Dilation (or dilatation) and curettage (D&C) is a gynecological procedure done by widening or opening the cervical canal and surgical removal of the uterine lining or uterine contents by scooping and scrapping (with the use of sharp curette) or suctioning (suction curettage).
It is a minor surgery done in ambulatory or outpatient surgery clinics or hospitals. D&C is considered to be either a diagnostic or therapeutic procedure depending on cases. It can be diagnostic if it pertains to determination for gynecological problems or malignancy (biopsy). Otherwise, it may be therapeutic if it used to halt bleeding from endometrial hyperplasia, endometrial polyps or myomas and sometimes because of first trimester abortions.
A physician may refer a client for D&C if she complains of menorrhagia known as excessive amount or duration of cyclic menstrual bleeding, metrorrhagia, termed as uterine bleeding between menstrual period and most especially if she may experience the so-called postmenopausal bleeding. These manifestations could be a symptom for several conditions that should not be ignored, like polyps, myoma (benign neoplasm of the uterus), or in some, endometrial cancer. Thus, this minor procedure is often used in line with hysteroscopy in order for the physician to view the uterus for the presence of some abnormal growths.
Dilation and curettage is performed with anesthesia. Depending on case to case basis, local, spinal or general anesthesias are used to allow the client to be unaware of pain involved during the procedure.
The physician and the nurse both have an important role in providing health teachings on the preparation prior to the procedure and the things that will happen during it. It is best to provide comfort and support to the client to relieve her fears about D&C and its results. The following preparations are made prior to D&C:
- Assessment of other medical conditions like cardiopulmonary diseases, pelvic infection, and bleeding tendencies.
- The client will undergo various tests like urinalysis, routine blood analysis, and other diagnostic tests to make sure that the client has no other illnesses that could hinder or complicate the procedure.
- Days prior to D&C, the client is advised not to take any unnecessary medications like aspirins, or take some alcohol.
- She is also advised not to take food or fluids 6 to 8 hours prior to the procedure to avoid aspiration of gastrointestinal contents while under anesthesia.
- Informed consent is properly obtained to ensure that the client understood and familiarized herself with the entire process and the things she would expect from the procedure.
It is performed in an operating room with strict maintenance of asepsis. The client is given the anesthesia and positioned with back lying and both legs flexed (like the position for Pap smear). The client is then prepped and draped properly. If the client is under general anesthesia, her vitals are being monitored by an anesthesiologist or an anesthesia nurse. During the procedure, the cervical canal is being dilated, by which the aftermath is being held open by a speculum. Curettage takes place by introducing a sharp curette to scrape or scoop the endometrial lining or uterine contents.
D&C would only last for more or less 20 to 30 minutes and after the procedure, the client may expect to experience some discomforts like cramping sensations and light bleeding which could last from half an hour to a day or days in some. Analgesics like NSAIDs are usually administered to relieve pain and the client is still being monitored and placed in a recovery room after it for an hour until she may able to move her lower extremities or until she is stable. Since this procedure is done as outpatient surgery, the client may be allowed to go home the next day if no untoward reactions occur. On the other hand, if the client is discharged, she will be not allowed to drive within 24 hours because drowsiness may still ensue due to anesthetic effects.
Despite being a safe gynecological method, some complications may be encountered.
- Introduction or spread of infection especially for clients with a pelvic infection which could be spread by the instruments used to other reproductive organs.
- Uterine perforation which could be detected by hemorrhage. This is due sometimes to the use of the sharp curette.
- Intrauterine adhesions could be referred to as Asherman’s syndrome– rarely it happens due to excessive scrapping of the uterine lining leading to the formation of scars. If this will not be treated, the possibility for more risks in future pregnancies may happen; for instance, miscarriages, abnormal placental presentations, and ectopic pregnancy.
Nowadays, this dilation and curettage is less likely used and recommended because of the availability of non-invasive diagnostic imaging procedures like ultrasound and hysteroscopy. The WHO even recommends this method only if manual vacuum aspiration is unavailable. This procedure may be linked to abortions but let it be known for the management of abortion complications.
Nursing care plans may involve nursing problems like fear, knowledge deficit, health-seeking behavior, volume fluid deficit and pain. It is very helpful to educate, too, the client to watch out for abnormal symptoms after the procedure, like:
- Fever
- Foul-smelling discharge from the vagina
- Excessive bleeding which may be prolonged in duration
- Excessive and persistent pain which is not relieved by any pain medications
References:
- Glickman, J. J. (1995). Phatom Notes Nursing: Maternal- Newborn 1st Edition. Info Access & Distribution Pte Ltd. Baginski, L. (2008).
- Dilation and Curettage. Retrieved last July 23, 2012 from www.medicinenet.com Stoopler, M. & Davis, C. Dilation and Curettage (D&C). Retrieved last July 20, 2012 from http://www.emedicinehealth.com
