What to Expect From a D&C for Early Miscarriage

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A D&C, or dilation and curettage, is one of the most common surgical procedures performed on women. It's often used to complete a miscarriage in cases where the uterus fails to fully empty the contents of a failed pregnancy. It involves the use of a spoon-shaped device called a curette which gently scrapes the lining of the uterine wall.

A D&C is similar to the procedure used to induce an abortion before the 12th week of pregnancy, and may also be used to diagnose or treat abnormal uterine bleeding and to help diagnose uterine cancer.

Overview

A D&C may be medically necessary following a miscarriage. If a woman has unusually heavy bleeding as a miscarriage complication, a D&C can even be lifesaving because it stops the bleeding at the source. In other cases, a D&C might be used if the doctor feels the miscarriage is unlikely to complete without intervention.

Although D&C is used as a general term for surgical treatment of a miscarriage, in the first trimester the procedure is usually a D&A (dilation and aspiration), meaning the doctor uses a "suction curette" rather than a sharp curette to empty the uterus.

Benefits

Women who have D&Cs have lower rates of unplanned hospital admissions than women who have miscarriages with medical intervention or no intervention.

Psychologically, a D&C can also have benefits in that it ends the physical part of the miscarriage much more quickly. A D&C may also make it easier to collect a usable tissue sample for couples who want to pursue chromosomal testing on the fetus.

Risks

A D&C carries a small risk of complications such as puncturing the uterus, weakening the cervix (increasing the risk of later cervical insufficiency), and scarring the uterus. These complications are rare but can occasionally occur.

The risk of reaction to anesthesia is small, however, it may be a serious complication. If you have had a prior reaction to anesthesia, be sure to tell your doctor.

Personal Preferences

Every miscarriage is different. In some cases, a woman may request a D&C to complete the miscarriage rather than the uncertainty of waiting for nature to take its course. Other women may feel that a D&C is more emotionally traumatic than a natural miscarriage and choose to try to avoid having an invasive procedure.

Most doctors will respect the woman’s wishes in cases where natural miscarriage does not pose an immediate risk to the woman’s health.

Preparing

A D&C can be performed either in a hospital or a doctor's office. When scheduling the procedure, you will be given instructions to follow. You may be asked to avoid eating and drinking for a period of time before your appointment.

If your D&C takes place in a hospital, you will have to check-in and usually undergo a few routine presurgical tests before going to the surgical area.

What to Expect

The experience of a D&C depends on the type of anesthesia. With local anesthesia, the physical procedure may simply seem like a longer pelvic exam. A speculum is inserted into the vagina, local anesthesia is given, and the cervix is dilated. You may experience moderate to severe cramping during the procedure.

Many women prefer to have a D&C under general anesthesia or local anesthesia with sedation. If this is the case, you may simply wake up in a recovery area afterward without any memory of the procedure.

Recovery

Physical recovery following a D&C should be relatively swift. Most women can go back to work after a day or two. Your doctor can prescribe pain medication as needed for recovery. You may have vaginal bleeding and cramping for a few days, but it should not be severe or heavy. Your doctor will probably advise avoiding tampons and sexual intercourse for one to two weeks.

Contact a doctor if you have heavy bleeding or severe cramping, or if you have symptoms of infection following a D&C.

Most women will resume a normal menstrual period within six to eight weeks after a D&C, depending on how far along the pregnancy was when the miscarriage happened.

For couples hoping to try again, your doctor may advise waiting for one to two menstrual cycles to begin trying to get pregnant again, though some doctors say you can start trying again right after your next period.

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