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dilation and curettage

 
Dictionary: dilation and curettage
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n. (Abbr. D & C)
A surgical procedure in which the cervix is expanded using a dilator and the uterine lining scraped with a curette, performed for the diagnosis and treatment of various uterine conditions.


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Oncology Encyclopedia: Dilatation and Curettage
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Key Terms: Endomerial hyperplasia, Endometrial polyps, Epidural anesthesia, Hysteroscopy.

Definition

Dilatation and curettage (D&C) is a gynecological procedure in which the lining of the uterus (endometrium) is scraped away.

Purpose

D&C is commonly used to obtain tissue for microscopic evaluation to rule out cancer. The procedure may also be used to diagnose and treat heavy menstrual bleeding and to diagnose endometrial polyps and uterine fibroids. D&C can be used to remove pregnancy tissue after a miscarriage, incomplete abortion, or childbirth, or as an early abortion technique up to 16 weeks. Endometrial polyps may be removed, and sometimes benign uterine tumors (fibroids) may be scraped away.

Description

D&C is usually performed under general anesthesia, although local or epidural anesthesia can also be used. Using local anesthesia reduces risk and costs, but the patient will feel cramping during the procedure. The type of anesthesia used often depends upon the reason for the D&C.

To begin the procedure (which takes only minutes to perform), the doctor inserts an instrument to hold open the vaginal walls, and then stretches the opening of the uterus to the vagina (the cervix). This is done by inserting a series of tapering rods, each thicker than the previous one, or by using other specialized instruments. The process of opening the cervix is called dilation.

Once the cervix is dilated, the physician inserts a spoon-shaped surgical device called a curette into the uterus. The curette is used to scrape away the uterine lining. One or more small tissue samples from the lining of the uterus or the cervical canal are sent for analysis by microscope to check for abnormal cells.

Although simpler, less expensive techniques such as a vacuum aspiration are quickly replacing the D&C as a diagnostic method, it is still often used to diagnose and treat a number of conditions, especially when cancer is suspected.

Preparation

Because opening the cervix can be painful, sedatives may be given before the procedure begins. Deep breathing and other relaxation techniques may help ease cramping during cervical dilation.

Aftercare

A woman who has had a D&C performed in a hospital can usually go home the same day or the next day. Many women experience backache and mild cramps after the procedure, and may pass small blood clots for a day or so. Vaginal staining or bleeding may continue for several weeks.

Most women can resume normal activities almost immediately. Patients 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

The primary risk after the procedure is infection. Signs of infection include:

  • fever
  • heavy bleeding
  • severe cramps
  • foul-smelling vaginal discharge A woman should report any of these symptoms to her doctor, who can treat the infection with antibiotics before it becomes serious.

D&C is a surgical operation, which carries certain risks associated with general anesthesia. Rare complications include puncture of the uterus (which usually heals on its own) or puncture of the bowel or bladder (which requires further surgery to repair).

Normal Results

Results are considered normal if no unusual thickening, growths, or cancers are found. Removal of the uterine lining causes no side effects, and may be beneficial if the lining has thickened so much that it causes heavy periods. The uterine lining soon grows again normally, as part of the menstrual cycle.

Abnormal Results

Some types of uterine thickening, called hyperplasia, are considered abnormal. Simple hyperplasia is a benign condition in which the uterine lining becomes thicker and with more endometrial glands. In complex hyperplasia, another condition where the uterine lining has thickened, the endometrial glands are crowded together. In 80% of cases these conditions will improve, and there is little risk of cancer. Only 1% of simple hyperplasia and 3% of complex hyperplasia will become cancerous.

Atypical hyperplasia is a more serious finding. In this type of endometrial thickening, the cells are abnormal. Twenty-nine percent of women with atypical hyperplasia develop cancer. In fact, in 17% to 25% of women with atypical hyperplasia who have a hysterectomy within one month of diagnosis, a carcinoma is found elsewhere in the endometrium.

Questions to Ask the Doctor

  • What are you looking for in the D&C?
  • Do you recommend any special preparation before the procedure?
  • How long will the procedure take?
  • What is the risk of finding cancer in my case?
  • What action will be taken if cancer is found?
  • Will a repeat D& C be necessary?

A D&C is not a fool-proof procedure because only a portion of the uterine lining is sampled. Therefore, it is possible for a cancer to be missed. Because of this, patients with atypical hyperplasia must have another D&C in three or four months. Combining a hysteroscopy (a procedure where a physician can see the lining of the uterus using a special tool) with D&C may increase the accuracy of the diagnosis in some cases. However, this combination is not recommended when endometrial carcinoma is suspected because of the possibility that the hysteroscopy itself can aid in the spread of cancer through the fallopian tubes.

Resources

Books

Berman, Michael L., and Michael T. McHale. "Uterus." In Cancer Treatment, edited by Charles M. Haskell. 5th ed. Philadelphia: W.B. Saunders, 2001, pp. 951-55.

Byers, Lowell J. et al. "Uterus." Clinical Oncology, edited by Abeloff, Martin D. et al., 2nd ed. Philadelphia: Churchill Livingstone, 2000, pp. 1987-97.

Organizations

American College of Obstetricians and Gynecologists. 409 12th St. SW, PO Box 96920, Washington, DC 20090-6920. .

—Carol A. Turkington

Medical Test: Dilation And Curettage (D & C)
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General information

Where It's Done Who Does It How Long It Takes Discomfort/Pain
Hospital operating room or ambulatory surgery clinic. Gynecologist. Less than 30 minutes for scraping, but entire procedure will take most of a day. None if general anesthesia is used; possible cramping if local anesthesia.

Results Ready When Special Equipment Risks/Complications Average Cost
1-3 days. Speculum, tenaculum, metal sound, metal rods of increasing thickness, and curette. Small risk of excessive bleeding or uterine perforation and infection. Rarely, damage to bowel or bladder. Repeat D & Cs or overscraping may lead to scar tissue, which may cause infertility or menstrual problems. $$

Other names

None.

Purpose
  • To help diagnose the cause of abnormal menstrual bleeding or infertility when an endometrial biopsy cannot be done.
  • As treatment, to stop heavy bleeding or remove residual tissue following miscarriage, abortion, or occasionally, childbirth.
How it works

The cervical opening is dilated, and a tissue sample from the lining of the uterus is scraped out.

Preparation
  • You may have to go to the hospital or doctor's office one or two days before the D & C for blood and urine tests and to rule out pregnancy if the procedure is diagnostic.
  • You must have nothing to eat or drink for eight hours before surgery if you are having general anesthesia.
  • You undress and don a hospital gown.
  • You will be given general anesthesia intravenously.
  • If the procedure is to be performed under local anesthetic, you may be given an oral sedative about 30 minutes before the procedure. You lie on a table with your feet in stirrups as for a pelvic exam. Once you are sedated, a local anesthetic is injected into the cervix.
Test procedure
  • The doctor inserts a speculum into your vagina and then uses a special clamp called a tenaculum to grip the cervix.
  • A thin metal rod called a sound is then inserted to determine the angle of the cervical canal and the depth of your uterus.
  • Your cervix is slowly dilated, using metal rods of increasing diameter up to about 1/2 inch (see figure).
  • A spoon-shaped curette is used to scrape tissue from the uterine lining. (In a therapeutic D & C, polyps or other unwanted tissue are removed as well.)
  • The tenaculum and speculum are then removed.
FIGURE

During dilation and curettage, or a D & C, the cervix is opened, or dilated, by using metal rods of increasing size. A spoon-shaped curette is then used to scrape tissue from the uterine lining.

After the test
  • A tissue sample is sent to the lab for examination.
  • If you have had general anesthesia, you will remain in a recovery room, and your vital signs will be monitored for about one hour until the anesthesia wears off.
  • Once you are up and moving around, you are free to dress and leave, but you should arrange to have a friend or family member drive you home.
  • You may experience mild to moderate cramping over the next 24 hours or so, and you may be given a prescription for a painkiller.
  • You can return to work or other usual activities as soon as you feel able, within hours or one or two days.
  • You may have bleeding requiring you to wear sanitary napkins for two weeks or more.
  • You should avoid sexual intercourse, tampons, and douching for at least two weeks to prevent infection.
  • If you experience heavy bleeding, strong cramping, unusual vaginal discharge, or fever, notify your doctor immediately.
Factors affecting results

Inadequate sample.

Interpretation

A pathologist will examine the tissue sample for any abnormalities.

Advantages
  • A large sample can usually be obtained in this way.
  • The test is accurate.
  • It may provide the cure if abnormal cells are removed.
Disadvantages

It's invasive and relatively expensive.

The next step
  • If the D & C was performed to stop heavy bleeding or remove residual tissue following a miscarriage or abortion, or to remove polyps, no further testing or treatment may be necessary.
  • If the laboratory results indicate cancer, surgery may be scheduled.

PATIENT TIP

If your doctor recommends a D & C, ask if a suction endometrial biopsy can be done instead. It carries a lesser risk of complications, but cannot be substituted in all cases.

Wikipedia: Dilation and curettage
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Dilation and curettage
(D&C)
Background
Abortion type Surgical
First use Late 19th century
Gestation 4-12 weeks
Usage
WHO recommends only when manual vacuum aspiration is unavailable
United States 1.7% (2003)
Medical notes
Undertaken under heavy sedation or general anesthesia. Risk of perforation. Day-case procedure
Infobox references

Dilation (dilatation) and curettage refers to the dilation (opening) of the cervix and surgical removal of the contents of the uterus. It is a therapeutic gynecological procedure as well as a rarely used method of first trimester abortion.[1][2] It is commonly referred to as a D&C.

D&C normally refers to a procedure involving a curette, also called sharp curettage.[1] However, some sources use the term D&C to refer more generally to any procedure that involves the processes of dilation and removal of uterine contents, which includes the more common suction curettage procedures of manual and electric vacuum aspiration.[3]

Contents

Procedure

The first step in a D&C is to dilate the cervix, usually done a few hours before the surgery. The woman is usually put under general anesthesia before the procedure begins. A curette, a metal rod with a handle on one end and a sharp loop on the other, is inserted into the uterus through the dilated cervix. The curette is used to gently scrape the lining of the uterus and remove the tissue in the uterus. This tissue is examined for completeness (in the case of abortion or miscarriage treatment) or pathologically for abnormalities (in the case of treatment for abnormal bleeding).[1]

Clinical uses

D&Cs are commonly performed to resolve abnormal uterine bleeding (too much, too often or too heavy a menstrual flow);[2] to remove the excess uterine lining in women who have conditions such as polycystic ovary syndrome (which cause a prolonged buildup of tissue with no natural period to remove it);[citation needed] to remove tissue in the uterus that may be causing abnormal vaginal bleeding,[1] including postpartum retained placenta;[citation needed] to remove retained tissue (also known as retained POC or retained products of conception) in the case of a missed or incomplete miscarriage;[3] and as a method of abortion that is now uncommon.[1]

Methods of abortion
Part of the abortion series
Surgical
Medical
Other

Because medical and non-invasive methods of abortion now exist, and because D&C requires heavy sedation or general anesthesia and has higher risks of complication, the procedure has been declining as a method of abortion. The World Health Organization recommends D&C as a method of surgical abortion only when manual vacuum aspiration is unavailable.[4] According to the Centers for Disease Control and Prevention, D&C only accounted for 2.4% of abortions in the United States in the year 2002,[5] down from 23.4% in 1972.[6]

Complications

One risk of sharp curettage is uterine perforation. Although normally no treatment is required for uterine perforation, a laparoscopy may be done to verify that bleeding has stopped on its own. Infection of the uterus or fallopian tubes is also a possible complication, especially if the woman has an untreated sexually transmitted infection.[1]

Another risk is intrauterine adhesions, or Asherman's syndrome. One study found that in women who had one or two sharp curettage procedures for miscarriage, 14-16% developed some adhesions.[7] Women who underwent three sharp curettage procedures for miscarriage had a 32% risk of developing adhesions.[7] The risk of Asherman's syndrome was found to be 30.9% in women who had D&C following a missed miscarriage [8], and 25% in those who had a D&C 1–4 weeks postpartum.[9][10][11] Untreated Asherman's syndrome, especially if severe, also increases the risk of complications in future pregnancies, such as ectopic pregnancy, miscarriage, and abnormal placentation (eg.placenta previa).[1] According to recent case reports, use of vacuum aspiration can also lead to intrauterine adhesions.[12]

See also

External links

References

  1. ^ a b c d e f g ""Dilation and sharp curettage (D&C) for abortion"". Women's Health. WebMD. 2004-10-07. http://women.webmd.com/dilation-and-sharp-curettage-dc-for-abortion. Retrieved 2007-04-29. 
  2. ^ a b Hayden, Merrill (2006-02-22). "Dilation and curettage (D&C) for dysfunctional uterine bleeding". Healthwise. WebMD. http://www.webmd.com/sexual-conditions/Dilation-and-curettage-DC-for-dysfunctional-uterine-bleeding. Retrieved 2007-04-29. 
    Nissl, Jan (2005-01-18). "Dilation and curettage (D&C) for bleeding during menopause". Healthwise. WebMD. http://www.webmd.com/menopause/Dilation-and-curettage-DC-for-bleeding-during-menopause. Retrieved 2007-04-29. 
  3. ^ a b "What Every Pregnant Woman Needs to Know About Pregnancy Loss and Neonatal Death". The Unofficial Guide to Having a Baby. WebMD. 2004-10-07. http://www.webmd.com/sexual-conditions/pregnancy-loss-neonatal-death?page=3. Retrieved 2007-04-29. 
  4. ^ "Dilatation and curettage". A-Z Managing Complications in Pregnancy and Childbirth by WHO. http://www.who.int/reproductive-health/impac/Procedures/Dilatetion_P61_P63.html. Retrieved February 20 2006. 
  5. ^ "Abortion Surveillance --- United States, 2002". MMWR Surveillance Summaries. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5407a1.htm. Retrieved February 20 2006. 
  6. ^ "Abortion Surveillance -- United States, 1990". MMWR Surveillance Summaries. http://www.cdc.gov/mmwr/preview/mmwrhtml/00031585.htm. Retrieved February 20 2006. 
  7. ^ a b Friedler S, Margalioth EJ, Kafka I, Yaffe H (1993). "Incidence of post-abortion intra-uterine adhesions evaluated by hysteroscopy--a prospective study". Hum. Reprod. 8 (3): 442–4. PMID 8473464. 
  8. ^ Schenker JG, Margalioth EJ (1982). "Intra-uterine adhesions: an updated appraisal.". Fertility Sterility 37 (5): 593–610. PMID 6281085. 
  9. ^ Kodaman P, Arici A (2007). "Intrauterine adhesions and fertility outcome:how to optimize success?". Curr Opin Obstet Gynecol 19 (3): 207–214. PMID 17495635. 
  10. ^ Rochet Y, Dargent D, Bremond A et al. (1979). "The obstetrical outcome of women with surgically treated uterine synechiae (in French).". J Gynecol Obstet Biol Reprod 8 (8): 723–726.. PMID 553931. 
  11. ^ Buttram VC, Turati G (1977). "Uterine synechiae: variations in severity and some conditions which may be conducive to severe adhesions". Int. J. Fertil. 22 (2): 98–103. PMID 20418. 
  12. ^ Dalton VK, Saunders NA, Harris LH, Williams JA, Lebovic DI (2006). "Intrauterine adhesions after manual vacuum aspiration for early pregnancy failure.". Fertil. Steril. 85 (6): 1823.e1–3.. doi:10.1016/j.fertnstert.2005.11.065. PMID 16674955. 
v • d • e
Genital surgical and other procedures (ICD-9-CM V3 60-71)
Male
reproductive system
Female
reproductive system
(gynecological surgery)
reproductive system navs: anat female,male/physio/dev, noncongen/congen/neoplasia, symptoms+signs/eponymous, proc

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Dictionary. The American Heritage® Dictionary of the English Language, Fourth Edition Copyright © 2007, 2000 by Houghton Mifflin Company. Updated in 2009. Published by Houghton Mifflin Company. All rights reserved.  Read more
Oncology Encyclopedia. Gale Encyclopedia of Cancer. Copyright © 2006 by The Gale Group, Inc. All rights reserved.  Read more
Medical Test. The Patient's Guide to Medical Tests by Faculty Members at The Yale University of Medicine and G.S. Sharpe Communications, Inc. Copyright © 1997 by Yale University of Medicine and G.S. Sharpe Communications, Inc. Published by Houghton Mifflin Company. All rights reserved.  Read more
Wikipedia. This article is licensed under the Creative Commons Attribution/Share-Alike License. It uses material from the Wikipedia article "Dilation and curettage".  Read more