A dilatation and curettage (DNC, or more accurately D&C) procedure is no walk in the park. It is actually one of the most unpleasant hospital experiences a woman can ever have. It involves some pain and a lot of discomfort, but in some cases, it is an absolute necessity.
Usually, a DNC is done after a miscarriage. The main aim of this surgery is to remove any remaining tissue that is stuck in the uterus after fetal death. If the tissue is not removed it can trigger infections or inflammations that can cause anything between sickness and death.
It is considered an outpatient procedure, which means that the patient does not need to stay in the hospital overnight after it is done. Most patients who do not develop any complications leave the hospital within a few hours. However, it is not to be taken lightly. Any invasive procedure that involves objects inside the body or anesthesia poses its own set of risks and has preparations crucial to its success. Women who are getting a D&C need to be mentally and physically prepared by talking to their doctors beforehand. They should get information on what happens before, during, and after the surgery so they can be on the same page and aware of what is going on. Providing information like medical history and current health status is a must.
There are also different ways to undergo this surgery and different uses for it that are not limited to miscarriage. Here, we list 13 facts about D&C surgeries that not all women know.
13 It Can Be Diagnostic
The most well-known requirement for a D&C procedure is miscarriage. Although miscarriages can progress on their own, known as natural miscarriage, in most cases it is a must to examine and remove any remaining tissue surgically. On the other hand, there are many cases in which this procedure is done for diagnostic purposes. For example, a D&C can be done to know the reasons behind symptoms like irregular bleeding and pain or postmenopausal bleeding.
What happens is that the doctor takes a sample from a woman’s endometrium – the lining of the uterus. This sample is then sent to the lab for analysis. It is used to diagnose uterine polyps that are benign or uterine cancer. It also detects endometrial hyperplasia, which is an excessive thickness in the endometrium, caused by responses to estrogen, but not to progesterone. Over time, this pattern results in an uncontrolled increase in the number of cells of the endometrial lining.
12 It Can Be A Treatment
D&C procedures do not only have diagnostic uses, but also, they have treatment ones. Besides miscarriage, a D&C procedure can enable a doctor to remove a molar pregnancy, a case in which a tumor grows in place of a normal pregnancy. It is also done postpartum in women whose placenta does not fully clear after birth. This excess tissue is very dangerous if it does not exit the body within minutes after birth.
Another rare yet annoying incidence is IUD removal. If a doctor fails to remove an IUD using the standard thread method, it’s possible for the thread to detach, leaving the IUD inside the uterus. The only option is to remove it surgically. This is especially urgent and common in women who develop unbearable side effects to IUDs. The procedure is quite similar to the regular D&C, because all the endometrial tissue has to be removed as long as the instrument has entered the body.
11 It Starts One Day Before
Being a one-day procedure, one would think that it is OK to relax and only start worrying upon admission to the hospital. Actually, that is not the case. If the woman getting a D&C is already in the hospital and needs an emergency procedure done, she has no time to prepare. However, a woman with a scheduled procedure needs to follow some rules. The procedure itself may take 10-15 minutes, but preparing for it starts the day before.
First, most doctors prohibit eating or drinking for 8 to 12 hours prior to the surgery. Second, many doctors apply a gel to dilate the cervix one day before the operation. This is done in cases when the cervix needs to be more dilated than what is usually needed for a normal D&C. This can be in cases such as some types of hysteroscopy and pregnancy termination.
10 The Invasiveness Starts Well Ahead Of Time
During the procedure, the doctor inserts an instrument called the speculum to open the vagina and expose the cervix. An OB/GYN does the same thing when a woman gets a PAP smear. A medication called Cytotec (misoprostol) is given, either orally or vaginally for cervical softening and dilation to begin. Cytotec could be given hours before the surgery or the day before. A different method is for the doctor to insert a slender rod into the cervix. The rod gradually expands by absorbing body fluid, causing the cervix to open.
Next, the doctor uses a series of thin rods, each of them larger than the next, to open up the cervix and enlarge the diameter of its opening. The cervix would be cleansed with antiseptic solution to minimize the risk of infection. Because the procedure goes beyond the cervix, it is possible to use a forceps-like instrument known as the tenaculum. This keeps the cervix open throughout the procedure, to allow the next step to happen inside the uterus.
9 There Is More Than One Method
The next step in the D&C procedure can be done in one of two ways. First, there is scraping, which uses a curette. A curette is a spoon-shaped instrument used to scrap out the unwanted tissue. It is inserted through the cervical opening and passed along the entire lining of the uterus to ensure that no spot is missed and no tissue is left. If the D&G is diagnostic, the scraped tissue is sent to the laboratory for analysis.
The alternative is to use a suction curette. The curette is connected to a hose that ends in a specimen bucket. The sucked liquid and tissue are stored in the specimen bucket for disposal or analysis depending on the case. Suction curettes are available in different sizes, depending on the estimated uterine size. The curette is rotated until no further material is aspirated, indicating an empty uterus. It is not an easy process, but qualified doctors are trained to perform it safely.
8 There Are Different Kinds Of Anesthesia
The anesthesia used to perform a D&C procedure varies greatly. Some women request general anesthesia and are therefore unaware of what is going on. Others go for spinal or epidural anesthesia. In rare cases, women could be given local anesthesia. However, it is not a preferable option, because most women prefer not to risk feeling any pain, and local anesthesia is considered the weakest.
In case of spinal anesthesia or an epidural, there is no feeling from the waist down. If general anesthesia is used, the anesthesiologist continuously monitors heart rate, blood pressure and breathing. Anesthesia is one of the reasons women are not allowed to eat or drink before the procedure. It causes nausea and vomiting that may be aggravated by a full stomach. The reason for choosing a specific type of anesthesia has a lot to do with the patient’s medical history and the reason for the D&C procedure.
7 No Driving Allowed
Although this a short procedure, its effect lasts for some time. As with any invasive surgery, there are feelings of tiredness afterwards. Also, anesthesia could cause a person to be drowsy and unfocused, even after the anesthesia wears off and they wake up. For those reasons, it is absolutely prohibited for a woman to leave the hospital alone and drive herself home. It could endanger her life, or someone else’s, if she loses control of the wheel, or fails to react if something serious happens.
There is no law to prevent driving, but it is medically discouraged. This is why women should arrange for someone to pick them up if no one already accompanies them to the hospital. It is advised for men to take their partners to the hospital and make sure they are doing fine. This is hardly an easy task to do, and good company is necessary for women to feel that things are going smoothly.
6 It Takes Time
The 15 minutes it takes to perform a D&C procedure may seem like all the action. Yet, it is not that simple. After the procedure is done, there is a chance that women need some time to wake up from the anesthesia. Even after that, leaving the hospital is not easy. After such a tiring procedure, women are usually too tired and need all the rest they can get.
It is estimated that the patient can leave the hospital 4 to 5 hours after admission. This includes the time taken to check on the patient’s vital signs and general well being before she is granted permission to leave. There is no need for a hospital stay unless complications develop. As with many other surgeries, women are encouraged to get up and walk as soon as they are awake. This stimulates the blood flow in the legs so no clots are formed in them. It also strengthens the muscles.
5 Risk For Possible Infections
One of the rare complications that could result from a D&C is infection. It could be due to exposing a vulnerable place of the body, an inner organ, to the environment. Also, the risk of infection comes from any procedure done in hospitals, which means that it is possible that having this procedure done at a clinic is actually safer. The doctor has to be ready to deal with complications in his/her clinic for the procedure to be safe.
Infection is easy to spot. If a patient experiences fever, prolonged cramping (more than 48 hours), heavy uncontrollable bleeding, exacerbating pain, or foul-smelling vaginal discharge, she must get checked out immediately. Usually, she will be given an antibiotic course to eradicate the microorganism causing the trouble. As unpleasant as it sounds, an infection has a small chance of happening. Also, one cannot afford to skip a life-saving D&C procedure for such a weak possibility.
4 Risk For Internal Damage
Other complications that happen after a D&C procedures has to do with the uterus. First, there is a chance of uterine perforation. If an instrument pokes a hole in the uterine wall, it could lead to severe bleeding. It is more common in recently pregnant women and in those who are postmenopausal. It is also more common with women who have had previous uterine surgery such as a Cesarean, or already have an infection. Women who have distorted internal uterine anatomy or a narrow cervical opening (cervical stenosis) are also at greater risk. If a perforation does occur, as long as no other internal organs were damaged, the hole is expected to heal on its own without any further surgery.
Cuts or tears are also possible and are usually treated in the moment to stop any bleeding by applying pressure to the area. Medication is applied directly to the wound and that is all that is usually needed. Very rarely is it necessary to place a few sutures to stop the bleeding.
3 After Effects Can Be Painful
After the surgery, there are a lot of scary symptoms that may crop up. They make women feel bad, but they are normal byproducts of the operation and should not cause alarm. First, bleeding is very common. When the tissue/IUD is removed, the uterus takes time to heal. Second, cramping is also continuous after the surgery. It should not persist more than two days and gradually becomes more bearable. Tiredness is also a very common post-surgical symptom – but it’s more severe and common with general anesthesia patients.
To help with the pain, painkillers are sometimes prescribed before leaving the hospital. Women are prohibited from inserting any object in the vagina for at least 2 weeks. This includes tampons, douches, or any other feminine hygiene products. Although women are tempted to douche to prevent infections, douching actually increases the risk. Sex is withheld as well. Such precautions minimize the risk of inflammation and complications so healing can occur normally.
2 Feelings Are Inevitable
Feelings vary from woman to woman, depending on her situation. However, it is rarely a good position to be in. If the surgery is done after miscarriage, a woman may still be grieving the lost baby. It is hard on her and her partner. The exhaustion and trauma of having to go through surgery when a woman already feels horrible is not to be underestimated. That is when she needs support the most.
It is not easier on patients who are in for diagnostics purposes. Actually, a woman’s suffering could end by the time she leaves the hospital with a few pills to pop for pain, but a woman who is in for a diagnosis is not spared the worry of what the results might be. Because cancer is one of the possibilities, a woman can have sleepless nights and worrisome days until she finally knows what is wrong and how she can deal with it.
1 Psychological Recovery Takes Time
Many people are focused on treating the body after a D&C, but lose sight of the emotional needs that require attention. People grieve differently, and what seems unbelievable for a woman might just be what another woman needs. For instance, many women take days off work to heal and rest. Others can’t wait to bury themselves under a pile of work so they can prevent their minds from wandering. It’s an unhappy experience that no woman ever forgets, but that doesn’t mean there is no way to deal with it.
The most important aspect of emotional recovery is support. Being surrounded by friends and family and a supportive partner can work wonders for the woman’s recovery. A network of friends that provide the activities she needs and respect her moods and wishes will make healing much easier. Some women need a big change, like a trip for 3-4 days to get away and clear their heads. Whatever makes the woman feel better must be done to help her get through such a tough time.
Sources: WebMD.com, NetDoctor.co.uk, AmericanPregnancy.org, MedScape.com, UpToDate.com