Pros and Cons of a D&C After a Miscarriage

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Dilation and curettage (D&C) is a surgical procedure used to remove any remaining tissue from the uterus after a miscarriage or abortion. During the procedure, a spoon-shaped device called a curette is used to gently scrape the lining of the uterine wall. Suction (referred to as vacuum aspiration) can also be used to aid the process.

In some cases, a D&C is considered a medical necessity. For example, if you have heavy bleeding following a miscarriage, the procedure is the quickest way to stop the bleeding and prevent hypovolemia (excessive blood loss) and anemia.

In non-emergency situations, including an incomplete miscarriage, a D&C may not be considered medically necessary. In this case, you may be able to choose to allow the miscarriage to proceed at its own pace instead of having a D&C.

The decision between allowing a miscarriage to proceed naturally (often referred to as expectant management) or having a D&C to aid the process is an incredibly personal one that should be discussed with your doctor. If you are trying to decide whether having a D&C is the right choice for you, here is a closer look at the pros and cons of having a D&C after a miscarriage.

Weighing the Benefits of D&C

As you're weighing the risks and benefits of having a D&C, consider the medical advice of your doctor. They will help you make a decision that is informed and safe. There are several potential benefits of having a D&C after a miscarriage.

Shortens the Physical Process

A D&C is a single, scheduled event, whereas a natural miscarriage can be drawn out over days and even weeks. In addition to reducing physical symptoms like bleeding and cramping, some people choose a D&C because it helps them overcome the immediate emotional trauma of a miscarriage.

While it may not offer complete closure, a D&C can help some people gradually work through their emotions without experiencing constant physical reminders of the loss.

Minimal Physical Pain

A D&C can be performed under anesthesia or with sedation, and pain medication can be given. Some people have mild cramps after the D&C is complete, but are usually physically able to return to their normal routine within a day or two.

Lowers Certain Risks

There are risks associated with an incomplete miscarriage. For example, pregnancy remnants can cause prolonged bleeding and infection. A D&C is generally considered to be safe, but as with any surgery, it also carries its own risks. The majority of the possible complications of having a D&C are treatable.

Pregnancy Remains Aren't Visible

Seeing the pregnancy remains (including the remnants of the gestational sac and potentially the recognizable remains of the fetus) can make the experience of a miscarriage even more traumatic. During a D&C, you will not see the tissue that is removed.

Reduces Chance of Follow-Up Procedures

If you are having a miscarriage and the bleeding persists, the tissues have not entirely shed, or you are developing an infection, you will need medical intervention (including a D&C) to prevent complications. Having a D&C takes care of many of the medical needs right upfront.

Unlikely to Affect Future Pregnancies

Research does not support a clear association between D&Cs and an increased risk for complications (including preeclampsia, placental abruption, malpresentation, first trimester bleeding, or miscarriage) in future pregnancies.

Every person who experiences miscarriage will grieve differently. There is no "right" or "wrong" way to respond to a miscarriage, and how you feel about the process may influence the course of treatment you choose in a non-emergency situation. You can and should consider both your physical health and emotional well-being when weighing your options.

Weighing the Risks of D&C

As with any medical procedure, there are possible risks and complications of having a D&C.

It's an Invasive Procedure

Some people opt to let nature take its course if they are having a miscarriage rather than undergoing a procedure that feels "too clinical" or subjects them to unwanted anesthesia.

Can Make the Loss Feel Rushed

A person experiencing a miscarriage may feel like a D&C erases evidence of their loss and effectively rushes them through the grieving process. A natural miscarriage, regardless of how long as it takes, may allow them to gradually process the loss in tandem with the shedding of birth tissues.

Potential for Serious Complications

Having a D&C can sometimes lead to heavy bleeding, infection, and uterine or bowel puncture. The procedure has also been associated with a rare condition called Asherman syndrome in which bands of scar tissue (adhesions) form in the uterine cavity. While these outcomes are uncommon, any person considering a D&C should be aware of the possibility of these complications.

Small Risk of Cervical Insufficiency

Cervical insufficiency (an incompetent cervix) is the weakening of the cervical muscles and tissues. Weakness can cause premature dilation of the cervix, which can increase the risk of preterm birth or miscarriage. Research has shown that cervical insufficiency and the risk of preterm birth have more often been associated with repeated D&C procedures.

A Word From Verywell

A miscarriage can be an emotionally devastating experience. Making a decision about medical care during this time is not necessarily an easy choice.

Try to focus on safety first when assessing the pros and cons of having a D&C versus a natural miscarriage. If avoiding a D&C could cause you harm, the choice may be made for you. However, that doesn't mean you have to rush through the process of grieving your loss.

If you are unsure about which choice is right for you, ask your doctor for help. They can guide you through the process of making a decision and ensure that you get the physical and emotional care you need after.

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Article Sources
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  1. Kaiser Permanente. Information for Informed Consent for Dilation and Curettage (D&C), for Missed or Incomplete Spontaneous Abortion (Miscarriage).

  2. Lohmann-Bigelow J, Longo SA, Jiang X, Robichaux AG 3rd. Does dilation and curettage affect future pregnancy outcomes?Ochsner J. 2007;7(4):173-176. PMID:21603540

  3. Lemmers M, Verschoor MA, Hooker AB, Opmeer BC, Limpens J, Huirne JAF et al. Dilatation and curettage increases the risk of subsequent preterm birth: A systematic review and meta-analysisHum Reprod. 2016;31(1):34–45. doi:10.1093/humrep/dev274

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