Overview

Dilation and Curettage (D&C) is a surgical procedure used to dilate the cervix and scrape the uterine lining. It is performed for diagnostic and therapeutic purposes.

D&C is crucial for treating incomplete abortion, abnormal uterine bleeding, and obtaining endometrial tissue for histological examination.

Indications

Incomplete Abortion

Retained products of conception

Abnormal Uterine Bleeding

Heavy or irregular bleeding

Endometrial Sampling

Diagnostic evaluation

Postmenopausal Bleeding

Evaluation of bleeding

Molar Pregnancy

Evacuation of molar tissue

Contraindications

Absolute Contraindications

Patient refusal
Active cervicitis
Pregnancy (if not intended)

Relative Contraindications

Coagulopathy
Severe medical conditions

📋 Equipment Checklist

Check off items as you gather them:

Pre-procedure Preparation

Preparation includes patient consent, anesthesia, sterile technique, and proper positioning. All equipment should be ready.

Step-by-Step Procedure

Step 1: Patient Preparation

Explain procedure, obtain consent, position patient.

⚠️ Common Mistakes to Avoid:

  • Inadequate consent
  • Poor positioning

💡 Pro Tip:

Position patient in lithotomy position.

Step 2: Anesthesia

Administer local or general anesthesia.

⚠️ Common Mistakes to Avoid:

  • Inadequate anesthesia
  • Wrong type

💡 Pro Tip:

Use appropriate anesthesia.

Step 3: Cervical Dilation

Dilate cervix gradually.

⚠️ Common Mistakes to Avoid:

  • Too rapid dilation
  • Cervical trauma

💡 Pro Tip:

Dilate gradually to avoid trauma.

Step 4: Curettage

Scrape uterine cavity systematically.

⚠️ Common Mistakes to Avoid:

  • Incomplete curettage
  • Uterine perforation

💡 Pro Tip:

Curette systematically.

Step 5: Tissue Removal

Remove all tissue and clots.

⚠️ Common Mistakes to Avoid:

  • Incomplete removal
  • Retained tissue

💡 Pro Tip:

Ensure complete evacuation.

Step 6: Hemostasis

Ensure adequate hemostasis.

⚠️ Common Mistakes to Avoid:

  • Bleeding
  • Hematoma

💡 Pro Tip:

Check for bleeding before completion.

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Post-procedure Care

Post-procedure care involves monitoring for complications, pain management, and patient education.

Complications & Management

Complication Incidence Signs Management Prevention
Uterine perforation 1-3% Abdominal pain, bleeding Laparoscopy, observation Gentle technique
Cervical trauma 2-5% Cervical bleeding Suturing, pressure Gradual dilation
Infection 3-8% Fever, foul discharge Antibiotics Sterile technique
Asherman syndrome 1-2% Amenorrhea, infertility Hysteroscopy, lysis Gentle curettage

Clinical Pearls

💡

Dilate cervix gradually to avoid trauma.

🎯

Curette systematically in all quadrants.

Ensure complete evacuation of tissue.

🔍

Check for uterine perforation.

📊

Use sterile technique throughout.

🎨

Document all findings carefully.

⚠️

Monitor for complications post-procedure.