WOMEN: GYNAECOLOGICAL OPERATIONS. DILATATION AND CURETTAGE (D&C)
This is the most commonly performed gynaecological procedure. It is used mainly to obtain endometrial tissue for examination under a microscope to determine the cause of abnormal uterine bleeding. D&C is a simple procedure. In Australia it is most often done with general anaesthetic, but local anaesthetic is also satisfactory.
After a bimanual examination to ascertain the size, shape and position of the uterus and other pelvic organs, a speculum is inserted into the vagina to bring the cervix into view. The cervix is held steady with forceps while the depth of the uterine cavity is sounded. The cervical canal is dilated to 6-7 mm in diameter (its undilated diameter is 2-4 mm) by inserting through it metal rods of gradually increasing thickness. A curette is then passed into the uterus to remove the endometrium, which separates very easily.
Other methods can be used to obtain samples of endometrium. Suction aspiration can remove the entire endometrium in the same way as does curettage. Other instruments have been designed that don’t need dilatation of the cervix for insertion into the uterine cavity and can be used with local or no anaesthetic. These instruments generally remove small fragments of the endometrium rather than all of it, and can be used when it’s not important to examine the entire uterine lining. When the purpose of the procedure is to exclude the possibility of endometrial cancer, curettage is preferred.
D&C may also be used for treatment, for instance to remove retained fragments of placenta after incomplete abortion or delivery. If heavy menstrual or irregular bleeding is due to endometrial hyperplasia, curettage can remove the overgrown endometrium. Recurrence of endometrial hyperplasia is prevented by correcting hormonal imbalance. Endometrial polyps also may be removed by curettage.
There are usually few after-effects from D&C: perhaps some mild cramps on the evening of surgery and light bleeding for a day or two afterwards. Complications are rare, but as with any surgical procedure infection, bleeding and anaesthetic complications are possible. Perforation of the uterus is very rare.
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