Dilatation and curettage (D & C)

Dilatation and curettage (D & C) is a procedure to remove tissue from inside the uterus. Doctors perform D & C to diagnose and treat certain uterine conditions — such as a heavy bleeding — or to clear the uterine lining after an abortion or miscarriage.

1. PRESENTED BY- SANDHYA KUMARI M.Sc NURSING AMITY UNIVERSITY DIALATATION AND CURETTAGE

2. INTRODUCTION  Dilation and curettage (D&C) is a procedure in which material from the inside of the uterus is removed. The "dilation" refers to dilation of the cervix, the lower part of the uterus that opens into the vagina.   " Curettage " refers to the scraping or removal of tissue lining the uterine cavity ( endometrium ) with a surgical instrument called a curette. Some curettes are sharp while others use suction. Mostly used in first trimester miscarriage or abortion.  

3. Purposes of D & C- To determine the reason for heavy bleeding during or between your menstrual periods To remove noncancerous tumors, or fibroids To remove and examine potentially cancerous tumors To remove infected tissue, which is often caused by a sexually transmitted disease called pelvic inflammatory disease (PID) To remove tissue left behind in the womb after miscarriage or childbirth To perform an elective abortion To remove an intrauterine device (IUD), which is a form of birth control

4. Indications for a diagnostic dilation and curettage include the following: Abnormal uterine bleeding Irregular bleeding Menorrhagia , Suspected malignant or premalignant condition. Retained material in the endometrial cavity.

5. Contraindications to dilation and curettage include the following: Viable desired intrauterine pregnancy. Inability to visualize the cervical os . Obstructed vagina.

6. D & C Tray:- Sponge holding-2 Sims vaginal speculum. Sims vaginal wall retractor. Cusco`s vaginal speculum. Vulsellum forceps 2 Cervical dilator( Hegar`s dilator). Sims uterine curette Ayre`s spatula. Uterine sounds.

7. Procedure of D & C Pre-Operative:-   Instructions to be given to the patient before the procedure:-   Limiting food and drink prior 48 hours of the procedure. Arrange for someone to help the patient get home because she may be drowsy after the anesthesia wears off. Clear the schedule to allow enough time for the procedure and recovery afterward. The patient would be spending a few hours in recovery after the procedure.

8. Intra-operative   During a D&C, the patient lie on her back and place her legs in stirrups like during a pelvic exam. Then the doctor inserts a speculum into the vagina and holds the cervix in place with a clamp. Although the D&C involves no stitches or cuts, the doctor cleanses the cervix with an antiseptic solution.   D&C involves two main steps:-   Dilation involves widening the opening of the lower part of the cervix to allow insertion of an instrument. The doctor may insert a slender rod ( laminaria ) into the opening beforehand or use a medication before the procedure to soften the cervix and cause it to widen.   Curettage involves scraping the lining and removing uterine contents with a long, spoon-shaped instrument (a curette). The doctor may also use a cannula to suction any remaining contents from the uterus. This can cause some cramping. A tissue sample then goes to a lab for examination.

9. Contd. Sometimes other procedures are performed along with a D&C. For example, The doctor may insert a hysteroscope to view the inside of the uterus (called hysteroscopy). He may remove a polyp or fibroid.

10. Post-Operative   The patient is sent to recovery room after the D&C for few hours so that the doctor can monitor heavy bleeding or other complications. This also gives the patient time to recover from the effects of anesthesia.   If the patient had general anesthesia, she may become nauseated or vomit, or might have a sore throat if a tube was placed in the windpipe to help in breathing. With general anesthesia or light sedation, she may also feel drowsy for several hours.  

11. Side effects Cramping Spotting or light bleeding Heavy or prolonged bleeding or blood clots Fever Pain

12. Complications Damaged cervix Perforated uterus or bladder and blood vessels Abdominal tenderness Foul-smelling discharge from the vagina In very rare cases, scar tissue (adhesions) may form inside the uterus called Asherman's syndrome, this may cause infertility and changes in menstrual flow. Surgery can repair this problem, so report any abnormal menstrual changes after a D&C.

13. Summary Introduction of D & C Purposes of D & C Indications of D & C Contraindications of D & C Articles used in D & C Procedure of D & C Side Effects of D & C Complications of D & C

14. Conclusion   Dilation and curettage ( D&C ) is a  procedure  to remove tissue from inside uterus. Doctors perform dilation and curettage to diagnose and treat certain uterine conditions — such as heavy bleeding — or to clear the uterine lining after a miscarriage or abortion.

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