DILATATION
AND
CURETTAGE
• D & C is a gynecological procedure
in which the cervix is dilated and
the lining of the uterus
Dilatation and (endometrium) is scraped away.
curettage • Is one of the most common
gynecological procedure.
• Refers to the process of dilating the
cervical passage with the use of a
vaginal speculum and scraping and
DILATION collecting tissues from the lining of the
uterine cavity through the use of a
AND curette.
• The procedure is usually performed
CURETTAGE diagnostically to determine
(D & C) gynecological abnormalities though it is
also done for therapeutic purposes in
case of missed or incomplete abortion.
• The procedure can be done with
regional or general anesthesia.
Diagnostic D&C
REASONS ▪ In some cases, the procedure is
FOR D&C used to gain information about
the uterus to diagnose a
medical condition
❑Therapeutic D &C
▪ In other cases, the procedure is
used to treat a medical problem
or condition.
• The primary reason for a
diagnostic D&C is to obtain and
examine samples of the
endometrium (lining of the
uterus).
Diagnostic • This may be done because of
abnormal uterine bleeding;
D&C following abnormal results from
a previous endometrial biopsy,
test, or imaging study; or, in
rare cases, to look for evidence
of pregnancy tissue in a woman
with an early abnormal
pregnancy
• is sometimes done in combination with
another procedure called hysteroscopy
• This involves dilating the cervix and
inserting a narrow camera to examine and
Diagnostic photograph the inside of the uterus.
• The images are displayed on a monitor,
D&C allowing the physician to directly see the
endometrium.
• This helps the physician to avoid missing any
structural findings (eg, polyps or fibroids)
that may be inside the uterus and to take a
sample of the most visibly abnormal areas.
• After diagnostic D&C, a pathologist
Diagnostic examines the tissue with a microscope
to evaluate for certain conditions such
D&C as endometrial polyps, precancer of the
lining of the uterus (endometrial
hyperplasia), or endometrial (uterine)
cancer.
Therapeutic D&C is done to remove the
contents of the uterine cavity in the
following circumstances:
• Miscarriage — In some miscarriages, the
Therapeutic tissues from a pregnancy are passed
completely. In other cases, a D&C is
D&C needed to remove this tissue or to ensure
that all of it has been passed.
• Abortion — A D&C is one method that can
be used when a woman chooses to
terminate (end) a pregnancy.
• Treatment of molar pregnancy — A
molar pregnancy is an abnormal
pregnancy in which a tumor forms in
place of normal placenta. D&C is the
standard treatment for molar
pregnancy.
Therapeutic • Prolonged or excessive vaginal
D&C bleeding — A D&C may be done as a
treatment in some cases of
prolonged or excessive uterine
bleeding that do not respond to
medical treatment.
• Pregnancy:
Contraindications • Allergy: Those with a known
OF D&C allergy to anesthetic drugs
may also be placed at risk
during the procedure.
• Excessive bleeding problems
• Retained pregnancy tissue
A D&C may be recommended for
management of bleeding or to
Therapeutic identify and remove retained
D&C (unpassed) pregnancy or placental
tissue following miscarriage,
abortion, or delivery.
• CBC,BT
PREPARING • Urine analysis
• And many more depends on
FOR D&C case of client
• A nurse may place an intravenous
line (IV), which can be used to give
fluids and medicine before, during,
PREPARING and after the procedure.
FOR D&C • The nurse or doctor will review your
medical history, list of medications
used, and any drug allergies.
• Obtaining consent
PREPARING • Perineal preparation
• Changing gown
FOR D&C • Removing of jewelries, nail
polish
• can be performed in an operating room in a
D&C hospital, in an outpatient clinic, or in an
outpatient surgery center.
PROCEDURE • Your blood pressure, pulse, and blood oxygen
levels are monitored during the procedure.
• The procedure itself typically takes only 15 to
30 minutes to complete.
• The procedure can be done
using general, regional, or
local block anesthesia.
Anesthesia • The type of anesthesia
chosen depends upon the
reason for the procedure as
well as your medical history.
Preoperative • Admission is 24 hours before the operation
preparation • NPO post-midnight
• Pre-op meds like analgesic, antiprostaglandin and a
of the laxative
• Enema early morning on the day of operation
patient: D&C • Health education on what to watch for following operation
like large blood clots and signs of impending infection
• Advised too that pending no complications, she may be
discharged the same day of operation or after 24 hours
• For most women undergoing such
procedure present no discomfort
except for mild cramps, backache, and
D&C of course the passing of small blood
clots for a day or two.
• There will also be vaginal bleeding or
staining for several weeks which is
normal.
• Postoperatively, the patient is monitored
for signs and symptoms of complication
which may include infection, uterine
perforation and intrauterine adhesions
which may directly or indirectly be caused
by the operation itself.
D&C • It is the responsibility of the nurse to
assess and record any manifestation
presented by the client.
• It is imperative too that the client be
educated on what to look for after the
operation so she can report it to the nurse
for validation and further evaluation.
❑ Obtain preoperative vital signs of the
client.
o This will serve as the baseline data and a
Nursing basis for comparison postoperatively.
Intervention: ❑ Conduct health education before the
operation on the following topics:
D& C • Signs and symptoms of infection like
increasing body temperature, foul-smelling
discharges from the perineum, moderate to
severe abdominal cramps
• Advice that should any sign of
infection occurs, it must be
reported immediately to the
Nursing nurse on duty for validation and
evaluation
Intervention: • Instructing clients on the signs
D& C and symptoms of impending
infection gives them the idea of
what to look for so immediate
action and intervention can be
sought.
• Good perineal hygiene
o Minimizes the entry of harmful
Nursing microorganisms.
• Use of tampons is
Intervention: contraindicated, use perineal pads
instead
D& C oTampons increase the risk for
infection and delay tissue healing.
• No sexual intercourse until the
vaginal discharge stops
o To allow tissue healing.
❑Coordinate with the OR/DR
team to ensure that aseptic
Nursing technique will be maintained
during the entire procedure of
Intervention: D & C.
D& C
❑Monitor for signs and
symptoms of infection inclusive
of vital signs and post D & C
CBC count.
❑D & C is an invasive procedure
and equipment and materials
used during the operation may
be a possible source of harmful
D& C microorganism, hence,
everything should be sterile.
❑ Prompt recognition and
intervention of manifestations
of infection prevent progression
into a worse septic condition.
❑Explain that the onset of the next menstrual
period may be delayed.
❑ Explain that intercourse should be avoided until
after the postoperative checkup and after vaginal
discharge has ceased.
D& C This precaution reduces the risk of infection.
❑Instruct the woman to rest for several days after
surgery, avoid heavy lifting and report any
bleeding that is bright red or exceeds that of a
normal menstrual period.
❑Vigorous activity, lifting, or straining interferes
with healing and may cause hemorrhage.
• D&C is a commonly performed procedure
that is usually very safe. As with any
operation, complications can occur.
D&C Potential complications of D&C include:
COMPLICATIONS 1. Uterine perforation —
▪ A uterine perforation is when one of the
surgical instruments makes a hole in the
uterus.
▪ It is more common when the procedure is
done during or just after pregnancy since
the uterine wall is softened by pregnancy.
2. Cervical injury
▪ Injuries to the cervix can occur
during dilation or from the
curette itself.
D&C ▪ Lacerations (cuts) to the cervix
are managed with pressure to the
COMPLICATIONS area, application of medications
that help stop bleeding, or, in
some cases, stitches or a balloon
to hold pressure on the cervix.
3. Bleeding
▪ It is uncommon to have excessive
bleeding or require a transfusion
D&C following a D&C.
COMPLICATIONS ▪ Call your doctor or go to the
emergency department right away if
you fully soak through two or more
pads or tampons in two hours and
are still bleeding.
4. Infection
▪ Infection from a D&C is rare.
D&C ▪ If you have a fever, pain that is
COMPLICATIONS getting worse instead of better, or
foul-smelling vaginal discharge after
a D&C, contact your doctor's office.
5. Intrauterine adhesions
▪ Adhesions (areas of scar tissue) can form
in the uterus following D&C in rare cases.
▪ Adhesions occur most commonly when
there is also a uterine infection and the
D&C D&C is performed during or after
COMPLICATIONS pregnancy.
▪ In some cases, this can lead to
abnormalities in the menstrual cycle or
problems with future pregnancies.
• Dilation and evacuation is the
DILATION dilation of the cervix and
surgical evacuation of the
AND uterus after the first trimester
EVACUATION of pregnancy.
• It is a method of abortion as
(D & E) well as a common procedure
used after miscarriage to
remove all pregnancy tissue
• D & E is used for pregnancies up to 12 –
24 weeks (3months – 6 months).
• The cervix is dilated using osmotic
dilators.
Dilation and • The osmotic dilators are either synthetic
evacuation or rods made of seaweed which absorb
moisture and slowly expand the cervix.
• The dilators are inserted into the cervix
24 hours before the surgery for maximum
expansion.
• Once dilation is done, the fetus is
removed using a forceps.
• Dilation and evacuation (D&E) is
performed during the second
trimester and is similar to D&C.
• Like a D&C it uses vacuum
aspiration, but unlike D&C, the
doctor uses additional instruments
to remove the tissue (such as a
forceps).
• You should be able to resume most
regular activities within a day or
two.
Recovery at • Mild cramping and spotting may
home occur for a few hours or days;
cramping can be treated with
nonsteroidal anti-inflammatory
medications (NSAIDs) such as
ibuprofen (Advil, Motrin) or
naproxen (Aleve).
• You should not put anything inside
the vagina (tampons, douches)
during this time and should ask
when you can safely have sexual
intercourse
Recovery at • If you have not yet gone through
menopause, your next menstrual
home period usually occurs within two to
six weeks of the procedure,
depending on the reason why the
D&C was performed.
• To avoid hemorrhaging and/or
infection, it is important that for the
following weeks, until your bleeding
completely stops, you take the
RECOVERY AT following precautions:
HOME * Avoid swimming
* Avoid introducing objects in your
vagina, including tampon and the
menstrual cup
• Avoid sex (vaginal penetration) for
at least 1 week after using the pills
(if this is not possible, it is important
to use a condom to prevent
RECOVERY AT infection and/or a pregnancy) - yes
you can get pregnant .
HOME • Avoid intense physical activity
(exercising, carrying, pushing or
pulling heavy objects, walking more
than normal, or walking up too
many flights of stairs).
DILATATION &
CURETTAGE
INSTRUMENT
1.Vaginal speculum
2.Hysterometer
3.Uterine forceps
4.Allis forceps
DILATATION 5.Tenaculum
6. Goose forceps
&CURETTAGE 7. Curette
INSTRUMENTS 8. Ovum forceps
9. Alligator forceps
10.*cotton balls
11. *Os
• Can be placed anywhere……..just drop from 4-
8 inches high from the table.
Ovum
forceps
a specialized surgical instrument always with two
parts that move together to hold something such as
dressings , tissues or organs.
CURETTE
a spoon-shaped surgical instrument used for
cleaning and scraping a diseased surface.
Vaginal
speculum
• a bivalve instrument
with two opening use it
to open the walls of the
vagina and examine the
vagina and cervix.
Allis
this has a scissors action wherein
each jaw curves slightly inward
with a row or teeth at the end.
The teeth hold tissue gently but
surely and are used primarily for
the retraction of tissues.
Uterine forceps
Long, curved forceps used to
grasp the uterus during a
procedure.
Uterine forceps have blunt
serrations, and may
be used to remove tissue or
insert packing.
.
Tenaculum
• a long handled, slender, hooked
instrument for lifting and holding parts
such as blood vessels during surgery.
The curved points on the end of the
jaws penetrate tissue to grasp firmly
such as when manipulating the uterus
during D&C,
Hysterometer
• is used for measuring
the depth of the
uterine cavity and
the cervix.
Goose forceps
• it is used to pick up
small fragments from
the uterus.
ALLIGATOR
FORCEP
• a grasping forceps with a
scissorlike handle and
blades opening in a vertical
plane similar to the jaws of
an alligator.
Uterine forcep
• an instrument
used to retract
the uterus.
OVUM
FORCEPS
• a specialized surgical
instrument always with two
parts that move together to
hold something such as
dressings , tissues or organs.
• CLEANING SUPPLIES AND EQUIPMENT
GUIDELINES Wear waterproof gloves, if the articles
are contaminate with highly pathologic
FOR materials especially when you have skin
abrasions on the hand.
CLEANING
Rinse the article first with cold running
SUPPLIES water which will wash fresh blood off
AND easily.
Wash the instrument properly and
EQUIPMENT completely with detergent soap.
• Use brush with stiff bristles as
GUIDELINES FOR indicated to clean articles were
CLEANING cleansed.
SUPPLIES AND • Prepare the articles for
EQUIPMENIES sterilization and for disinfections.
References
• https://www.uptodate.com/contents/dilation-and-curettage-d-c-
beyond-the-basics
