Womens Health

Treatment after Miscarriage-D & C

Common Procedure

The most common surgical procedure for many gynecological ailments, including after miscarriage, is known as dilatation and curettage. Most people know of this procedure as a D & C. Dilatation refers to the dilation, or opening of the cervix and curettage refers to the removal of the contents of the uterus.

While the term D & C refers to a procedure that involves an instrument known as a curette, some use the term to refer to any procedure that involves dilation and the subsequent removal of uterine contents. This would include the more common procedure known as suction curettage, which involves a manual or electric vacuum instead of a curette.

The dilation of the cervix is most often done a few hours in advance of the surgery.  Once this first step is accomplished, a curette, a kind of metal rod with a handle on one end and a sharpened loop at the other end, is inserted into the uterus by way of the dilated cervix. The loop end of the curette effects a gentle scraping of the lining of the uterus and this tissue is then removed for examination. The examination helps to determine that the scraping is complete in the case of miscarriage or abortion. The tissues may also be checked for pathological abnormalities where there is abnormal bleeding.

D & Cs are performed when there is abnormal bleeding of the uterus, as in too much, too often, or too heavy a menstrual flow. The procedure is also performed to remove prolonged tissue buildup without menstruation, to remove tissue in the uterus that may cause abnormal bleeding such as the retention of placental tissue postpartum, as a method of abortion, and to remove an incomplete miscarriage.

Since D & C involves anesthesia and there are newer methods that are less invasive, the procedure has declined as the method of choice for abortion. The World Health Organization (WHO) recommends D & C only when manual vacuum aspiration is not available. According to the Center for Disease Control (CDC) D & C accounted for only 2.4% of United States abortions in 2002, down from 23.4% 30 years earlier.

Common Risks

One complication associated with D & C is uterine perforation that does not often require treatment, though a laparoscopy may be performed to ascertain that the bleeding has stopped. Infection is another risk.

Perhaps the most common risk of D & C is intrauterine adhesions, known as Asherman's syndrome. The risk increases with multiple D & C procedures. One study found that women who had undergone one or two D & Cs developed such adhesions at a rate of 14-16%, whereas women who had undergone three such procedures developed adhesions at a rate of 32%

Women who had a D & C after miscarriage developed Asherman's syndrome at a rate of 30.9%, whereas women who had the procedure postpartum developed the syndrome at a rate of 25%.

Asherman's syndrome, left untreated, increases the risk of complications in future pregnancies. Such complications include ectopic pregnancy, miscarriage, and placenta previa. There are case reports that vacuum aspiration can also lead to such intrauterine adhesions.

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