertility). The primary risk after the procedure is infection (as instruments are inserted into the uterus) and bleeding. Signs and symptoms to watch out for include the following:
A woman should report any of these symptoms to her doctor, who can treat the infection with antibiotics before it gets serious. Most bleeding is rather self-limiting and requires nothing more than oral medications. Follow up Follow-up consultations vary depending on your doctors preferences. Most doctors have their patients return to the office to make sure that all is well and to discuss the results of the tissue samples that were obtained. Usually, this is done 2 to 6 weeks post-operatively. You may also be simply notified by a phone call with the results and no direct contact with your health care provider is necessary. Frequently Questions Asked Q: What is D&C? A: Dilation and curettage (D&C) is a procedure that involves expanding the cervix or the lower part of your uterus to take tissue samples from the uterus. It is used to diagnose or treat many conditions that cause abnormal bleeding. Uterine cancer can be detected as well with this procedure. Q: What is the difference between a diagnostic and a therapeutic D&C? A: A diagnostic D&C is used to gain information about the uterus to diagnose a medical condition. It is done by obtaining samples of the endometrium to evaluate abnormal uterine bleeding or abnormal cells found during routine screening for cervical cancer. It is usually performed with hysteroscopy; this involves dilating the cervix and inserting a small instrument that allows the physician to examine and photograph the inside of the uterus. This helps the doctor to avoid missing small polyps and ensures that the most visibly abnormal areas are sampled. In other cases, the procedure is used to treat a medical problem or condition, known as therapeutic D&C. It is done to remove the contents of the uterus in cases as miscarriages, abortions, treatment of molar pregnancies, prolonged or excessive vaginal bleeding and postpartum hemorrhage. Q: Why is the D&C procedure becoming less common?
Q: In what situations will my health care provider avoid performing D&C? A:
Q: What are some medical issues to consider? A: You will be advised to have nothing to eat or drink for at least six to eight hours before the surgery. In some cases, you are given an injection an hour before your operation to make you feel drowsy and help dry up internal fluids. Women younger than 35 years are generally advised to not undergo D&C, unless there is no other alternative. Q: What are other alternatives to D&C? A: Other forms of treatment depend on the condition. These may include:
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