What symptoms after a dilation and curettage (D&C) procedure require immediate medical attention?

Warning Signs After Dilation and Curettage (D&C)

Seek immediate medical attention if you experience severe abdominal pain, fever above 100.4°F (38°C), heavy bleeding (soaking through more than one pad per hour for 2+ hours), or signs of shock (dizziness, rapid heartbeat, weakness) after a D&C procedure. 1

Immediate Emergency Symptoms (Call 911 or Go to Emergency Department)

• Heavy, uncontrolled bleeding: Soaking through more than one pad per hour for two consecutive hours, or bleeding from both vaginal and other sites 1
• Signs of hypovolemic shock: Severe dizziness, fainting, rapid heartbeat (tachycardia), confusion, cold/clammy skin, or orthostatic hypotension 1
• Severe, unrelenting abdominal pain: Especially sharp pain that worsens or doesn't respond to prescribed pain medication, which may indicate uterine perforation or rupture 1
• High fever with chills: Temperature ≥100.4°F (38°C) accompanied by chills, which suggests infection or sepsis 1
• Chest pain or difficulty breathing: May indicate pulmonary embolism or other serious cardiopulmonary complications 1

Urgent Symptoms (Contact Your Provider Within Hours)

• Moderate to heavy bleeding: More bleeding than a normal heavy period, or passing large clots (larger than a golf ball) 1
• Persistent fever: Temperature between 99.5-100.3°F that doesn't resolve with acetaminophen 1
• Worsening abdominal pain: Pain that progressively increases over hours rather than improving 1
• Foul-smelling vaginal discharge: Particularly if accompanied by fever, suggesting endometritis or retained products of conception 1
• Severe nausea and vomiting: Inability to keep down fluids for more than 12 hours 1

Symptoms Requiring Next-Day Follow-Up

• Mild fever: Temperature 99-99.4°F without other concerning symptoms 1
• Moderate cramping: Cramping similar to menstrual cramps that is controlled with over-the-counter pain medication 1
• Light to moderate bleeding: Bleeding similar to or slightly heavier than a normal period 1
• Mild fatigue or weakness: Without signs of anemia or hypovolemia 1

Special Considerations for High-Risk Patients

If you have a history of prior cesarean section or uterine surgery, you are at significantly increased risk for uterine perforation at the scar site and should have an even lower threshold for seeking evaluation. 1 Any new or worsening abdominal pain in this population warrants immediate assessment, as the weakened scar tissue is more vulnerable to complications during instrumentation. 1

Patients with known bleeding disorders (such as von Willebrand disease) or those on anticoagulation therapy should be monitored more closely for hemorrhagic complications and may require earlier intervention for bleeding that would otherwise be considered "normal." 2, 3

Critical Pitfalls to Avoid

• Do not ignore persistent or worsening symptoms: Even if bleeding seems "moderate," progressive worsening over hours indicates the need for urgent evaluation 1
• Do not delay seeking care for fever: Post-procedure infections can progress rapidly to sepsis, particularly within the first 14 days after the procedure 4, 1
• Do not assume all bleeding is normal: While some bleeding is expected, soaking through pads hourly or passing large clots is never normal 1
• Do not perform vigorous physical activity or sexual intercourse until cleared by your provider, as this can precipitate bleeding or introduce infection 1

Expected Normal Recovery

For context, normal post-D&C symptoms include mild cramping (similar to menstrual cramps), light to moderate bleeding for up to 2 weeks, and mild fatigue. 1 These symptoms should progressively improve, not worsen. Any deviation from this improving trajectory warrants medical evaluation.

Timeline for Concern

Most serious complications occur within 14 days of the procedure, with the highest risk in the first 48-72 hours. 4 However, delayed complications such as retained products of conception with secondary hemorrhage or infection can occur up to several weeks post-procedure. 1 Maintain vigilance throughout the entire recovery period and do not hesitate to seek evaluation for any concerning symptoms.