Dilation and Curettage (D & C)

Introduction

Dilation and Curettage (D & C) is a minor surgical procedure that involves dilating the cervix and scraping the uterine lining. This procedure is often performed for both diagnostic and therapeutic purposes. It can be used to diagnose uterine conditions, treat abnormal uterine bleeding, or clear the uterine lining following a miscarriage or abortion.

Purpose and Indications

Dilation and Curettage may be recommended for several reasons, including:

• Diagnostic purposes: To investigate abnormal uterine bleeding, endometrial hyperplasia, or uterine cancer.
• Therapeutic purposes: To treat heavy menstrual bleeding, remove tissue following a miscarriage, or manage conditions such as polyps or fibroids.

The Procedure

Preparation

Before undergoing a D & C, patients will typically have a pre-operative appointment where their medical history is reviewed, and any necessary tests are conducted. Patients are advised to avoid eating or drinking for a certain period before the surgery.

Steps of the Procedure

1. Anaesthesia: The procedure is usually performed under general or local anaesthesia to ensure the patient is comfortable and pain-free.
2. Dilation: The cervix is gently dilated using a series of progressively larger dilators.
3. Curettage: A curette, which is a small instrument with a loop at the end, is used to scrape the uterine lining and remove tissue.

Recovery

After the procedure, patients are typically monitored for a few hours before being discharged. Some cramping and light bleeding are common for a few days. Most patients can return to their normal activities within a day or two, but strenuous activities should be avoided for a short period.

Risks and Complications

While D & C is generally considered safe, it does carry some risks, including:

• Infection: There is a slight risk of infection in the uterus or surrounding areas.
• Perforation: In rare cases, the uterus may be perforated during the procedure, which may require further treatment.
• Scarring: The procedure can cause scarring of the uterine lining, known as Asherman’s syndrome, which may affect future fertility.
• Bleeding: Excessive bleeding can occur, though this is uncommon.

Alternatives to D & C

Depending on the underlying condition, there may be alternative treatments to D & C, such as:

• Medication: Certain medications can be used to manage abnormal bleeding or to help expel tissue following a miscarriage.
• Endometrial Ablation: A procedure that destroys the uterine lining to reduce heavy menstrual bleeding.
• Hysteroscopy: A procedure that uses a thin, lighted instrument to examine the inside of the uterus and perform certain treatments.

Nursing Care of a Patient Undergoing Dilation and Curettage (D & C)

Dilation and Curettage (D & C) is a surgical procedure performed to remove tissue from inside the uterus. It is commonly used to diagnose or treat certain uterine conditions, such as heavy bleeding, or to clear the uterine lining after a miscarriage or abortion. As with any surgical procedure, proper nursing care is essential to ensure patient safety and promote recovery.

Preoperative Care

Patient Education

Before the procedure, educate the patient about what to expect during and after the D & C. Explain the reasons for the procedure, the steps involved, potential risks, and the recovery process. Address any questions or concerns the patient may have.

Informed Consent

Ensure that the patient has signed the informed consent form after understanding the procedure and its risks. Confirm that the patient is aware of alternative treatments and has chosen D & C voluntarily.

Preoperative Assessment

Conduct a thorough preoperative assessment, including a review of the patient’s medical history, allergies, current medications, and any previous surgeries. Perform baseline vital signs and document them.

Preparation

Instruct the patient to fast for a specific period before the procedure, usually 6-8 hours. Administer preoperative medications as prescribed, which may include antibiotics to prevent infection and sedatives to help the patient relax.

Intraoperative Care

Monitoring

During the procedure, closely monitor the patient’s vital signs, including heart rate, blood pressure, and oxygen saturation. Be prepared to assist the surgical team with any required instruments or supplies.

Assistance

Assist the surgical team by providing sterile instruments and supplies as needed. Ensure that the sterile field is maintained throughout the procedure to prevent infection.

Documentation

Accurately document the procedure, including the time it started and ended, any medications administered, and any complications that occurred. Record the patient’s response to the procedure and any intraoperative findings.

Postoperative Care

Recovery Monitoring

After the procedure, monitor the patient closely in the recovery area. Assess vital signs frequently and observe for any signs of complications, such as excessive bleeding, pain, or infection.

Pain Management

Administer prescribed pain medications to manage postoperative discomfort. Encourage the patient to report any severe or unrelieved pain.

Observation for Complications

Be vigilant for signs of potential complications, including:

• Infection: Look for signs such as fever, chills, and foul-smelling discharge.
• Excessive Bleeding: Monitor for heavy bleeding or passing large clots.
• Perforation: Watch for severe abdominal pain, which may indicate uterine perforation.
• Asherman’s Syndrome: Be aware of reduced menstrual flow or missed periods in the months following the procedure, which may suggest scarring.

Patient Education

Provide the patient with detailed postoperative instructions, including:

• Avoiding strenuous activities and heavy lifting for a specified period.
• Refraining from using tampons or having sexual intercourse until cleared by the healthcare provider.
• Watching for signs of infection or other complications and knowing when to seek medical attention.
• Keeping follow-up appointments for further evaluation and care.

Emotional Support

Recognize the emotional impact of the procedure, especially if it was performed following a miscarriage. Offer emotional support and, if needed, refer the patient to counseling services or support groups.

Discharge Planning

Follow-Up Care

Ensure that the patient has a follow-up appointment scheduled with their healthcare provider. Discuss the importance of attending this appointment to monitor recovery and address any concerns.

Home Care Instructions

Provide written instructions for home care, including information on managing pain, recognizing signs of complications, and activity restrictions. Make sure the patient understands these instructions and has a point of contact for any questions.

REFERENCES

1. American Academy of Family Physicians. Dilation and Curettage (D and C) (https://familydoctor.org/dilation-curettage-d-c/). Last updated 4/2022.
2. American College of Obstetricians and Gynecologists. Dilation and Curettage. https://www.acog.org/womens-health/faqs/dilation-and-curettage. Last updated 8/2022.
3. American Pregnancy Association. D&C Procedure After a Miscarriage. https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/d-and-c-procedure-after-miscarriage/). 
4. Ziegler N, Korell M, Herrmann A et al. Uterine perforation following a fractional curettage successfully treated with the modified polysaccharide 4DryField® PH: a case report. J Med Case Rep. 2016;10(1). doi:10.1186/s13256-016-1029-x
5. DeCherney AH, et al., eds. Therapeutic gynecologic procedures. In: Current Diagnosis & Treatment: Obstetrics & Gynecology. 12th ed. McGraw Hill; 2019. https://accessmedicine.mhmedical.com.
6. American Society for Reproductive Medicine. Fact Sheet: Dilation and Curettage (D&C) https://www.reproductivefacts.org/globalassets/_rf/news-and-publications/bookletsfact-sheets/english-pdf/dilation_and_curettage_factsheet.pdf).
7. Cooper DB, Menefee GW. Dilation and Curettage (https://www.ncbi.nlm.nih.gov/books/NBK568791/). 2023 May 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. 

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