Hysteroscopic Dilation and Curettage (D&C): Pre-procedure Requirements and Potential Risks
Prior to undergoing a hysteroscopic dilation and curettage (D&C), patients should be referred to specialized centers for comprehensive evaluation including transvaginal ultrasound, complete pathology assessment, and possibly pelvic MRI to exclude myometrial invasion when endometrial abnormalities are suspected. 1, 2
Pre-procedure Requirements
Diagnostic Workup
- Complete clinical and gynecological examination including inventory of comorbidities and geriatric assessment when appropriate 1
- Transvaginal ultrasound to characterize uterine pathology 1
- Pregnancy testing to exclude pregnancy (which is a contraindication) 3
- Assessment of hemoglobin levels if heavy bleeding is present 1
Timing Considerations
- For premenopausal women with regular menstrual cycles, the optimal timing is during the follicular phase after menstruation for better visualization 3
- Patients requiring pre-operative optimization (particularly those with hemorrhagic shock, severe anemia, or infection) should be admitted for stabilization 2
Special Circumstances Requiring Admission
- Patients with atypical hyperplasia/endometrial intraepithelial neoplasia (AH/EIN) or grade 1 endometrioid endometrial cancer (G1 EEC) 1, 2
- Cases requiring specialist gynaecopathologist confirmation of diagnosis 2
- Patients with unstable vital signs or significant comorbidities that increase procedural risk 2
- Patients undergoing D&C as part of fertility-preserving therapy protocols 1, 2
Potential Risks and Complications
Common Complications
- Uterine perforation (rate 0.76%), with approximately half being entry-related 4
- Bleeding requiring intervention (rate 0.16%) 4
- Cervical laceration during dilation 5
Procedure-Specific Risks
- Diagnostic hysteroscopy has a significantly lower complication rate (0.13%) compared to operative procedures (0.95%) 4
- Fluid overload of distention medium (rate 0.20%) 4
- Risk varies by procedure type: intrauterine adhesiolysis (4.48%), endometrial resection (0.81%), myomectomy (0.75%), and polyp removal (0.38%) 4
Post-Procedure Considerations
- Post-operative bleeding typically lasts approximately 7 days 6
- Resolution of serum β-hCG (if pregnancy-related) takes approximately 14 days 6
- Potential for treatment failure requiring additional interventions, particularly in cases of cesarean scar pregnancy 6, 7
Risk Mitigation Strategies
- Avoid unnecessary dilation of the cervix and introduce the hysteroscope under direct vision to reduce entry-related complications 4
- Consider cervical preparation for patients at higher risk of cervical stenosis or anticipated procedural pain 3
- Ensure proper selection of distending medium based on compatibility with electrosurgical instruments 5
- Prioritize patient safety and comfort with appropriate analgesia regimens, particularly for office-based procedures 3
- Consider hysteroscopic approach over ultrasound-guided D&C when possible, as it may result in less intraoperative blood loss and fewer complications 7