Dilatation and curettage are medical procedures which are performed on the cervix and uterus. This procedure is performed by a physician in the medical practice of obstetrics and gynecology. Many times, the procedure is simply referred to as a “ D & C”.
During a dilatation and curettage procedure, the cervix is dilated and then the lining of the uterus is gently scraped away. This is a procedure often heard about when the topic of abortion arises, however, there are other medical circumstances that require dilatation and curettage such as miscarriage, menstrual irregularities, and biopsies for certain cancers.
In information obtained from nursing resources web site, according to the Centers for Disease Control, D&C only accounted for approximately 2.4% of abortions in the United States in the year 2002, which is down from 23.4% in the year 1972.
Anesthesia
Dependant upon the physician, and patient’s health, a D & C may be performed while the patient is fully awake with localized pain control to the surgical site, or while the patient is completely asleep under the use of general anesthesia. When local anesthesia is chosen, an orally administered sedative/relaxant, may be given prior to the injection of numbing medication to the cervical/uterine area to help the patient to relax throughout the duration of the D & C procedure. Little to no discomfort is felt with the combination use of local anesthesia.
There is also the chance that the physician may choose not to use a sedative/relaxant, and instead, perform the D & C under local cervical/uterine numbing injection only. There is the possibility of patients feeling some discomfort without the prior administration of a relaxant/sedative, but the discomfort may be largely in part to nervousness, and/or fear of the procedure.
If the physician chooses to perform the procedure under the use of general anesthesia, an intravenous line is inserted into a vein and fluids, along with any other required injected medications, are given via the I.V. before inhalation of the general anesthetic is given. A breathing tube will be placed into the windpipe to control breathing mechanically. The breathing tube is needed due to the reasons that general anesthesia is so powerful, that the patient may stop breathing independently, and so that the physician can maintain an open airway in the event of an emergency.
How Dilatation is Performed
The first segment of the procedure involves dilating the female cervix. The first instrument used in the procedure will be the placement of a speculum into the vagina to create access to the cervix. An antiseptic solution will be used prior to beginning the actual dilatation to cleanse the area thoroughly to aid in the defense of infection. There are a few ways the physician may use to achieve the results of successful dilation.
The first method involves possibly using a medication, such as cervidil or cytotek, to cause the cervical tissue to widen medicinally. These types of medications are also sometimes used in the induction of pregnancy.
Another possible dilatation method can be accomplished by using an instrument called a lamanaria. The lamanaria is a small rod instrument that is placed inside the cervical opening to cause the cervical secretions to be absorbed. Absorption of the cervical secretions for the duration of several hours causes the cervical walls to become swollen, and thus they dilate the opening to expose the uterus.
There is also a method that is simply called synthetic dilation. With synthetic dilation, narrow rods are inserted into, and just beyond the cervical opening. The rods gradually increase in width until dilation is complete.
How Curettage is Performed
The second segment of the procedure, curettage, is the gentle scraping away of the lining of the uterus. A small instrument, called a curette, is maneuvered all along the internal surface of the uterus by the physician. The curette has a handle on one end, and a loop-shaped end which scrapes the uterine lining away.
In some cases, the physician may opt to use suction aspiration along with the use of a curette. The suction method of curettage is similar to single curette usage except that it acts as a vacuum which draws the uterine lining away from the uterus. After suction aspiration is complete, the performing physician will inspect the uterus with the a curette to ensure completion of the lining/tissue removal. After completion of the procedure, the uterine lining that has been collected will be sent to pathology for testing. By the time of the post-procedure visit with the physician, the results of the D & C should be ready to relay to the patient.
Sources:
“Dilation and sharp curettage (D&C) for abortion”. Women’s Health. WebMD. 2004-10-07. Retrieved 2007-04-29.
List of Medical Procedures | Nursing-Resource.com on June 26, 2010
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www.womenshealth.ca
www.medicineplus.gov
