Dilation and curettage
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 and curettage
Intervention
MeSH D004107

Dilation (or dilatation) and curettage (D&C) refers to the dilation (widening/opening) of the cervix and surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and scooping (curettage). It is a diagnostic gynecological procedure.[1][2]

D&C normally is referred 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

Clinical uses

D&Cs are commonly performed for the diagnosis of gynecological conditions leading to 'abnormal uterine bleeding';[4] 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;[5] 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.[1] D&C remains 'standard care' for missed and incomplete miscarriage in many countries among the options currently used for abortions.[clarification needed]

Because medical and non-invasive methods of abortion now exist, and because D&C often involves sedation or general anesthesia, 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.[6] 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,[7] down from 23.4% in 1972.[8] Suction D&Cs are now considered mainstay to manage pregnancy loss (miscarriage) and to obtain tissue for chromosomal analysis when necessary.[citation needed]

Hysteroscopy is a valid alternative to D&C for many gynecologic indications from diagnosis of uterine cancer to removal of fibroids and polyps. It can be used to visualize areas of concern when disease is confined to a specific area of the uterus.[citation needed] Hysteroscopy still requires some local and/or IV pain control measures. Oftentimes, hysteroscopy is performed in conjunction with D and C when indicated.

Medical management of miscarriage and medical abortion using drugs such as misoprostol and mifepristone are generally safe, non-invasive and alternatives to D&C in specific cases. Medical management for abortion has a higher failure rate when used in early pregnancy.[citation needed]

Complications

Any intrauterine procedure (hysteroscopy or D and C) carries with it a risk of infection, bleeding or uterine perforation. These complications are quite low and should not dissuade a patient from undergoing such procedures when necessary.[citation needed]

Another risk is intrauterine adhesions, or Asherman's syndrome. This risk is extremely low[citation needed] in an uncomplicated setting but when infection exists it may increase the risk.

See also

References

  1. ^ a b c d "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. ^ Anastasiadis PG, Koutlaki NG, Skaphida PG, Galazios GC, Tsikouras PN, Liberis VA. (2000). "Endometrial polyps: prevalence, detection, and malignant potential in women with abnormal uterine bleeding.". Eur J Gynaecol Oncol. 21 (2): 180–183.. PMID 10843481. 
  5. ^ Wolman I, Altman E, Fait G, Har-Toov J, Gull I, Amster R, Jaffa A. (2009). "Evacuating retained products of conception in the setting of an ultrasound unit.". Fertil Steril. 91 ((4 Suppl)): 1586–88.. doi:10.1016/j.fertnstert.2008.10.032. PMID 19064261. 
  6. ^ "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. 
  7. ^ "Abortion Surveillance --- United States, 2002". MMWR Surveillance Summaries. http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5407a1.htm. Retrieved February 20, 2006. 
  8. ^ "Abortion Surveillance -- United States, 1990". MMWR Surveillance Summaries. http://www.cdc.gov/mmwr/preview/mmwrhtml/00031585.htm. Retrieved February 20, 2006. 

External links


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