Dilation and curettage procedure after a miscarriage

Dilation and curettage is a surgical procedure often performed after a first trimester miscarriage. In dilation and curettage, dilatation refers to the opening of the cervix; Curettage involves removing the contents of the uterus. Curettage can be done by scraping the uterine wall with a curette or by aspiration curettage (also called vacuum aspiration).

Do you need dilation and curettage after a miscarriage?

The process is for:

Removal of uterine tissue during or after a miscarriage or abortion, or to remove small pieces of the placenta after childbirth. This helps prevent infection or heavy bleeding.
Diagnosis or treatment of abnormal uterine bleeding. Dilation and curettage can help diagnose or treat growths such as fibroids, polyps, hormonal imbalances, or uterine cancer. A sample of uterine tissue is examined under a microscope to look for abnormal cells.
About 50% of women who have a miscarriage do not undergo dilation and curettage. Women can have a safe miscarriage with few problems in pregnancies that end before 10 weeks. After 10 weeks, the miscarriage is likely to be incomplete, requiring a dilatation and curettage procedure. Choosing a natural miscarriage or a dilatation and curettage procedure is often a personal choice best made after talking with your doctor.

For some women, the emotional toll of expecting a miscarriage is understandably too unpredictable and too great to handle in an already difficult situation. Healing for them may begin with a dilation and scraping procedure. Dilation and curettage may be recommended for women who have miscarried after 10 to 12 weeks, who have had complications, or who have medical conditions that may require emergency care.

How is dilation and curettage performed?

You can get dilation and curettage at your doctor's office, clinic, or hospital. It usually only takes 10-15 minutes, but you can stay in the office, clinic or hospital for up to five hours.

Your doctor will need your complete medical history and a signed consent form. Be sure to tell your doctor if:

You suspect you are pregnant
You are sensitive or allergic to any medications, iodine, or latex
You have a history of bleeding disorders or are taking any blood-thinning drugs

A sedative is usually given first to help you relax. General anesthesia is most commonly used, but intravenous anesthesia or paracervical anesthesia may also be used. You must be prepared to have someone drive you home after the procedure if general or intravenous anesthesia is used.

You may receive intravenous or oral antibiotics to prevent infection.
The cervix will be examined to determine if it is open. If the cervix is closed, dilators (narrow instruments of various sizes) will be inserted to open the cervix and allow passage of the surgical instruments. A speculum will be placed to hold the cervix open.
The vacuum aspiration procedure (also called aspiration curettage) uses a plastic cannula (flexible tube) attached to a suction device to remove the contents of the uterus. The diameter of the cannula in millimeters is approximately equal to the number of weeks of pregnancy. For example, a 7 mm cannula would be used in a 7 week pregnancy. A curette (sharp loop) can also be used to scrape the lining of the uterus, but this is often not necessary.
Tissue removed during the procedure can be sent to a pathology laboratory for examination.
Once the doctor finds that the uterus has become firm and the bleeding has stopped or is minimal, the speculum will be removed and you will be sent to convalesce.

Are there risks and complications?

Risks associated with anesthesia such as an adverse reaction to medication and breathing problems
Hemorrhage or heavy bleeding
Infection in the uterus or other pelvic organs
Perforation or puncture to the uterus
Laceration or weakening of the cervix
Scarring of the uterus or cervix, which may require further treatment
Incomplete procedure that requires another procedure to be performed

What to expect after dilatation and curettage

Most women are discharged from the surgical center or hospital a few hours after the procedure. If there are any complications or other health concerns, you may need to stay longer. You will most likely be prescribed an antibiotic to prevent infection and possibly pain medication to ease the initial cramping after the procedure.

What you need to know to take care of yourself at home:

Most women can return to normal activities within a few days, and some feel well enough to return to normal stress-free activities within 24 hours.
You may experience painful spasms at first, but they should not last more than 24 hours.
Mild cramping and bleeding can be expected from a few days to 2 weeks. Ibuprofen is usually recommended for the treatment of seizures.
You should not insert anything into the vaginal area (including showering or having sex) for at least 2 weeks or until the bleeding has stopped. Your doctor should give you specific instructions on when to resume intercourse.
Tampons should not be used until the next regular period begins, which may be between 2 and 6 weeks after the dilation and curettage procedure.
It is not known when ovulation will return, so once intercourse is allowed, you must use birth control until your doctor tells you that you can try to get pregnant again.
Be sure to come back for a follow-up appointment.

When to see a doctor

Most women experience several complications after a dilation procedure and a miscarriage curettage, but you should be aware of the symptoms that could signal a possible problem.

Your doctor should give you specific instructions on what to expect, but contact them as soon as possible if you experience any of the following:

Dizziness or fainting
Prolonged bleeding (over 2 weeks)
Prolonged cramping (over 2 weeks)
Bleeding heavier than a menstrual period, or filling more than one pad per -hour
Severe or increased pain
Fever
Chills
Foul smelling discharge