Dilation and curettage

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 gynecologic procedure used for diagnostic and therapeutic purposes, and is the most commonly used method for first-trimester miscarriage or abortion. D&C normally refers to a procedure involving a curette, also called sharp curettage. However, some sources use the term D&C to refer 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. D&Cs may be performed in pregnant and non-pregnant patients, for different clinical indications. A D&C may be performed early in pregnancy to remove pregnancy tissue, either in the case of a non-viable pregnancy, such as a missed or incomplete miscarriage, or an undesired pregnancy, as in a surgical abortion. Medical management of miscarriage and medical abortion using drugs such as misoprostol and mifepristone are safe, non-invasive and potentially less expensive alternatives to D&C. Because medication-based non-invasive methods of abortion now exist, dilation and curettage has been declining as a method of abortion, although suction curettage is still the most common method used for termination of a first-trimester pregnancy. The World Health Organization recommends D&C with a sharp curette as a method of surgical abortion only when manual vacuum aspiration with a suction curette is unavailable. For patients who have recently given birth, a D&C may be indicated to remove retained placental tissue that does not pass spontaneously or for postpartum hemorrhage. D&Cs for non-pregnant patients are commonly performed for the diagnosis of gynecological conditions leading to abnormal uterine bleeding; to remove the excess uterine lining in women who have conditions such as polycystic ovary syndrome; to remove tissue in the uterus that may be causing abnormal uterine bleeding, such as endometrial polyps or uterine fibroids; or to diagnose the cause of post-menopausal bleeding, such as in the case of endometrial cancer.

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Related concepts (14)

Miscarriage

Miscarriage, also known in medical terms as a spontaneous abortion, is the death and expulsion of an embryo or fetus before it is able to survive independently. The term miscarriage is sometimes used to refer to all forms of pregnancy loss and pregnancy with abortive outcome before 20 weeks of gestation. Miscarriage before 6 weeks of gestation is defined by ESHRE as biochemical loss. Once ultrasound or histological evidence shows that a pregnancy has existed, the used term is clinical miscarriage, which can be early before 12 weeks and late between 12–21 weeks.

Dilation and curettage

Endometrial biopsy

The endometrial biopsy is a medical procedure that involves taking a tissue sample of the lining of the uterus. The tissue subsequently undergoes a histologic evaluation which aids the physician in forming a diagnosis. There are a number of indications for obtaining an endometrial biopsy from a non-pregnant woman: Women with chronic anovulation such as the polycystic ovary syndrome are at increased risk for endometrial problems and an endometrial biopsy may be useful to assess their lining specifically to rule out endometrial hyperplasia or cancer.