Warning Signs After Dilation and Curettage (D&C)
After a dilation and curettage (D&C) procedure, patients should be monitored for several warning signs that may indicate complications, with heavy bleeding, severe pain, and signs of infection being the most critical to recognize and address promptly.
Key Warning Signs to Monitor
Bleeding
- Excessive bleeding - Soaking through more than one pad per hour for 2 consecutive hours requires immediate medical attention 1
- Large blood clots (larger than a quarter) may indicate incomplete evacuation or uterine atony 1
- Persistent bleeding beyond 1-2 weeks should be evaluated, as normal post-procedure bleeding typically decreases gradually 1
Pain
- Severe abdominal pain that is not relieved by prescribed pain medication may indicate complications such as uterine perforation or infection 1
- Cramping is expected after D&C but should gradually improve; worsening pain suggests complications 1
- Shoulder pain may indicate diaphragmatic irritation from intra-abdominal bleeding, potentially from uterine perforation 2
Signs of Infection
- Fever (temperature >100.4°F or 38°C) suggests possible infection 1
- Foul-smelling vaginal discharge indicates potential endometritis or other infection 1
- Increasing pelvic tenderness with fever and discharge forms the classic triad of post-procedural infection 1
Other Critical Warning Signs
- Syncope or dizziness may indicate significant blood loss or vasovagal response 1
- Nausea and vomiting with abdominal pain could suggest peritoneal irritation from perforation 2
- Prolonged bleeding with rising or plateauing hCG levels after molar pregnancy evacuation requires immediate evaluation for persistent gestational trophoblastic neoplasia 1
High-Risk Complications
Uterine Perforation
- Occurs in approximately 1% of D&C procedures 3
- May present with:
- Acute severe pain during or after procedure
- Signs of intraperitoneal bleeding (hypotension, tachycardia)
- Visible intestinal tissue in vagina (rare but serious) 2
- Women who are <15 weeks postpartum have significantly higher risk of perforation 3
Infection (Endometritis)
- Presents with fever, pelvic pain, and purulent discharge 1
- Risk increases with:
- Retained products of conception
- Pre-existing infection
- Prolonged procedure time 1
Incomplete Evacuation
- May present as continued bleeding or persistent symptoms 1
- Can lead to persistent or recurrent undiagnosed bleeding requiring further evaluation 4
Asherman Syndrome
- Intrauterine adhesions following D&C can cause:
- Amenorrhea
- Infertility
- Recurrent pregnancy loss
- Future preterm birth (OR 1.29,95% CI 1.17-1.42) 5
Special Considerations
Post-Molar Pregnancy D&C
- hCG monitoring is essential - levels should be checked every 1-2 weeks until normalized (defined as 3 consecutive normal assays) 1
- Warning signs of persistent gestational trophoblastic neoplasia include:
- hCG levels that plateau for 4 consecutive values over 3 weeks
- hCG levels that rise >10% for 3 values over 2 weeks
- hCG persistence 6 months or more after molar evacuation 1
Post-Endometrial Biopsy/D&C for Cancer Evaluation
- Persistent or recurrent abnormal bleeding, even with normal initial biopsy results, warrants further evaluation 4
- Office endometrial biopsies have a false-negative rate of approximately 10%, requiring follow-up with fractional D&C under anesthesia if negative but symptoms persist 4
When to Seek Immediate Medical Attention
- Heavy bleeding (soaking >1 pad/hour for 2+ hours)
- Severe pain unrelieved by medication
- Fever >100.4°F (38°C)
- Foul-smelling vaginal discharge
- Signs of shock (dizziness, rapid pulse, low blood pressure)
- Visible tissue in vaginal discharge 2