Uterine Infection After D&C: Incidence and Management
Uterine infections after dilation and curettage (D&C) procedures are uncommon, with infection rates of approximately 1-3% in uncomplicated cases. The risk varies based on patient factors, procedural circumstances, and whether prophylactic antibiotics were used.
Incidence of Infection After D&C
The evidence regarding infection rates specifically after D&C is limited, but we can draw conclusions from available research:
- In a study examining antibiotic use after D&C for metrorrhagia in women with negative vaginal-cervical cultures, only 4 out of 33 women (12%) in the antibiotic group and 3 out of 34 women (9%) in the no-antibiotic group developed pelvic inflammatory disease (PID) after the procedure 1
- This suggests that in healthy women without pre-existing infection, the baseline risk of developing PID after D&C is relatively low
Risk Factors for Post-D&C Infection
Several factors can increase the risk of infection following D&C:
- Pre-existing cervical or vaginal infections
- Retained products of conception
- Uterine perforation (a complication that occurs in approximately 1% of D&C procedures) 2, 3
- Prolonged procedure time
- Multiple procedures
- Immunocompromised state
Comparison to Other Procedures
For context, infection rates after other gynecological procedures are:
- After cesarean section without prophylactic antibiotics: 85-95% in high-risk women 4
- After cesarean section with prophylactic antibiotics: significantly reduced to approximately 24% 4
- After D&E (dilation and evacuation) for PPROM: only 1.3% infection rate compared to 23.9% with induction of labor 5
Prevention of Infection
Preventive measures to reduce infection risk include:
- Proper sterile technique during the procedure
- Screening and treatment of pre-existing infections before the procedure
- Consideration of prophylactic antibiotics in high-risk cases
- Complete evacuation of uterine contents to prevent retained tissue
Signs and Symptoms of Post-D&C Infection
Patients should be educated about potential signs of infection after D&C:
- Fever (temperature ≥38°C)
- Increasing abdominal pain or tenderness
- Foul-smelling vaginal discharge
- Prolonged or heavy bleeding
- Malaise or flu-like symptoms
Management of Post-D&C Infection
If infection occurs after D&C, management should follow similar principles to postpartum endometritis:
- Prompt initiation of antibiotics upon diagnosis 6
- First-line treatment typically includes clindamycin plus an aminoglycoside (gentamicin) 6
- Additional testing for sexually transmitted infections may be warranted 6
- Ultrasound evaluation to rule out retained products of conception
Conclusion
While uterine infection is a potential complication after D&C, it is relatively uncommon in uncomplicated cases with proper technique. Patients with risk factors may benefit from prophylactic antibiotics, though routine antibiotic prophylaxis is not universally recommended for all D&C procedures based on the available evidence.