Dilation and curettage

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Surgical: Suction-Aspiration · D&E D&C* · IDX* Hysterotomy* · Instillation* Medical: Mifepristone · Misoprostol *Rarely performed
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Dilation (dilatation) and curettage (D&C) or sharp curettage is a gynaecological procedure performed on the female reproductive system that involves dilating the cervix and inserting instruments to remove the lining of the uterus, while the woman is under an anaesthetic. A curettage is performed with a curette, a metal rod with a handle on one end and a sharp loop on the other.

D&Cs are commonly performed to resolve abnormal uterine bleeding (too much, too often or too heavy a menstrual flow); to remove the excess uterine lining in women who have conditions such as PCOS (which cause a prolonged buildup of tissue with no natural period to remove it); to remove uterine fibroids or other suspected abnormalities, such as premalignant cells in their uterine lining; to remove retained tissue (also known as retained POC or retained products of conception) in the case of an incomplete miscarriage; and historically, as a method of abortion that is now uncommon.

D&Cs for miscarriage may be performed under general anaesthesia or under sedation.

Because medical and non-invasive methods of abortion now exist, and because D&C requires heavy sedation or general anesthesia and has higher risks of complication, the procedure has been declining as a method of abortion. The World Health Organization recommends D&C as a method of abortion only when manual vacuum aspiration is unavailable^[1]. According to the Centers for Disease Control and Prevention, D&C only accounted for 2.4% of abortions in the United States in the year 2002^[2], down from 23.4% in 1972^[3].

Three related procedures used for abortion are suction or vacuum aspiration, dilation and evacuation and dilation and extraction, the latter of which is also known non-medically as partial-birth abortion.

If the procedure is performed too roughly, scar tissue may form and seal the uterus shut (Asherman's syndrome), resulting in infertility. Another consequence of excessively forceful technique is uterine perforation, which may require an emergency laparotomy and/or hysterectomy to resolve.

[edit] References

1. ^ Dilatation and curettage. A-Z Managing Complications in Pregnancy and Childbirth by WHO. Retrieved on February 20, 2006.
2. ^ Abortion Surveillance --- United States, 2002. MMWR Surveillance Summaries. Retrieved on February 20, 2006.
3. ^ Abortion Surveillance -- United States, 1990. MMWR Surveillance Summaries. Retrieved on February 20, 2006.