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| |    Dilation and Curettage to Complete Miscarriage by Marjorie Greenfield, M.D. reviewed by Marjorie Greenfield, M.D. Dilation and curettage (D&C) is a procedure to empty your uterus after a miscarriage. Description of the procedure The D&C procedure takes between five and fifteen minutes to complete. When D&C is done in the operating room, the patient is usually in the room for 30-60 minutes. Dilation (opening of the cervix) is required in miscarriages when the cervix has not yet opened. Sterile metal probes of increasing width are placed through the cervical os (opening). This slow stretching prevents tearing of the cervix. Curettage empties the uterus of all its contents. In miscarriage, curettage is performed with a suction curette, a sterile plastic tube that attaches to a vacuum machine. The tube is placed up into the uterus and the suction is turned on. Placental tissue and uterine lining are suctioned down the tubing and into a collecting device. Often we do not see the embryo. Will it hurt? D&C can cause moderate to severe cramps if no anesthesia is used. Many different anesthesia options are available, including para-cervical block (local anesthetic injected into the cervix), intravenous sedation, and general anesthesia. Some practitioners provide an epidural for D&C, but the epidural takes more time to put in than the D&C takes to do! Benefits of D&C Sometimes in miscarriage there is excessive bleeding (hemorrhage) and D&C is the only way to stop the bleeding. In that case, there is a great benefit to having the procedure done. Sometimes the miscarriage is not yet complete, but might complete on its own given time, and the D&C could be avoided. While some families choose to wait and see, many feel anxious to "get it over with" and prefer to have the procedure sooner, rather than later. If you are in this situation, discuss your options with your physician. Risks There is rarely a serious complication when D&C is done for miscarriage in the first trimester. Bleeding and infection are risks of D&C, but also risks inherent in miscarriage itself, since waiting to miscarry at home also can lead to excess blood loss or infection. Perforation, where the instrument pokes a hole through the uterine wall, can occur. Often, since the uterus is made of muscle, the hole closes as the uterus contracts, and no problems come of the perforation. If a major complication is recognized during the procedure, it will be fixed at the time of the D&C, even if that involves a bigger surgery. When you go home after D&C, you should receive instructions that include warning signs. Home-going instructions typically are to call your practitioner if you have bleeding heavier than a heavy period, severe pain, or fever, so you can be assessed for unrecognized complications. What can be learned from the D&C procedure? All the tissue that is obtained at D&C gets sent to the lab for analysis. Sometimes this can identify the reason for the miscarriage, but usually it does not give a definitive answer. Chromosome testing can be done on the tissue, but the testing is expensive, and although it may be less frustrating to have a reason for the loss, the information about the chromosomes usually does not help you in the next pregnancy. Your practitioner can help decide if it is worthwhile to test the chromosomes.
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