The most common type of pregnancy loss is miscarriage according to the American College of Obstetricians and Gynecologists (ACOG). Studies reveal that 10-25% of clinically recognized pregnancies will end in miscarriage, and most of them occurs during the first 13 weeks of pregnancy.
The main concern of treatment during or after a miscarriage is to prevent hemorrhaging and/or infection. The earlier you are in your pregnancy, the more likely the body will expel all the fetal tissue by itself and no further medical procedures are required. If the body does not expel all the tissue, the most common procedure performed to stop bleeding and to prevent infection is D&C.
What is a D&C Procedure?
A D&C known as dilation and curettage, is a surgical procedure often performed after a first trimester miscarriage. Here, dilation refers to opening the cervix and curettage refers to removing the contents of the uterus. Curettage may be performed by scraping the uterine wall to remove the contents with a curette instrument or by a suction curettage; also called vacuum aspiration.
Is a D&C necessary after a miscarriage?
Women can safely miscarry on their own before 10 weeks without any major risks. After 10 weeks, the miscarriage may be incomplete, requiring a D&C procedure. Choosing whether to miscarry naturally (called expectant management) or to have a D&C procedure is often a personal choice that can be discussed with health care provider. For most first trimester miscarriages, expectant management should be a reasonable option. A D&C may be recommended for those who miscarry later than 10-12 weeks, which may require special medical care.
How is a D&C procedure performed?
A D&C may be performed as an outpatient or inpatient procedure either in a hospital or any other type of surgical center. General anesthesia is the commonly used sedative, but IV anesthesia or paracervical anesthesia may also be used. Be prepared to have someone to drive you home after the procedure if general or IV anesthesia is used.
You may be given antibiotics intravenously or orally to prevent infection.
The cervix will be examined in order to determine whether it is open or not. If the cervix is closed, dilators will be inserted to open the cervix in order to allow the surgical instruments to pass through. A speculum will be placed to keep the cervix open.
The vacuum aspiration procedure uses a plastic cannula attached to a suction device to remove the contents of the uterus. The diameter of cannula is decided based on the number of weeks gestation the pregnancy is. For example, a 7mm cannula would be used for a pregnancy that is 7 weeks gestation. The curette or a sharp-edged loop is used to scrape the lining of the uterus, but not necessarily.
The tissue removed during the procedure may be sent to a pathology lab for testing.
Once the uterus has become firm and the bleeding has stopped or is minimal, the speculum will be removed and you will be sent to recovery.
Risks and Complications of a D&C procedure
Hemorrhage or heavy bleeding
Risks associated with anesthesia include adverse reaction to medication and breathing problems
Perforation or puncture to the uterus
Infection in the uterus or other pelvic organs
Laceration or weakening of the cervix
Scarring of the uterus or cervix, which may require further treatment
Incomplete procedure may require another procedure to be performed
What to expect after the D&C Procedure?
Most women are discharged from the hospital within a few hours of the procedure based on the severity of complication. Antibiotics are used to prevent infection and possibly some pain medication are used to help with the initial cramping after the procedure.
The following points must be taken care of in order to avoid additional complications:
Most women can return to normal activities within a few days, and some may return to normal non-strenuous activity within 24 hours.
Light cramping and bleeding can be expected from a few days to up to 2 weeks. Ibuprofen is usually suggested for treating cramps. But this cramping may not last for long.
Avoid sexual intercourse for at least 2 weeks or until the bleeding stops. Your health care provider may give you specific instruction for when to resume the intercourse.
Tampons should not be used until you start your next regular period, anywhere from 2-6 weeks after the D&C procedure.
It is unknown when ovulation will return, so once sexual intercourse is allowed, use any method of contraception until your health care provider says it is okay to try to get pregnant again.
Make sure to attend the follow up appointment.
When to contact health care provider?
A few complications may occur after a D&C procedure, but one must be aware of symptoms that could signal a possible problem.
Consult the health care provider as soon as possible if you experience any of the following:
Prolonged bleeding (over 2 weeks)
Dizziness or fainting
Prolonged cramping (over 2 weeks)
Bleeding heavier than a menstrual period, or filling more than one pad per hour