After her dilation and curettage (d&c) surgical procedure last October, Katie Ong was told that pregnancy after d&c, while possible, can be marred by complications. She was given a list of precautions including when and how to have sex.
Six months later, the 30-year-old was happy to report that she was expecting twins. Ong, who always had unusually heavy menstrual bleeding was recommended a d&c procedure by her doctor. This was after she shared her desire to become a mother.
As it turns out, the procedure was exactly what her body needed.
What is d&c and why is it done?
Whether it is to try for pregnancy after d&c or to get rid of heavy bleeding, the procedure’s two main functions are to diagnose and treat. | Image courtesy; Shutterstock
A notably minor surgical procedure, dilation and curettage is the removal of tissue from inside the uterus. The cervix (lower, narrow part of your uterus) is first dilated and a special instrument called curette is used to scrape off the uterine lining.
Doctors generally perform this surgery to treat specific uterine conditions, including heavy menstrual bleeding as in the case of Ong, or to rid the womb of remaining lining after an abortion or miscarriage.
However, there could be a few more notable reasons your doctor might suggest a d&c.
1) To diagnose a medical condition
Some women are often recommended a specific dilation and curettage procedure called endometrial sampling. This helps to diagnose three different types of conditions including:
- An abnormal uterine bleeding
- Post menopausal bleeding
- Abnormal endometrial cells to check for cervical cancer
In order to perform this test, your doctor will take a small portion of the tissue from your uterus lining (endometrium) and lab tests will determine if you have the following:
- Endometrial hyperplasia (a precancerous condition where the uterine lining becomes thick leading to unusual bleeding)
- Uterine cancer (a type of cancer that begins from the uterine lining and can increase the chances of hormonal imbalance and obesity)
- Uterine polyps (this is the overgrowth of typically non-cancerous cells in the lining of the uterus and could lead to heavy menstrual bleeding and bleeding post menopause).
2) To treat a condition
While performing a d&c, your doctor will remove a part of the uterine tissue to treat the following conditions:
- Clear out tissues that remain inside the uterus after a miscarriage or an abortion. This is done to prevent infection and even heavy bleeding.
- Removal of molar pregnancy, where a tumour gets formed inside the placenta, due to the abnormal growth of trophoblasts.
- A d&c is also done to remove remaining placenta from the uterus post delivery.
- It may also be undertaken to remove uterine polyps that are usually non-cancerous and benign.
The doctor generally performs d&c along with another procedure called hysteroscopy. In this procedure, a slim instrument with a light is inserted into the vagina, through the cervix and up into the uterus.
This allows the specialist to check the inside of your uterus. During the process, he or she can check the lining and even remove polyps and fibroids, as needed. The process ensures that pregnancy after d&c is possible and heavy bleeding is under control.
Now, if you are considering a d&c there are a few things you must know.
What Happens During D&C?
Post the anesthesia, you will be made to lie down on your back, as your legs rest on stirrups. | Image courtesy; Shutterstock
Your doctor will tell you that pregnancy after d&c is possible, but with a few necessary precautions. However, there are a few things you must know about the process itself.
Before the procedure, you will receive an anaesthesia based on your medical condition and history. This may be a general or local anaesthesia. The former numbs your entire body, and the latter, a small area.
During the d&c procedure you will have to go through the following:
- You will first have to lie down on your back, as your legs rest on stirrups.
- Your doctor will then insert a speculum, the slim instrument that enters your vagina through the cervix.
- The doctor will slowly insert a set of thick rods in order to open the cervix adequately.
- Your doctor will then insert a spoon-shaped or a suction device to remove a sample of the uterine tissues.
Due to the anaesthesia, you won’t feel any discomfort. But you will have to stay at the clinic or the hospital for a few hours post the procedure for a checkup. The doctor will check you for any post-op bleeding or complications.
As for the anaesthesia, if it was general, you may feel nauseated or even vomit. You may even have a sore throat if a windpipe was used to help you breathe. And even if you received local anaesthesia, you’ll still feel a bit drowsy for a few hours post the procedure.
The doctor may also inform you that pregnancy after d&c is not almost immediately recommended, And that a cooling off period of three to four months is required for you to heal before you try again.
Be mindful of the two main side effects of a d&c procedure.
- You may experience mild cramping
- There could be some spotting or light bleeding
If you experience any discomfort, your doctor may recommend a painkiller. However, the most important point to note would be to avoid putting anything into your vagina till the cervix goes back into its normal healed self.
This prevents bacterial infection in the vagina. You must also make sure to ask your doctor when you can possibly use tampons and have sex again.
Another point to note here are the timings of your period. Since it is at the moment still recovering, you may not get your periods at the same time next month. If you underwent a d&c due to a miscarriage, its best to ask your doctor when you can try and if immediate pregnancy after d&c is safe.
With that being said, as is the case with most surgical procedures, while d&c is safe, there could be rare but potential complications.
Potential Risks After The D&C Procedure
These complications are not as common, but chances of them occurring cannot be negated. These include the following:
- Perforation of the uterus. This complication can occur when a surgical instrument accidentally pokes a hole in the uterus. It can be more common in women who have just delivered or those who have gone through menopause. Although most perforations are minor, if an organ or an artery has been punctured, it can only be rectified through another surgery.
- Cervical damage. There could be a chance that the cervix gets damaged during d&c. If that happens, your doctor may apply pressure to stop the bleeding. Alternatively, the doctor may also give you sutures.
- Asherman’s syndrome. This is the most common complication after a d&c, especially for those who’ve had it done after a miscarriage. It is basically the formation of a scar tissue inside the uterine cavity. This can lead to painful bleeding or abnormal menstrual cycles, and even future miscarriages.
- Infection. A uterine or cervical infection after a d&c is rare, but it is a possibility. Which is why most doctors prefer to keep the patients under observation for a while before they are allowed a discharge.
After a d&c if you have the following symptoms of concerns, its best to notify the doctor immediately.
- Fever
- Heavy bleeding where you have to change the napkin every hour
- Cramps
- Foul-smelling vaginal discharge
Remember that complications are usually rare after this procedure and also that pregnancy after d&c is very much a possibility. However, the best way to ensure you are able to start a family is to keep your doctor abreast with your medical history and your condition post op.
Also read: Incompetent Cervix And Miscarriage
Sources: Healthline, Mayo Clinic, WebMD, Medline Plus