Dilatation and Curettage (D&C) is a minor surgical procedure used to remove tissue from the uterus. It’s both a diagnostic and therapeutic tool in gynecology, often performed in outpatient settings.
Definition
Assisting in expansion of cervical canal of uterus and scraping the surface lining of the uterine wall using a metal instrument called curette. This procedure is done during the premenstrual phase.
Indications for Dilatation and Curettage
Diagnostic
- Infertility.
- Dysfunctional uterine bleeding.
- Pathologic amenorrhea.
- Endometrial tuberculosis.
- Endometrial carcinoma.
- Postmenopausal bleeding.
- Chorion epithelioma.
Therapeutic
- Dysfunctional uterine bleeding.
- Endometrial polyp.
- Removal of intrauterine contraceptive device (IUCD).
- Incomplete abortion.
- Evacuation of hydatidiform mole.
- Prior to insertion of intrauterine radium implants.
- To prevent cervical stenosis in Manchester operation for uterine prolapse.
- To drain pyometra.
Contraindications
- Vaginal and cervical infection.
- Pelvic infection.
- Suspected uterine pregnancy.
Articles
The procedure is carried out in the operation theatre (OT) and may be performed as adjunct procedure.
- Dilators (different sizes of Hegar’s dilators).
- Vulsellum forcep.
- Uterine sound.
- Curette.
- Mayo scissor.
- Sims speculum.
- Kidney tray.
- Sponge holding forceps.
Procedure
| Nursing action | Rationale | |
| 1. | Before procedure Explain procedure to patient. | Helps in allaying fear and anxiety. |
| 2. | Obtain informed consent from patient. | Prevents legalities to staff members. |
| 3. | Instruct patient to empty the bladder prior to operation. | Avoids chances of injury to bladder. |
| 4. | Maintain NPO for 6 hours before procedure. | Prevents chances of aspiration during procedure. |
| 5. | During procedure Administer premedication as per physician’s order. | Reduces anxiety and promotes calmness. |
| 6. | Start IV line. | For hydration and administration of IV medication. |
| 7. | Maintain lithotomy position and clean the perineum with antiseptic solution. | Enhances good visualization. Prevents spread of microorganisms. |
| 8. | Physician performs vaginal examination to note condition of vulva, vagina, and cervix including the size, consistency, position, and mobility of the uterus. | Helps to know the position of uterus and to exclude possibility of pregnancy. |
| 9. | Assist the physician in administering anesthesia. | Prepares mother for the procedure. |
| 10. | Physician introduces Sims vaginal speculum inside the vagina. In nulliparous women, the blade of the speculum is lubricated with savlon solution and introduced from the side of the vaginal outlet after separating the labia minora with the other hand till the entire blade is introduced inside the vagina. In parous women, the blade is introduced on separating labia minora. | Helps in visualization of cervix. |
| 11. | The anterior lip of the exposed cervix is grasped by the toothed vulsellum and pulled down near the vaginal introitus. | Provides for smooth performance of procedure. |
| 12. | A uterine sound is introduced with the tip directed forward into uterus. | Helps to measure the length of uterine cavity and determine position of the uterus. |
| 13. | Assist in dilatation of the cervix. The tip of the dilator should be directed anteriorly or posteriorly according to position of the uterus. | Avoids injury. |
| 14. | After the desired dilatation, the uterine cavity is curetted by uterine curette either in clockwise or anticlockwise direction in a smooth manner. | Vigorous curettage may damage the basal layer of the endometrium and uterine muscle. |
| 15. | Take out the vulsellum and curette. | Completes the procedure. |
| 16. | Clean the cervix with antiseptic solution and check for any unusual bleeding. | Leaves mother clean and comfortable. |
| 17. | After procedure The curetted material is preserved in 10% normal saline, labelled properly, and sent for histological examination. | Helps in diagnosing abnormality. |
| 18. | Record the data and time of procedure with patient’s reactions. | Acts as a communication between staff members. |
Post operative care
- Check the vital signs.
- Instruct the patient to rest in bed until the anesthetic effect is reversed.
- Check the amount of bleeding.
Complications
Immediate Complications
- Injury to the cervix.
- Uterine perforation.
- Bowel injury.
- Pelvic inflammation.
Remote Complications
- Cervical incompetence due to injury to internal os resulting in midtrimester abortion.
- Uterine synechiae (adhesion) due to injury to uterine muscle resulting in secondary amenorrhea.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Annamma Jacob, Manual of Midwifery and Gynaecological Nursing, 4th Edition, 2023, Jaypee Publishers, ISBN: 978-9356961593
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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