Dilation and curettage
Dilation and curettage (D&C) is a surgical procedure used to remove tissue from the lining of the uterus (endometrium) for diagnostic purposes. This procedure involves two main steps: dilation, which is the process of opening the cervix to access the uterus, and curettage, which refers to the scraping of the endometrial lining using a specialized instrument called a curette. D&C is commonly performed to investigate potential uterine cancers, such as endometrial carcinoma, as well as to collect tissue samples when precancerous changes or growths are suspected.
Typically conducted in an outpatient setting under anesthesia, D&C requires careful preparation, including fasting prior to the procedure. After the procedure, patients may experience mild discomfort, such as cramps, and light bleeding, which is expected to subside over time. While considered low-risk, D&C does carry some potential complications, including infection or injury to the uterus. Patients are advised to rest and avoid certain activities following the procedure, ensuring a safe recovery. The collected tissue is examined by a pathologist to provide critical information regarding the presence of cancerous or precancerous cells.
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Subject Terms
Dilation and curettage
ALSO KNOWN AS: Uterine scraping
DEFINITION: Dilation and curettage (D&C) is used to surgically remove sections of tissue within the lining of the uterus and as well as suspicious growths in the uterus in an examination for cancer cells. The lining of the uterus is called the endometrium. Dilation refers to manually opening the cervix to access the uterus. Curettage refers to using a curette, which is a surgical instrument that gently scrapes sections of the endometrium away from the uterus.
Cancers diagnosed:Uterine cancer (uterine sarcoma), endometrial cancer (endometrial carcinoma), precancerous cellular changes that can lead to cancer (endometrial intraepithelial hyperplasia), precancerous growths that can change to cancer (endometrial polyps)
Why performed: D&C is performed to diagnose uterine cancer, endometrial cancer, or precancerous cells in the uterus. A D&C obtains tissue specimens for analysis by a pathologist. A D&C may be used if cancer is suspected or if a is suggestive of cancer but not conclusive. A small tissue sample is obtained in a biopsy, and a larger representation of the uterine tissues is collected with a D&C. Additionally, the tissue specimens may be tested for estrogen and progesterone receptor cells. Increases in these hormones are associated with an increased risk of uterine and endometrial cancer.
Patient preparation: A D&C is a short outpatient procedure performed at a hospital’s surgery department or an outpatient surgical center. General, spinal or epidural anesthesia may be used. Patients should not eat or drink past midnight prior to the day of the procedure or for seven hours before the D&C.
On the day of the procedure, the patient provides a urine sample and wears an examination gown.
Steps of the procedure: The patient lies on her back on a surgical table. The patient’s knees are spread, and her feet are placed in stirrups. The anesthesiologist monitors the patient’s vital signs, and anesthesia is administered.
The vaginal area and urethra are sterilized. A tube may be inserted into the urethra to collect urine during the procedure. A speculum is inserted into the vagina to separate the vaginal walls. The cervix and vagina are then sterilized. Metal devices are used to dilate the cervical opening to allow the doctor to access the uterus. Forceps called tenaculum are used to hold the cervix in place.
A curette is an instrument used to scrape the lining of the uterus in sections. It has a long, narrow handle with a metal loop at the end. The curette is inserted through the vagina and cervix and into the uterus. The doctor uses the curette to gently scrape the lining of the uterus. The tissue specimens are prepared and sent to a pathologist for examination for cancer cells.
When the D&C is complete, the dilating device, speculum, and catheter are removed. The patient is monitored in a postsurgical recovery area until she is alert and is provided with a sanitary napkin to protect her clothing from blood. The patient should not drive after the procedure and needs to receive a ride home from another person.
After the procedure: Patients may experience menstrual-like cramps or backache and are often prescribed pain medication. Bleeding and the passing of small blood clots may occur for a few days following the procedure. Light vaginal bleeding or staining may continue for several weeks. Patients should wear sanitary napkins but should not use tampons to avoid developing an infection. Patients are encouraged to rest for a few days following the surgery and should not participate in sexual intercourse during this time.
Risks: A D&C is considered a low-risk procedure. The risks include those of general anesthesia as well as uterine or bowel perforation, cervical laceration, endometrium scarring, heavy bleeding, and infection. Patients should contact their doctors if they experience heavy bleeding, increased pain, problems breathing, or fever.
Results: A pathologist examines the tissue specimens for cancerous or precancerous cells. The pathologist’s report is conveyed to the doctor.
Bibliography
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Demirkiran, Fuat, et al. "Which Is the Best Technique for Endometrial Sampling? Aspiration (Pipelle) versus Dilation and Curettage (D&C)." Archives of Gynecology and Obstetrics, vol. 286, no. 5, 2012, pp. 1277–82. doi:10.1007/s00404-012-2438-8.
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Knowlton, Christin A., and Michelle K. Mackay. "Dilation and Curettage." Encyclopedia of Radiation Oncology, 2013, ndl.ethernet.edu.et/bitstream/123456789/20251/1/102.pdf.
Novatt, Hilary, et al. "Clinic versus the Operating Room: Determining the Optimal Setting for Dilation and Curettage for Management of First-Trimester Pregnancy Failure." Cureus, vol. 16, no. 3, 2024. doi:10.7759/cureus.56490.
Leitao, Mario M. Jr., et al. “Comparison of D&C and Office Endometrial Biopsy Accuracy in Patients with FIGO Grade 1 Endometrial Adenocarcinoma.” Gynecologic Oncology, vol. 113, no. 1, 2009, pp. 105-8. doi:10.1016/j.ygyno.2008.12.017.
Salim, S., et al. "Diagnosis and Management of Endometrial Polyps: A Critical Review of the Literature." Journal of Minimally Invasive Gynecology, vol. 18, no. 5, 2011, pp. 569-81. doi:10.1016/j.jmig.2011.05.018.