Dilation and Curettage (D&C)
Dilation and curettage (or D&C for short) is a very common gynaecological procedure that has a number of uses. The name gives a good indication of what the procedure involves: dilation of the cervix (the opening of the uterus) and scraping (curettage) of the contents or the lining of the uterus. This procedure is known in Maltese as raxkament.
​
​
The Procedure
​
D&C is usually considered a minor procedure and can be performed under local anesthesia, with light sedation, or under a general anaesthetic. The first step is to visualise the cervix through the vagina using a speculum, and then the cervix is dilated (enlarged) by inserting dilators of increasing size. This allows the curette - a surgical instrument with a sharp loop at one end and a handle at the other end - to be inserted into the uterus. Sometimes a curette with suction is used. The lining or the contents of the uterus are then gently scraped, collected, and sent to a pathology lab for further analysis. Sometimes a scope with a camera at the end (hysteroscopy) is also inserted to allow the doctors to see the inside of the uterus.
​
​
Indications for a D&C
​
D&C can be used either to diagnose problems with the uterus, or as a treatment.
​
In pregnant women, D&C is used in early pregnancy to remove an incomplete miscarriage or perform a surgical abortion.
​
In women who have just given birth, D&C can be used to remove retained placental tissue.
​
In women who are not pregnant, D&C is often used as part of the investigations of post-menopausal bleeding. D&C allows doctors to obtain samples of the lining of the uterus which are then sent to a pathology lab for analysis. The lab scientists and pathologists examine the samples under the microscope and can identify problems such as endometrial cancer. D&C also allows doctors to remove some of the causes of abnormal bleeding, such as uterine polyps and certain types of uterine fibroids.
​
​
Possible Complications
​
Like any other surgical procedure, there are possible complications that can occur during or after D&C.
​
Infection is the most common complication, especially when D&C is performed on pregnant women. This is treated with antibiotics.
​
A perforation of the uterus is uncommon but can occur, especially when D&C is performed after a miscarriage. Very rarely, organs around the uterus could also be damaged.
​
Adhesions inside the uterus after a D&C may rarely occur. These may be a problem if the woman becomes pregnant in the future, and they may cause pregnancy complications like ectopic pregnancy, miscarriage, or abnormal placentation.
​
There can also be complications related to the anaesthesia that is used during the procedure. Your doctor will explain this in more detail.