How soon after an 8-week miscarriage can a dilation and curettage (D&C) be performed?

Timing of D&C After an 8-Week Miscarriage

A dilation and curettage (D&C) procedure can be performed immediately after the diagnosis of an 8-week miscarriage is confirmed, with no required waiting period. 1

Management Options for Miscarriage

When a miscarriage is diagnosed at 8 weeks gestation, there are three primary management options:

1. Expectant management (waiting for natural passage)
2. Medical management (using medications to facilitate passage)
3. Surgical management (D&C)

Surgical Management (D&C) Timing

• D&C can be performed as soon as the miscarriage is diagnosed and confirmed
• There is no medical reason to delay the procedure
• The CDC guidelines indicate that surgical evacuation can be safely performed immediately following confirmation of pregnancy loss 1

Considerations for D&C Timing

Several factors may influence the decision on when to perform a D&C:

• Patient preference: Some women may prefer time to process the loss emotionally before proceeding
• Scheduling logistics: Availability of operating room and provider
• Medical stability: Ensuring the patient is hemodynamically stable
• Bleeding status: Heavy bleeding may necessitate more urgent intervention

Benefits of Prompt D&C

1. Reduced bleeding duration: Expectant management results in more days of bleeding compared to surgical management 2
2. Lower risk of incomplete miscarriage: Expectant management has a higher risk of incomplete miscarriage requiring later intervention 2
3. Psychological closure: Some women prefer definitive management for emotional closure
4. Tissue collection: Allows for collection of tissue for genetic testing if desired

Potential Risks to Consider

• Infection: Surgical evacuation carries a higher risk of infection compared to expectant management 2
• Future pregnancy complications: D&C procedures are associated with an increased risk of subsequent preterm birth 3
• Intrauterine adhesions: Multiple D&Cs increase the risk of Asherman syndrome 4

Special Considerations

For women with a history of prior uterine surgery (e.g., cesarean section):

• D&C remains safe but requires careful technique 5
• No additional waiting period is necessary

Follow-up After D&C

• Clinical follow-up within 1-2 weeks is recommended
• Contraception can be initiated immediately following the procedure if desired 1
• Patients should be counseled about when they can resume trying to conceive (typically after one normal menstrual cycle)

Conclusion

While a D&C can be performed immediately after diagnosis of an 8-week miscarriage, the decision should take into account the patient's clinical status, preferences, and the availability of services. There is no medical requirement for a waiting period before performing a D&C for an 8-week miscarriage.