Unfortunately, miscarriage is the most common type of pregnancy loss, according to the American College of Obstetricians and Gynecologists (ACOG). Studies reveal that anywhere from 10-25% of all clinically recognized pregnancies will end in miscarriage, and most miscarriages occur during the first 13 weeks of pregnancy.
Pregnancy can be such an exciting time, but with the great number of recognized miscarriages that occur, it is beneficial to be informed on miscarriage in the unfortunate event that you find yourself or someone you know faced with one.
The main goal of treatment during or after a miscarriage is to prevent hemorrhaging and/or infection. The earlier you are in the pregnancy, the more likely that your body will expel all the fetal tissue by itself and will not require further medical procedures. If the body does not expel all the tissue, the most common procedure performed to stop bleeding and prevent infection is a D&C.
What is a D&C Procedure?
D&C, also known as dilation and curettage, is a surgical procedure often performed after a first trimester miscarriage. Dilation means to open up the cervix; curettage means to remove the contents of the uterus. Curettage may be performed by scraping the uterine wall with a curette instrument or by a suction curettage (also called vacuum aspiration), using a vacuum-type instrument.
Is a D&C necessary after a miscarriage?
About 50% of women who miscarry do not undergo a D&C procedure. Women can safely miscarry on their own, with few problems in pregnancies that end before 10 weeks. After 10 weeks, the miscarriage is more likely to be incomplete, requiring a D&C procedure to be performed. Choosing whether to miscarry naturally (called expectant management) or to have a D&C procedure is often a personal choice, best decided after talking with your health care provider.
Some women feel comfort in going through a miscarriage in their own home, trusting their own body to do what it needs to. Some see this as a vital part of the healing process, eliminating the question of “what if?” about the health of the pregnancy. There are also many women who miscarry who have a history of gynecological problems and don’t want to risk the possibility of any more complications occurring from having a D&C procedure done. For most first trimester miscarriages, expectant management should be a viable option.
For some women, the emotional toll of waiting to miscarry naturally is just too unpredictable and too much to handle in an already challenging time. Healing for them may only start once the D&C procedure is done. A D&C may be recommended for women who miscarry later than 10-12 weeks, have had any type of complications, or have any medical conditions in which emergency care could be needed.
How is a D&C procedure done?
A D&C procedure may be done as an outpatient or inpatient procedure in a hospital or other type of surgical center. A sedative is usually given first to help you relax. Most often, general anesthesia is used, but IV anesthesia or paracervical anesthesia may also be used. You should be prepared to have someone drive you home after the procedure if general or IV anesthesia is used.
1) You may receive antibiotics intravenously or orally to help prevent infection.
2) The cervix is examined to evaluate if it is open or not. If the cervix is closed, dilators (narrow instruments in varying sizes) will be inserted to open the cervix to allow the surgical instruments to pass through. A speculum will be placed to keep the cervix open.
3) The vacuum aspiration (also called suction curettage) procedure uses a plastic cannula (a flexible tube) attached to a suction device to remove the contents of the uterus. The cannula is approximately the diameter in millimeters as 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 use of a curette (sharp edged loop) to scrape the lining of the uterus may also be used, but is often not necessary.
4) The tissue removed during the procedure may be sent off to the pathology lab for testing.
5) Once the health care provider has seen that the uterus has firmed up and that the bleeding has stopped or is minimal, the speculum will be removed and you will be sent to recovery.
What are the possible risks and complications of a D&C procedure?
- Risks associated with anesthesia such as adverse reaction to medication and breathing problems
- Hemorrhage or heavy bleeding
- Infection in the uterus or other pelvic organs
- Perforation or puncture to the uterus
- Laceration or weakening of the cervix
- Scarring of the uterus or cervix, which may require further treatment
- Incomplete procedure which requires another procedure to be performed
What to expect after the D&C Procedure:
Most women are discharged from the surgical center or hospital within a few hours of the procedure. If there are complications or you have other medical conditions, you may be kept longer. You will more than likely be given an antibiotic to help prevent infection and possibly some pain medication to help with the initial cramping after the procedure. Things to know about taking care of yourself at home:
- Most women can return to normal activities within a few days, and some feel good enough to return to normal non strenuous activity within 24 hours.
- You may experience some painful cramping initially, but this should not last longer than 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.
- You should not insert anything into the vaginal area, including douche and sexual intercourse, for at least 2 weeks or until the bleeding stops. (Your health care provider should give you specific instruction for when intercourse can resume.)
- Tampons should not be used until you start your next regular period, which could be anywhere from 2-6 weeks after the D&C procedure.
- It will be unknown when ovulation will return, so once sexual intercourse is allowed, you should use a method of contraception until your health care provider says it is okay to try to get pregnant again.
- Make sure to attend your follow up appointment.
When to contact your health care provider:
Most women experience few complications after a D&C procedure, but you should be aware of things that could signal a possible problem. Your health care provider should give you specific instructions on what you should expect, but you should contact them as soon as possible if you experience:
- Dizziness or fainting
- Prolonged bleeding (over 2 weeks)
- Prolonged cramping (over 2 weeks)
- Bleeding more than a menstrual period, or filling more than a pad an hour
- Severe or increased pain
- Fever over 100.4 °F or chills
- Foul smelling discharge
Compiled using information from the following sources:
Managing Complications in Pregnancy and Childbirth, World Health Organization http://www.who.int/
D & C for Miscarriage, Medem Medical Library, http://www.medem.com
A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M., Inc.; ©2005. D and C; [updated 2004 Apr 14; cited 2006 Jul 12]; [about 2 p.]. Available from: http://www.nlm.nih.gov/medlineplus/ency/article/002914.htm
Women’s Health Care: 20 Common Problems. Smith, Mindy, et al, Ch. 15, 2000.
William’s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 9.
Danforth Obstetrics and Gynecology Ninth Ed. Scott, James. Gibbs, et al, Ch. 9