Dilation and sharp curettage (D&C) for abortion

Surgery Overview

Dilation and curettage (D&C) uses a sharp instrument to remove tissue from inside the uterus. It is a rarely performed type of surgical abortion done in the first 12 weeks (first trimester) of a pregnancy. D&C has an increased risk of bleeding and injury to the uterus compared with the usual procedure that uses suction to clear the uterus (manual or machine vacuum aspiration).¹

D&C may also be done to:

• Remove tissue that may remain after a miscarriage.
• Remove tissue in the uterus that may be causing abnormal vaginal bleeding. The tissue can then be examined to see if there are any abnormalities.
• Remove tissue that may remain after a vacuum aspiration abortion.
• Control heavy uterine bleeding.

A D&C usually takes less than 10 minutes. It is done in an outpatient surgery center or hospital and does not require an overnight stay. It can also be done at a clinic where health professionals are specially trained to perform abortions. The D&C procedure involves:

• Inserting a slowly expanding sponge or tube called an osmotic dilator into the cervix hours before the procedure, to slowly open (dilate) the cervix. A medicine called misoprostol is also used to soften and open the cervix. See an illustration of the reproductive organs .
• Giving general anesthesia, in most cases.
• Positioning you on the exam table in the same position used for a pelvic exam, with your feet on stirrups while lying on your back.
• Inserting a speculum into the vagina.
• Cleaning the vagina and cervix with an antiseptic solution.
• Grasping the cervix with an instrument to hold the uterus in place.
• Dilating the cervical canal further with a small probe, if necessary. Dilation reduces the risk of any injury to the cervix during the procedure.
• Passing a curved instrument (curette) into the uterus. The curette is used to gently scrape the lining of the uterus and remove the tissue in the uterus. Many women feel cramping and pain during this part of the procedure (if not receiving general anesthesia).

The tissue removed during the D&C will be examined to make sure that all of the tissue was removed and the abortion is complete.

If you and your health professional have planned ahead, this is a time when you can also have an intrauterine device (IUD) put in place for long-term birth control.

What To Expect After Surgery

Dilation and curettage (D&C) is a minor surgical procedure. A normal recovery includes:

• Irregular bleeding or spotting for the first 2 weeks. During the first week, avoid tampons and use only sanitary pads.
• Cramps similar to menstrual cramps, as the uterus shrinks back to its nonpregnant size. This can last for several hours to a few days.
• Emotional reactions for 2 to 3 weeks.

After the procedure:

• Antibiotics are given to prevent infection.
• Rest quietly that day. You can do normal activities the following day, based on how you feel.
• Acetaminophen (such as Tylenol) or ibuprofen (such as Advil) can help relieve cramping pain.
• Do not have sexual intercourse for at least 1 week, or longer, as advised by your health professional.
• When you start having intercourse again, use birth control, as well as condoms to prevent infection. For immediately effective birth control, you can use a barrier method (such as a diaphragm, cervical cap, or condom). An intrauterine device (IUD) is effective immediately after it is placed in the uterus. If you start hormone birth control pills, patches, or injections right after the procedure, be sure to use a backup method until the hormone medicine becomes effective. For more information, see the topic Birth Control.

Signs of complications

Less than 1% of all women who have an abortion have serious problems afterward.²

Call your health professional immediately if you have any of these symptoms after an abortion:

• Severe bleeding. Both medical and surgical abortions usually cause bleeding that is different from a normal menstrual period. Severe bleeding can mean:
  • Passing clots that are bigger than a golf ball, lasting 2 or more hours.
  • Soaking more than 2 large sanitary pads in an hour, for 2 hours in a row.
  • Bleeding heavily for 12 hours in a row.
• Signs of infection in your whole body, such as headache, muscle aches, dizziness, or a general feeling of illness. Severe infection is possible without fever.
• Severe pain in the abdomen that is not relieved by pain medicine, rest, or heat
• Hot flushes or a fever of 100.4°F (38°C) or higher that lasts longer than 4 hours
• Vomiting lasting more than 4 to 6 hours
• Sudden abdominal swelling or rapid heart rate
• Vaginal discharge that has increased in amount or smells bad
• Pain, swelling, or redness in the genital area

Call your health professional for an appointment if you have had any of these symptoms after a recent abortion:

• Bleeding (not spotting) for longer than 2 weeks
• New, unexplained symptoms that may be caused by medicines used in your treatment
• No menstrual period within 6 weeks after the procedure
• Signs and symptoms of depression. Hormonal changes after a pregnancy can cause postpartum depression that requires treatment.

Why It Is Done

Dilation and curettage (D&C) is usually done when another abortion method has failed to completely clear the contents of the uterus. D&C is done to be sure that no tissue is left in the uterus.

Vacuum aspiration is more commonly used for surgical abortion in the first trimester because it is safer than D&C.

How Well It Works

A surgical abortion during the first trimester is safe and effective and has few complications.

Risks

The risks of dilation and curettage (D&C) include:

• Injury to the uterine lining or cervix.
• Infection. Bacteria can enter the uterus during the procedure and cause an infection. This is more likely if an untreated disease, such as a sexually transmitted disease (STD), is present before the procedure. Symptoms of fever, pain, and abdominal tenderness will usually start within 2 to 3 days of the procedure. Antibiotics given during or after the procedure reduce the risk of infection.
• Excessive bleeding.

Rare complications include:

• A hole in the wall of the uterus (uterine perforation, rare), which most commonly happens during cervical dilation. Bleeding is usually minimal, and no repair is necessary. If bleeding is a concern, a laparoscopy (a procedure that uses a lighted viewing instrument) can be used to see whether it has stopped.
• Constant, excessive bleeding.
• Tissue remaining in the uterus (retained products of conception), usually causing recurring cramping abdominal pain and bleeding within a week of the procedure. However, prolonged bleeding sometimes does not occur until several weeks later.
• Blood clots. If the uterus doesn't contract to pass all of the tissue, the cervical opening can become blocked, preventing blood from leaving the uterus. The uterus becomes enlarged and tender, often with abdominal pain, cramping, and nausea. A repeat vacuum aspiration and medicine to stop bleeding are used to treat retained products of conception or blood clots.

Having two or more D&C abortions could create enough scar tissue to affect your future ability to become pregnant (infertility), as well as your risk of pregnancy complications. Such complications include implantation of a fertilized egg outside of the uterus (ectopic pregnancy), miscarriage, or growth of the placenta over the cervix (placenta previa).³

Undiagnosed ectopic pregnancy

It is possible to have an undiagnosed ectopic (tubal) pregnancy that isn't discovered until after a D&C procedure. Although the pregnancy test before the procedure is positive, the pregnancy is not in the uterus. Therefore, the abortion method does not end the pregnancy. Symptoms of an ectopic pregnancy that occur after an abortion procedure can include:

• Abdominal or pelvic pain that is getting worse.
• Pain with intercourse.
• Vaginal bleeding.
• Lightheadedness or fainting caused by blood loss.

What To Think About

Choosing a medical or surgical procedure for an abortion will depend on your medical history, how many weeks pregnant you are, what options are available where you live, and your personal preferences.

Vacuum aspiration is more commonly used in the first trimester because it is safer than D&C. (For more information on vacuum aspiration, see the Choices: Surgical Abortion section of this topic.)

Your health professional may recommend dilation and curettage (D&C) if there is concern that a vacuum aspiration procedure has left tissue behind in the uterus.

Postpartum depression can be triggered by changing pregnancy hormones after an abortion. If you have more than 2 weeks of symptoms of postpartum depression, such as fatigue, sleep or appetite change, or feelings of sadness, emptiness, anxiety, or irritability, see your health professional about treatment. Keep track of your symptoms with a postpartum depression checklist (What is a PDF document?).

Future pregnancy

An abortion is unlikely to affect your fertility, so it is possible to become pregnant in the weeks right after the procedure. Avoid sexual intercourse until your body has fully recovered, for at least 1 week or as advised by your health professional. When you do start having intercourse again, use birth control, and use condoms to prevent infection.

Two or more abortions using the sharp curettage (D&C) method may reduce your ability to become pregnant in the future.

The hospital or surgery center may send you instructions on how to get ready for your surgery or a nurse may call you with instructions before your surgery.

Right after surgery, you will be taken to a recovery area where nurses will care for and observe you. You will probably stay in the recovery area for 1 to 4 hours, and then you will go home. In addition to any special instructions from your doctor, your nurse will explain information to help you in your recovery. You will go home with a page of care instructions including who to contact if a problem arises.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

Author:	Healthwise Medical Writer	Last Updated October 6, 2006
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Lori A. Boardman, MD, ScM - Obstetrics and Gynecology
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