Dilation and curettage of the uterus in Türkiye

What is the process of dilatation and curettage of the uterus?

Also called a D&C, it is a surgical procedure in which the cervix (the lower, narrow part of the uterus) is dilated so that the lining of the uterus can be scraped off with a curette to remove abnormal tissue.

Other related procedures used to diagnose and treat endometriosis include endometrial ablation, hysteroscopy, and hysterectomy. 

What are the reasons for the process of dilatation and curettage of the uterus?

• D&C may be used as a diagnostic or treatment procedure for abnormal bleeding. 
• A dilation and curettage may be done to determine the cause of abnormal or excessive uterine bleeding, to detect cancer. or as part of a test for infertility (inability to become pregnant).
  Causes of abnormal bleeding include abnormal tissue, such as fibroids (benign tumors that develop in the uterus, also called myomas), endometrial or uterine tumors
•  The tissue obtained from the D&C can be examined under a microscope
•  Abnormal uterine bleeding may be due to a hormonal imbalance or imbalance (particularly estrogen and progesterone) especially in women who are approaching menopause or after menopause.
• Suction is used to perform a dilation and curettage to remove the contents of the uterus. 
• A D&C aspiration may be used after a miscarriage to remove the fetus and other tissues if not all are passed normally. 
  Infection or severe bleeding can occur if these tissues are not completely removed.
• Sometimes after delivery, small pieces of the placenta remain attached to the lining of the uterus and are not passed. This could cause bleeding or infection
• . A dilation and curettage may be used to remove these fragments so that the endometrium can heal properly.
• There may be other reasons for your doctor to recommend a D&C

What are the risks of dilation and curettage of the uterus?

As with any surgical procedure, complications may occur. Some potential complications of the developments and changes may include, but are not limited to, the following:

• severe bleeding
• infection
• Perforation of the uterine or intestinal wall
• Adhesion (scar tissue) may occur within the uterus

Patients who are allergic or sensitive to medications, iodine, or latex should inform their physician.

If you are pregnant or suspect you may be pregnant, you should notify your healthcare provider.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Before performing a uterine dilation and curettage

• Your doctor will explain the procedure to you and offer you the opportunity to ask any questions you may have about the procedure.
• You will be asked to sign a consent form giving you permission to perform the procedure
• In addition to a complete medical history, your doctor may perform a complete physical examination to ensure that you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
• If your procedure requires general, spinal or epidural anesthesia, you will be asked to fast for eight hours before the procedure.
• If you are pregnant or suspect you may be pregnant, you must inform your doctor. He or she may recommend a pregnancy test before the procedure.
• Tell your doctor if you are allergic to any medications, iodine, latex, tape, and anesthetic agents (local and general).
• Let your doctor know about all the medications (prescription and over-the-counter) and herbal supplements you’re taking.
• Also if you have a history of bleeding disorders or if you are taking any anticoagulant (blood thinning) medicines, aspirin or other medicines that affect blood clotting. It may be necessary for you to stop these medicines before the procedure.
• If you were given a sedative before the procedure, you’ll need someone to drive you home afterwards.
• You may want to bring a sanitary napkin to wear at home after the procedure.
• Depending on your medical condition, your doctor may order another specific preparation.

How is the process of dilatation and curettage of the uterus?

D&C may be done in your doctor’s office, on an outpatient basis, or as part of your hospital stay. Procedures may vary depending on your condition and your doctor’s practices.

The type of anesthesia depends on the specific procedure being performed. Some D&C procedures may be performed while you are asleep under general anesthesia, or while you are awake under spinal or epidural anesthesia. If spinal or epidural anesthesia is used, you will not feel any feeling from your waist down. The anesthesiologist will constantly monitor your heart rate , blood pressure, breathing, and blood oxygen level during surgery.

1. You will be asked to undress and given a gown to put on.
2. You will be asked to empty your bladder.
3. You will be positioned on the operating or examination table, with your feet and legs supported as for a pelvic exam.
4. An intravenous (IV) line may start in your arm or hand.
5. A urinary catheter may be inserted.
6. Your doctor will insert an instrument called a speculum into your vagina to spread the vaginal walls apart to expose your cervix.
7. The cervix can be cleansed with an antiseptic solution.
8. For local anesthesia, the doctor may numb the area by using a small needle to inject the medication.
9. If general or local anesthesia is used, the anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during surgery.
10. A type of forceps, called a tenaculum , may be used to stabilize the cervix in the operation.
11. The inside of the cervical canal may be scraped with a small mass if cervical tissue examination is needed.
12. A thin, rod-like instrument called a uterine sound can be inserted through the opening of the cervix to determine the length of the uterus. 
13. The cervix will be dilated by inserting a series of thin rods. Each rod will be larger in diameter than the previous one. This process will gradually widen the opening of the cervix so that the curette (a spoon-shaped instrument) can be inserted.
14. The scoop will be inserted through the cervical opening into the uterus and the sharp, spoon-shaped edges will be passed through the lining of the uterus, scraping out the tissue. In some cases, suction may be used to remove tissue. 
15. Tools will be removed.
16. Any tissue collected with the procedure will be sent to a lab for testing. 

After the procedure of dilation and curettage of the uterus

• The recovery process will vary depending on the type of procedure that was performed and the type of anesthesia that was performed.
• If you received local or general anesthesia, you will be taken to a recovery room for a follow-up. Once your blood pressure , pulse and breathing are stable, you will be taken to a hospital room or sent home. 
• After the procedure of dilatation and curettage using local anesthesia, you can rest for two hours before going home.
• You may want to wear a sanitary pad for bleeding. It is normal to have some spotting or light vaginal bleeding for a few days after the procedure.
• You may experience cramping for the first few days after the D&C.
• You will be instructed not to douching, using tampons, or having sex for two to three days after your D&C, or for the period of time your doctor recommends.
• You may also have other restrictions on your activity, including no strenuous activity or heavy lifting.
• Because a dilation and curettage removes the lining of the uterus, the lining must build up again. 
• Your next period may start earlier or later than usual.
• You can resume your normal diet unless your doctor advises you differently.
• Take pain relievers for cramps or pain as recommended by your doctor. Aspirin or some other pain relievers may increase the chance of bleeding
•  Make sure you take only the recommended medications.

Your doctor will advise you when to return for further treatment or care.

Tell your doctor if you have any of the following:

• severe bleeding
• Foul-smelling discharge from the vagina
• Fever and/or chills
• severe abdominal pain;

Your doctor may give you additional or alternative instructions after the procedure, depending on your specific situation.

For inquiries about dilation and curettage of the uterus in Türkiye, please contact the doctors of REHABTÜRK.

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