D&C Stands for Dilation and Curettage
D&C stands for "Dilation and Curettage" (also written as "Dilatation and Curettage"), a surgical procedure involving cervical dilation followed by scraping or suctioning of the uterine lining. 1
Procedure Components
The procedure consists of two distinct steps:
- Dilation: The cervix is gradually opened (dilated) to allow access to the uterine cavity 1
- Curettage: The endometrial lining is scraped or removed using a curette instrument 1
Primary Clinical Applications
D&C serves multiple diagnostic and therapeutic purposes in reproductive medicine:
- Diagnostic evaluation: D&C provides definitive histologic sampling when office endometrial biopsy is inadequate or yields false-negative results (which occurs in 10% of cases) 1, 2
- Fertility-sparing assessment: D&C is the optimal method for obtaining accurate tumor grading when considering conservative management of grade 1 endometrial cancer or atypical hyperplasia in young women desiring fertility 2
- Miscarriage management: D&C is used for surgical management of first-trimester pregnancy failure 3
- Abnormal bleeding evaluation: When endometrial thickness exceeds 3-4mm on transvaginal ultrasound and symptoms persist despite negative office biopsy, fractional D&C under anesthesia is indicated 1, 2
Fractional D&C Technique
Fractional D&C provides comprehensive sampling by separately collecting tissue from the endocervix first, then the uterine cavity, allowing precise localization of pathology 1, 4
Important Safety Considerations
- Perforation risk: Endoscopists performing fewer than 500 diagnostic procedures are four times more likely to cause uterine perforation 5, 2
- Preterm birth risk: D&C is associated with increased risk of subsequent preterm birth (OR 1.29 for <37 weeks), with risk increasing further after multiple procedures (OR 1.74) 6
- Post-procedure monitoring: Watch for excessive bleeding (soaking more than one pad per hour for 2 consecutive hours), fever >100.4°F (38°C), or severe unrelieved abdominal pain 7, 5