What is a D&C procedure for abnormal uterine bleeding?
A dilatation and curettage (D&C) is a minimally invasive surgical procedure performed to obtain a sample of the uterus lining (endometrium). The cervix that normally keeps the uterus closed, needs to be dilated (widened) before surgical instruments can be inserted to remove a small sample of the endometrium for tissue analysis. Typically, a D&C is combined with a hysteroscopy, which means that a tiny telescope is inserted into the uterus to visualise its cavity. The procedure is mainly diagnostic (to investigate an issue) but it may not fix the issue.
Why is a D&C performed?
A D&C is a diagnostic test used to investigate:
- abnormal menstrual bleeding, including heavy bleeding, bleeding between periods, or postmenopausal bleeding.
- abnormal endometrial cells
- uterine infection
Prior to having a hysterectomy for abnormal uterine bleeding, a D&C is performed to exclude uterine cancer or pre-cancer of the uterus.
While I only perform D&C for the above diagnostic tests, it may also be used to investigate infertility. A suction D&C (as opposed to scraping) may also be performed to remove remnants of a placenta after childbirth, or after a woman has a miscarriage or abortion to remove all the remaining contents of the uterus to prevent infection.
What happens during D&C for abnormal bleeding?
D&C is a minor procedure and is completed as day surgery at a hospital under general anaesthetic. A D&C procedure involves:
- Firstly, the patient is anaesthetised by an anaesthetist.
- The surgeon examines the patient under anaesthetic to determine the size of the uterus, its position or any other abnormal findings (if there are any).
- A general inspection of the vulva and walls of the vagina is performed.
- A speculum is inserted by the surgeon, and the cervix is dilated using surgical dilators.
- A hysteroscopy is inserted to visualise the inner uterine cavity.
- A surgical instrument called a curette is used to take a sample of tissue from the lining of the uterus.
The total procedure takes about 30 minutes. Patients are discharged from hospital the same day in most cases. The samples are sent to a laboratory and examined under a microscope. This analysis (called histopathology) will test for cancer, polyps or endometrial hyperplasia (pre-cancer when the uterine lining becomes too thick which can indicate abnormalities).
Risks of D&C
D&C is a safe procedure; the risk of complications is minimal. However, all surgery carries risks. Possible risks include bleeding and infection. Rare complications may include damage to the uterus, cervix or other pelvic organs and scar tissue formation. Allergy to the aesthetic medications used is also unusual, but may occur.
What to expect after
After surgery patients may expect mild discomfort in the week following the procedure including:
- Cramping or mild abdominal discomfort (which is considered normal after a D&C). Should the pain become severe, please contact your doctor.
- Spotting or light bleeding. Should this occur, use pads and not tampons for the bleeding. Heavy bleeding after D&C may indicate a complication and should be immediately investigated.
In most cases women can return to regular activities within a couple of days. A follow-up appointment 1-2 weeks after surgery will discuss the results of the procedure.
If you wish to discuss a D&C procedure for abnormal uterine bleeding please contact Dr Obermair for an appointment.