Dilatation and Curettage
In the operational setting, D&C (dilatation and curettage) is often required to resolve complications of early pregnancy loss, such as an incomplete abortion. Rarely would it be necessary in a non-pregnant woman with intractable uterine bleeding.
Under anesthesia, the bladder is catheterized and a pelvic exam performed so the surgeon can feel the orientation of the uterus. Of particular importance is noting whether the cervix leads directly into the uterus or whether there is any angulation anterior or posterior. Equally important is determining the size of the uterus as this will guide the surgeon in inserting the instruments.
The cervix is grasped with a tenaculum or a ring forceps on its anterior lip. (Posterior lip – in a women whose uterus is tilted posteriorly.)
The cervix is then dilated by inserting “dilators” of gradually increasing diameter. In the case of incomplete abortion, the cervix will already be dilated and no additional dilation will be necessary.
Polyp forceps or Ring forceps are then inserted through the cervix into the uterus to grasp and remove any large pieces of pregnancy tissue. It is relatively easy to perforate the soft walls of the uterus and cause damage to the surrounding structures (bladder, bowel, ureters)! Then a curette is gently inserted and used to scrape any remaining tissue off the uterine walls. Excessive scraping at this time can result in too much tissue being removed and later infertility.
Prophylactic antibiotics may be given (particularly in an incomplete abortion situation) as well as ergotamine 0.2 mg PO three times a day for 2 days to stimulate uterine contractions and reduce blood loss.