Dilation and Curettage (D&C) is a common gynecological surgical procedure that involves dilating the cervix and scraping the endometrial tissue to diagnose or treat related conditions. This procedure is often used for uterine evacuation after miscarriage, diagnosis of abnormal bleeding, or removal of residual tissue within the uterus. The primary goal is to ensure complete removal of endometrial tissue, reducing the risk of infection or subsequent complications.
The surgery is typically performed in a hospital or clinic setting under local or general anesthesia, lasting approximately 30 to 45 minutes. Medical staff will first dilate the cervix, then use a curette or suction device to remove tissue. Postoperative observation focuses on bleeding and pain. This procedure can be performed alone or combined with other treatments such as medical abortion.
D&C is classified into "diagnostic" and "therapeutic" types. Diagnostic D&C involves obtaining endometrial tissue samples to confirm conditions such as endometrial hyperplasia or cancer. Therapeutic D&C involves direct removal of tissue, such as residual placental tissue after miscarriage or for hemostasis. The mechanism involves mechanical dilation of the cervix using metal dilators to gradually open the cervical canal, followed by tissue removal with a curette or suction device.
Medications such as misoprostol may be used beforehand to soften the cervix and reduce trauma during dilation. This combination of physical operation and pathological examination allows direct observation of endometrial changes, providing immediate diagnostic and therapeutic results. The tissue obtained postoperatively is sent for pathological analysis to confirm the presence of abnormal cells.
This treatment is mainly indicated for the following situations:
In certain cases, such as persistent bleeding after medical abortion or imaging showing residual tissue within the uterus, a physician may recommend this procedure. However, the necessity and risk-benefit ratio should be evaluated based on patient age, uterine size, and bleeding cause.
The procedure consists of three stages:
There is no fixed "dose" concept; the duration and scope of the surgery are adjusted according to the patient's condition. Preoperative antibiotics may be administered to prevent infection, or prostaglandin drugs may be used to soften the cervix in advance.
Main advantages include:
This procedure is usually completed on an outpatient basis, without the need for prolonged hospitalization. Patients can quickly resume daily activities, and the diagnostic accuracy is high, especially in cases of post-miscarriage curettage or malignancy screening.
Possible side effects include:
Serious complications are rare but require careful assessment:
Preoperative considerations include:
Contraindications include:
If patients are on anticoagulants (such as aspirin or warfarin), they should discontinue medication before surgery and switch to short-acting anticoagulants. When combined with analgesics, attention should be paid to addiction risks or gastrointestinal discomfort.
If concurrently receiving hormone therapy (such as progesterone), inform the physician to adjust medication timing. Postoperative antibiotics should be used cautiously to avoid drug interactions, such as reduced efficacy when combined with anticonvulsants.
Clinical studies show that D&C has an immediate success rate of over 90% in removing uterine tissue, especially effective after miscarriage. Diagnostic curettage for endometrial cancer has an accuracy rate of 85-95%, clearly distinguishing benign from malignant lesions.
However, complete tissue removal cannot be guaranteed, with about 5-10% of patients requiring a second procedure. Clinical guidelines recommend combining ultrasound or serum hCG testing to confirm uterine clearance post-surgery.
Non-surgical alternatives include:
Choice of alternative depends on the patient's specific condition. For example, patients with thin endometrium or fibrotic tissue may benefit more from surgical removal, while medical abortion is suitable for pregnancies less than 9 weeks.
Typically, preoperative assessments include pelvic ultrasound, blood tests, and infection screening to evaluate uterine condition and exclude infection risks. Patients on anticoagulants or with chronic diseases should inform the doctor in advance for medication adjustments. Fasting and abstaining from water for 8 hours before surgery are required to reduce anesthesia risks.
Is postoperative bleeding or abdominal pain normal? How can it be alleviated?Light bleeding or lower abdominal discomfort are common short-term reactions, usually lasting 1 to 2 weeks. If bleeding exceeds normal menstruation, is accompanied by severe abdominal pain, or fever, it may indicate infection or incomplete uterine evacuation, requiring immediate medical attention. Doctors may prescribe painkillers or antibiotics and advise avoiding heavy lifting to promote recovery.
When can daily activities resume? What behaviors should be avoided?Mild activities such as walking can usually resume after 1 to 2 days, but strenuous exercise or heavy lifting should be avoided for at least 2 weeks. Doctors typically recommend abstaining from sexual intercourse and tampon use for 2 weeks post-surgery to prevent infection or wound tearing. Specific restrictions depend on individual recovery and should follow medical advice.
What is the approximate success rate and risk rate of dilation and curettage?The procedure has a success rate of over 90% in diagnosing uterine abnormalities or treating miscarriage curettage, but risks include uterine perforation, infection, or cervical injury, with an incidence of about 1-2%. Older patients or those with uterine anomalies have slightly higher risks. Preoperative assessment can reduce complication rates.
Is regular follow-up necessary after surgery? What does follow-up include?Follow-up is recommended 4 to 6 weeks post-surgery, including pelvic ultrasound or blood tests to confirm uterine recovery and exclude ongoing bleeding. If the purpose was to diagnose endometrial abnormalities, tissue report results should be reviewed, and subsequent treatment plans formulated accordingly.
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