Dilation and Curettage (D&C) — How It Works, Benefits & Recovery — Procedure Guide, Recovery & Risks | MyMedicPlus

Dilation and curettage (D&C) is a minor but important gynaecological surgical procedure in which the cervix is gradually dilated (widened) and the uterine cavity is emptied or sampled using a curette — a spoon-shaped or loop-shaped scraping instrument — or a suction cannula. It serves both diagnostic and therapeutic purposes depending on the indication. As a therapeutic procedure, D&C removes retained products of conception after miscarriage, molar pregnancy, or incomplete abortion; removes endometrial polyps causing abnormal uterine bleeding; and manages uterine haemorrhage unresponsive to medical treatment. As a diagnostic procedure, D&C allows histopathological sampling of the endometrium to investigate abnormal uterine bleeding (AUB), postmenopausal bleeding, or suspected endometrial hyperplasia and malignancy. Modern practice increasingly uses suction curettage (vacuum aspiration) rather than sharp curettage, as suction is faster, reduces blood loss, causes less pain, and — crucially — is associated with a lower rate of intrauterine adhesion (Asherman syndrome) compared to sharp metal curettes. Hysteroscopy is often combined with D&C to allow direct visualisation of the uterine cavity, improving diagnostic accuracy and enabling targeted removal of polyps or submucosal fibroids under direct vision.

D&C is indicated across a range of gynaecological conditions. The most common therapeutic indication is incomplete or missed miscarriage where retained products of conception require surgical evacuation — alternatives include medical management with misoprostol or expectant management, and the choice is made with patient preference and clinical factors in mind. Other indications include: molar pregnancy (hydatidiform mole), where D&C is the definitive treatment and suction curettage is mandatory; postpartum haemorrhage due to retained placental tissue refractory to uterotonic agents; abnormal uterine bleeding (menorrhagia, intermenstrual bleeding, postmenopausal bleeding) where endometrial biopsy and polyp removal are required; endometrial hyperplasia requiring sampling and grading to guide further management; diagnostic sampling when office endometrial biopsy is insufficient or non-diagnostic; and termination of pregnancy in the first trimester. Contraindications include active pelvic infection (requiring antibiotic treatment before surgery), known or suspected uterine perforation from prior instrumentation, and coagulopathy requiring correction. Pre-operative cervical preparation with misoprostol or osmotic dilators (Dilapan) is used in nulliparous women or when significant cervical stenosis is anticipated.

D&C is a day-case procedure usually performed under general anaesthesia, though local (paracervical block) or regional (spinal/epidural) anaesthesia are options, particularly in medically high-risk patients. The patient is positioned in the lithotomy position (legs in stirrups). A bimanual examination confirms uterine size and position. A speculum is inserted to expose the cervix, which is grasped with a tenaculum (ring-holding forceps) for stabilisation. The uterus is sounded to determine cavity depth. Progressive mechanical dilators (Hegar dilators in increasing sizes, typically to 8–10 mm) are gently inserted through the cervical os to dilate the canal. Once adequate dilation is achieved, a suction curette (Karman cannula or electric vacuum aspirator) or sharp curette is introduced to evacuate the uterine contents. Ultrasound guidance is increasingly used to confirm complete evacuation and reduce the risk of uterine perforation. If hysteroscopy is being performed simultaneously, the hysteroscope is introduced before curettage to inspect the cavity, identify pathology, and target the biopsy. Tissue obtained is sent for histopathological analysis. The procedure typically takes 15–30 minutes, after which the instruments are removed and haemostasis confirmed. Hysteroscopic-guided D&C allows direct uterine cavity visualisation during curettage, significantly improving completeness of evacuation and diagnostic accuracy compared to blind curettage, and is the preferred approach in many specialist gynaecology units.

D&C provides swift resolution of retained products of conception — one of the most distressing gynaecological emergencies — with procedural success rates exceeding 95%. For women experiencing incomplete miscarriage with haemorrhage or infection risk, surgical evacuation by D&C is faster and more reliable than medical management with misoprostol (complete evacuation in 95% vs. 80–85% respectively). As a diagnostic tool, D&C combined with hysteroscopy achieves near 100% sensitivity for endometrial pathology when the entire cavity is systematically curetted — superior to office endometrial biopsy, which samples only a portion of the endometrial surface (sensitivity for endometrial cancer approximately 90%). For women with endometrial polyps causing menorrhagia, hysteroscopic polypectomy under direct vision achieves relief of heavy bleeding in 80–85% of cases. D&C for molar pregnancy followed by hCG surveillance is curative in over 80% of patients with complete moles, with only 15–20% requiring additional chemotherapy for gestational trophoblastic neoplasia. The minimally invasive nature of the procedure — performed through the natural vaginal and cervical canal without abdominal incisions — means rapid recovery and minimal scarring.

D&C carries recognised risks that must be discussed with patients as part of informed consent. Uterine perforation is the most feared immediate complication, occurring in approximately 0.1–1% of cases; most perforations are small and clinically insignificant if recognised promptly, but a missed bowel injury requires laparoscopy or laparotomy. Cervical laceration from the tenaculum or dilators occurs in under 1%. Haemorrhage requiring transfusion is rare for elective procedures but more common in the context of molar pregnancy or retained products with placenta accreta spectrum. Post-procedural infection (endometritis) occurs in 1–3% and presents with fever, uterine tenderness, and discharge; managed with oral or IV antibiotics. Asherman syndrome (intrauterine adhesions) is the most important long-term complication from a fertility perspective — adhesions form in 1.5–7.7% of D&C cases from scarring of the basalis endometrium, and risk increases dramatically with repeat procedures, curettage of a post-partum uterus, or concurrent infection. Asherman syndrome causes hypomenorrhoea, amenorrhoea, and infertility; hysteroscopic adhesiolysis restores fertility in most cases. Anaesthetic risks are standard for brief general anaesthesia. Incomplete evacuation requiring repeat procedure occurs in approximately 2–5%.

Most patients are discharged home within 2–4 hours of the procedure once they are fully awake, comfortable, and tolerating oral fluids. Mild-to-moderate uterine cramping, similar to period pain, is expected for 1–5 days and managed effectively with regular ibuprofen and paracetamol. Vaginal bleeding or spotting typically continues for 1–2 weeks; sanitary pads are recommended over tampons for the first 2 weeks to reduce infection risk. Tampons, sexual intercourse, and swimming should be avoided for 2 weeks. A temperature above 38°C, heavy bleeding saturating more than one pad per hour, foul-smelling discharge, or severe abdominal pain should prompt immediate contact with medical services and may indicate infection or incomplete evacuation. A follow-up appointment at 4–6 weeks allows review of histopathological results, assessment of recovery, and discussion of management implications. For women who have had D&C for pregnancy loss, menstruation typically resumes within 4–8 weeks. For women desiring future pregnancy, no specific waiting period is required unless Asherman syndrome or other complications occurred — most specialists recommend waiting for 1–3 normal menstrual cycles before attempting to conceive.