Dilation and curettage (D&C)

The following methods are recommended by World Health Organization (WHO) for abortions in the first trimester of pregnancy:

  • vacuum aspiration (manual or electric) in case of pregnancies with gestational age up to 12-14 weeks;
  • medical abortion by oral administration of mifepristone, followed by administration of a single dose of misoprostol in case of pregnancies with gestational age up to 9 weeks.

Dilation and curettage refers to the methods not recommended by the WHO  in the first trimester of pregnancy.

Dilation of the cervix and curettage is a less safe procedure than vacuum aspiration and, at the same time, much more painful for women.

In most industrialised countries, but also in other countries, the procedure of dilation of the cervix and curettage has been replaced by vacuum aspiration. The incidence of severe complications following dilatation and curettage exceeds 2 – 3 times the incidence of complications caused by vacuum aspiration.

Both the WHO and the International Federation of. Gynecologists and Obstetricians (FIGO) consider that the dilatation and curettage (D&C) is an old to date method of surgical abortion and should be replaced by vacuum aspiration and/or by methods of medical abortion.

What is dilatation and curettage?

D&C is a surgical procedure that involves dilating the cervix with the help of mechanical dilator   or of pharmacological agents, after which the walls of the uterus are cleaned with curette (surgical instrument in form of a spoon).

How long does it take dilatation and curettage?

The procedure D&C lasts from 7 to 20 minutes and is carried out in a single visit. You may need a control visit after it.

What do you feel during the procedure?

As a rule, the painful sensations in case of D&C are stronger, but can be total absent with general anesthesia, after which for a few hours may follow a state of drowsiness, weakness and dizziness.

How do you feel after the procedure?

For a week after D&C pains of moderate intensity, similar or more intense than menstrual pains,  and hemorrhagic discharges are a normal occurrence.

Disadvantages of dilatation and curettage method

  • Maximal dilatation of the cervix and curettage with a sharp metal tool causes a trauma to the cervix, so the risk of complications is much higher compared with vacuum aspiration.
  • The tissue is destroyed and cannot be examined.
  • General anesthesia can lead to adverse reactions and complications.

Possible complications after dilatation and curettage

  • Pelvine infections
  • Sterility
  • Ectopic pregnancy
  • Cervical lesions
  • Perforation of the uterus
  • Bleeding which, according to studies, are encountered more frequently and may be seen in about 3 -13% of cases

What need to know a patient after dilatation and curettage?

  • After the procedure of D & C, you will need someone to drive you home. If you had general anesthesia, you may feel dizzy for a period of time, you may have nausea, or may vomit.
  • You can return to regular activities within one or two days.
  • It is possible to have light cramps.
  • You may have spots of light before eyes for a few days.
  • To avoid infections, it is desirable not to use tampons.
  • In case of necessity administer analgesics for pain.
  • You can expect changes in the menstrual cycle (the menstrual cycle may start earlier or later than usual).

After the procedure you should refer immediately to the physician if you have:

  • Fever
  • Pain or abdominal tenderness
  • Bad smelling vaginal discharge
  • Cramps
  • Bleeding