Do I need a dilation and curettage (D&C) given that I am three weeks post‑miscarriage, have serum beta‑human chorionic gonadotropin (β‑hCG) of 6 IU/L, an endometrial thickness of 8 mm, and persistent red spotting with a negative pregnancy test?

No, You Do Not Need a D&C

Based on your clinical picture—hCG of 6 IU/L (essentially normalized), negative pregnancy test, and 3 weeks post-miscarriage—a dilation and curettage is not indicated at this time. Your findings are consistent with normal resolution of miscarriage, and the persistent spotting with an 8.2mm endometrial lining does not meet criteria for surgical intervention.

Why D&C Is Not Indicated in Your Case

Your hCG Level Indicates Complete Resolution

• An hCG of 6 IU/L is essentially at the threshold of normal non-pregnant levels (typically <5 IU/L), and your negative home pregnancy test confirms this 1
• After first-trimester pregnancy loss, hCG falls with a half-life of approximately 0.63 days initially, then 3.85 days over the subsequent 2 weeks, meaning most women reach undetectable levels within 2-4 weeks 1
• Persistent gestational trophoblastic neoplasia (the main concern requiring intervention) is defined by hCG that plateaus for 4 consecutive values over 3 weeks OR rises >10% for 3 values over 2 weeks—neither of which applies to you 2

Your Endometrial Thickness Is Not Concerning

• An 8.2mm endometrial stripe at 2.5-3 weeks post-miscarriage does not automatically indicate retained products of conception 3
• The endometrium naturally rebuilds after miscarriage as your menstrual cycle resumes
• D&C is indicated for endometrial sampling when thickness is >3-4mm in the context of abnormal bleeding requiring diagnostic evaluation for endometrial pathology—not in the post-miscarriage setting where some thickness is expected 4

Spotting at 3 Weeks Post-Miscarriage Is Within Normal Range

• Normal post-miscarriage bleeding can persist for 1-2 weeks, but some spotting extending to 3 weeks is not uncommon as the endometrium regenerates 5
• Red spotting without excessive bleeding (soaking >1 pad/hour for 2 consecutive hours), large clots (>quarter-sized), or severe pain does not indicate complications requiring surgical intervention 5

What You Should Monitor Instead

Continue Watchful Waiting With These Parameters

• Your pregnancy test is already negative, confirming hCG normalization—no further hCG monitoring is needed unless bleeding worsens or symptoms develop 2, 1
• Expect the spotting to resolve over the next 1-2 weeks as your first normal menstrual period approaches (typically 4-6 weeks post-miscarriage)

Seek Immediate Evaluation Only If You Develop Warning Signs

• Excessive bleeding: soaking through >1 pad per hour for 2 consecutive hours 5
• Large blood clots larger than a quarter 5
• Fever >100.4°F (38°C) with foul-smelling discharge or increasing pelvic pain—this triad suggests endometritis 5
• Severe abdominal pain not relieved by over-the-counter pain medication—may indicate rare complications like uterine perforation from the original miscarriage process 5

When D&C Would Actually Be Indicated Post-Miscarriage

Clinical Scenarios Requiring Surgical Intervention

• Persistent or rising hCG levels meeting gestational trophoblastic neoplasia criteria: plateau for 4 consecutive values over 3 weeks, rise >10% for 3 values over 2 weeks, or persistence beyond 6 months 2
• Hemodynamically significant bleeding with confirmed retained products on ultrasound (typically showing heterogeneous endometrial contents with increased vascularity on Doppler) 3
• Clinical signs of infection (endometritis) not responding to antibiotics, with suspected retained tissue 5

Important Caveat About Repeat D&C

• If D&C were needed, repeat curettage after initial miscarriage management has a 68% success rate in avoiding chemotherapy for persistent gestational trophoblastic disease, but is most beneficial when urinary hCG is <1,500 IU/L—your level of 6 IU/L is far below this threshold 2

Bottom Line for Your Situation

Your clinical picture—near-zero hCG, negative pregnancy test, and mild spotting at 3 weeks—represents normal resolution of miscarriage. The 8.2mm endometrial lining likely reflects early regeneration as your cycle restarts, not retained products. Continue monitoring for warning signs, but surgical intervention is not warranted based on current evidence-based guidelines 2, 5.