What is a D&C?



A D&C, or dilation and curettage, is a procedure that may be used to diagnose or treat abdominal uterine bleeding. At this time it is one of the most common surgical procedures performed on women around the world. The dilation and curettage procedure will also give the important information to the gynecologist and oncologist about whether uterine cancer is present.

The uterus is a pear-shaped muscular organ that sits in the lower abdomen. The top of the uterus is why and it narrows like the neck of the bottle toward the bottom where it connects with the cervix and vagina. The cervix is round and has a small opening which dilates during labor to enable the baby to pass through. During a politic examination your gynecologist can see the cervix by using a speculum-an instrument that separates the walls of the vagina.

The inner wall of the uterus is lined with endometrial tissue. This tissue proliferates, gets larger, during the menstrual cycle in order to support a pregnancy. If the woman does not become pregnant then this endometrial tissue dies, is sloughed off, and leaves the body as blood.

A D&C procedure might be required to diagnose or treat different problems of the reproductive system and women. Some of these may include heavy or prolonged menstruation as well is unexplained bleeding between periods. One of the more common causes for menstrual abnormalities are a hormonal imbalances which can cause a thickening of the endometrium that may result in irregular or pro-long cycles. Although this can happen at any age it appears to be more common in young women and older premenopausal women.

Abnormal bleeding is also a warning of a variety of different groves which are most often noncancerous. One of these benign growths are polyps which can attach either biased downwards stalk to the lining of the uterus or cervix. Fibroid tumors are another common benign growths that occurs in the uterus. They can be silence, causing no symptoms, or they can cause heavy bleeding and painful cramping. Although they may be detected during a D&C they are often too large to be removed at this time and another surgical procedure is necessary.

Endometrial cancer, especially in women over 40, may cause abnormal bleeding and necessitate a D&C. Occasionally a hysteroscopy is performed at the same time which allows the doctor a better view inside the cervix, vagina and uterus. A D&C is also commonly perform following a miscarriage when the uterus fails to fully empty its contents.

Currently, a D&C is seldom done as a loan procedure as it once was in the late 1990s. In-Stat, it is frequently done as an adjunct procedure to a hysteroscopy or Polypectomy.

The dilation and curettage procedure can be done as an outpatient or inpatient at a hospital or surgical center. Women are often given a sedative in order to help them relax and general anesthesia is used during the procedure. Depending upon the type of anesthesia used the doctor will most likely ask you to avoid unnecessary drugs and will want to other medical conditions to be under good control. There should be no eating or drinking for 12 hours before a D&C done under general anesthesia or eight hours before a local or regional anesthetic.

If the procedure is done under local anesthetic you will be in the lithotomy position, common position for a pelvic examination. The inner and outer vagina including the cervix will be cleaned and span a local anesthetic will be injected into the cervix. This is called a pair of cervical block and relieves pain from the dilation of the cervix. If local anesthetic is being used the physician will insert a spinal needle in order to cause numbness from the level of the belly button down. This wears off and approximately 1 to three hours. If general anesthesia is given the woman will not be aware of anything including the steps listed at the beginning of this paragraph.

The first step is dilation of the cervix. The doctor will pass a small thin flexible piece of metal called a sound to determine the depth an angle of the uterus. The measurements allow the doctor to know how far into the uterus the curette can be safely inserted. Then a stand, smooth metal rod be gently inserted into the cervical opening and left in place for a moment. It will be withdrawn and replaced with a slightly larger Rod. This process is repeated until the cervix has been violated about the width of the finger. Using this method the process usually takes about 10 minutes.

Under local anesthetic most women experience cramping and discomfort. Another method for dilation is to insert Laminaria tents into the cervix eight to 20 hours before the procedure is done. This naturally violates the cervix and is less dramatic than using metal dilators.

The second step is to curettage and hysteroscopy. The gynecologist will insert the hysteroscope so that they may look inside the uterus and visualize any abnormalities. Then a metal loop (curettage) is inserted through the cervix and the physician will scrape or suction the uterine wall.

Risks include hemorrhage, infection, perforated uterus, missed disease and Asherman syndrome. Asherman syndrome is a complication which is where your and involves the formation of scar tissue inside the uterus. Thick stars can results which can feel the uterus completely and cause a woman to become infertile.

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