Dilatation and Curettage (D&C) is a procedure in which the uterine lining is sampled with a metal device called a curette in order to determine if there is an abnormality of the cells that line the uterus (endometrium). Most commonly, this surgery is done in order to help determine the cause of abnormal uterine bleeding.
It can also be done to help determine the degree of abnormality of the endometrium in cases of cancer or pre-cancerous cells that are detected by an in-office biopsy. D&C is also used to evaluate post-menopausal women who have had abnormal cells appear on their pap smears.

Most D&Cs are done under general anesthesia. The procedure is normally very short and the general anesthetic can be quickly reversed, with the patient going home soon afterwards. Some patients prefer or require spinal or epidural blocks, but these forms of anesthesia take more time for the anesthetist to perform and require more recovery time for the patient.

Occasionally, depending on the medical condition of the patient and other factors, a doctor may choose to do the procedure under a local anesthetic with or without intravenous pain medication or twilight sleep. Overall, the choice of anesthetic is generally determined by the anesthesiologist and the patient. The surgeon performing the procedure only requires that the patient not move during the surgery.

The actual procedure is done in an operating room, either in a hospital, or in a specially designated room in a physician’s office. After adequate anesthesia has been administered, and with the patient in position (similar to that for a pap smear), the vagina and cervix are cleansed with an antibacterial scrub (usually betadine). An instrument is used to grasp the upper portion of the cervix and then the opening to the uterus is gradually widened with metal dilators to about the size of a large pencil.

Once this dilatation has been completed, the curette, which is an instrument with a flat metal loop at the end, is inserted into the uterine cavity and is used to gently scrape the lining of the uterus. When the surgeon feels the gritty layer of cells just above the muscle of the uterus, then he/she knows that the scraping has gone deep enough to sample the tissue adequately. This scraping is done throughout the uterus and the tissue that is removed is then sent to a pathologist for microscopic examination.

Once the surgeon feels that enough tissue has been obtained, or that all of the cavity has been sampled, or that any abnormal growths that were seen on ultrasound were removed, then the procedure is stopped. Often, the doctor uses a viewing instrument to examine the uterus visually (hysteroscopy) prior to the D&C to make the procedure more complete. This is not, however, always necessary.

The D&C procedure done by a skilled surgeon, usually produces no complications. The most common complication that can occur is perforation of the uterus with either the dilators or the curette. When this happens, as long as no internal organs (intestines, bladder, or rectum), or large blood vessels are damaged, the hole will almost always heal itself without further surgery.

The risk for this problem is increased in patients with a narrowed opening to the cervix (cervical stenosis) or in patients with distorted internal uterine anatomy. This risk is also increased if the uterus is infected or has undergone previous surgeries such as cesarean sections or myomectomies.

Other complications include bleeding and infection. Bleeding is usually self-limiting and requires nothing more than occasional oral medications. Infection is also rare and can normally be managed with antibiotics. Most D&Cs do not require the routine use of post operative antibiotics.

On occasion, in patients with certain heart defects, the surgeon may give the patient antibiotics before and after the surgery to prevent bacteria from the vagina from infecting the heart valves.

In general the number of D&Cs being performed has declined over the years. This procedure is no longer done to regulate abnormal bleeding patterns in women. Most of these problems are now managed with medications, such as hormones. Ultrasound is likewise playing a greater role in helping to evaluate the uterus without surgery.

Probably the single greatest reason for fewer D&Cs is the option of endometrial sampling that can be performed with a very thin plastic suction curette. This procedure is very quick and easy, and is generally only as painful as a bad menstrual cramp. If the patient is given some oral pain medications before the procedure, the cramps are minimal. Also, the tissue sample obtained is in many instances as good as that achieved during a D&C surgery.