D & C (Dilation and Curettage) after Miscarriage
August 13, 2010
A miscarriage is when a woman has a loss of a pregnancy before 20 weeks of gestation. Approximately 15 to 20 percent of known pregnancies end in miscarriage. The actual number of miscarriages is most likely much higher, as many women will lose a pregnancy very early, before they even realize that they are pregnant.
When a miscarriage occurs, the cervix becomes dilated and tissue comes out from the vagina. Most of the time your body will expel all of the fetal tissue on its own.
Sometimes, however, fetal tissue is retained. The fetus is not alive, but hasn’t passed out of your body. This is called a missed abortion. Retained tissue can cause pain and heavy bleeding. When this occurs, a procedure called dilation and curettage (D and C) is performed.
What is a D & C?
A D&C, or dilation and curettage, is a surgical procedure where the cervix is dilated and then tissue is carefully removed from the uterus, either by scraping or suction. It is often performed following a miscarriage in order to make sure there is no fetal tissue remaining in the uterus.
Is it necessary to have a D & C after miscarriage?
Many women who have miscarriage do not receive a D&C procedure. You should speak to your health care provider to help determine if this is the right thing for you.
Often if a pregnancy ends after 10 weeks of gestation, the miscarriage may be incomplete and require a D & C procedure.
Sometimes medication can be used to help speed up a miscarriage. For more information about this, please discuss your situation with your health care provider.
How is a D & C Performed?
A D&C is performed in a hospital or outpatient surgery center. You will be given a local, spinal, or general anesthesia. Your doctor may give you antibiotics either through and IV or by oral prescription.
The fist step to a D&C is dilation. Your cervix will be first checked to see if it is open. If it is not open, your health practitioner will insert thin, flexible instruments into the cervical opening to help dilate it.
Once dilation is completed, curettage will be done. This involves suctioning with a vacuum and possibly scraping the uterine walls with a metal loop. Any tissues removed will be sent to a laboratory for testing and evaluation.
The D&C procedure takes about 20 minutes to complete.
What are the Risks of D&C?
Risks of D&C procedure include:
- Hemorrhage or Bleeding
- Perforated Uterus
- Asherman syndrome (scar tissue formation in the uterus)
- Missed areas of tissue could require the procedure to be repeated
- Stretching or weakening of the cervix
- Adverse reaction to anesthesia
After the D&C Procedure
After the D&C procedure, you may experience cramps. In most women, the cramps will ease within about an hour after the procedure, though some report cramping that persists for a day or longer.
You may experience light bleeding for a few days.
You should have someone who is able to drive you home after the procedure. Driving is not recommended for 24 hours following D&C procedures.
Following dilation, it will take a couple weeks for your cervix to shrink back to normal size. Because of this, you should avoid intercourse for 2 weeks, as it could allow bacteria to enter your uterus and cause infection.
Do not insert any tampons or use any douches. Only sanitary pads may be used for bleeding.
If you are having cramping, ibuprofen may be used to alleviate pain.
When to Call Your Doctor After D&C
- If you develop the following symptoms following D&C, contact your physician:
- Fever over 100.4
- Severe pain
- Heavy Bleeding, where you need to change sanitary pads several times an hour, that lasts more than 6 hours
- Discharge from the vagina that is foul smelling