Dilation and Curettage (D & C) refers to the process of dilating the cervical passage with the use of a vaginal speculum and scraping and collecting tissues from the lining of the uterine cavity through the use of a curette. The procedure is usually performed diagnostically to determine gynecological abnormalities though it is also done for therapeutic purposes in case of missed or incomplete abortion. The procedure can be done with regional or general anesthesia.
A woman may indicate to undergo D & C under the following circumstances:
- dysfunctional uterine bleeding(DUB)
- polycystic ovary syndrome
- retained product of conception(POC) like retained placenta
- missed or incomplete abortion.
Currently, D & C is now uncommonly used as a method of abortion where the World Health Organization (WHO) recommends D&C as a method of surgical abortion only when manual vacuum aspiration is unavailable.
Preoperative preparation of the patient:
- Admission is 24 hours before the operation
- NPO post-midnight
- Pre-op meds like analgesic, antiprostaglandin and a laxative
- Enema early morning on the day of operation
- Health education on what to watch for following operation like large blood clots and signs of impending infection
- Advised too that pending no complications, she may be discharged the same day of operation or after 24 hours
For most women undergoing such procedure present no discomfort except for mild cramps, backache, and of course the passing of small blood clots for a day or two. There will also be vaginal bleeding or staining for several weeks which is normal.
Postoperatively, the patient is monitored for signs and symptoms of complication which may include infection, uterine perforation and intrauterine adhesions which may directly or indirectly be caused by the operation itself. It is the responsibility of the nurse to assess and record any manifestation presented by the client. It is imperative too that the client be educated on what to look for after the operation so she can report it to the nurse for validation and further evaluation.
Nursing Care Plan (D&C) Dilation and Curettage
Potential for infection related to invasive procedure of dilation and curettage and tissue trauma during the procedure.
After a series of nursing interventions, the patient will be free from infection and will demonstrate knowledge on what to look for as signs of impending infection.
1. Obtain preoperative vital signs of the client.
2. Conduct health education before the operation on the following topics:
- Signs and symptoms of infection like increasing body temperature, foul-smelling discharges from the perineum, moderate to severe abdominal cramps
- Advice that should any sign of infection occurs, it must be reported immediately to the nurse on duty for validation and evaluation
a. Good perineal hygiene
b. Use of tampons is contraindicated, use perineal pads instead
c. No sexual intercourse until the vaginal discharge stops
3. Coordinate with the OR/DR team to ensure that aseptic technique will be maintained during the entire procedure of D & C.
4. Monitor for signs and symptoms of infection inclusive of vital signs and post D & C CBC count.
1. This will serve as the baseline data and a basis for comparison postoperatively.
2. Instructing clients on the signs and symptoms of impending infection gives them the idea of what to look for so immediate action and intervention can be sought.
a. Minimizes the entry of harmful microorganisms.
b. Tampons increase the risk for infection and delay tissue healing.
c. To allow tissue healing.
3. D & C is an invasive procedure and equipment and materials used during the operation may be a possible source of harmful microorganism, hence, everything should be sterile.
4. Prompt recognition and intervention of manifestations of infection prevent progression into a worse septic condition.
After a series of nursing interventions, the patient was free from infection and demonstrated an understanding of the possible signs and symptoms of impending infection.