Dilation and Curettage (D & C)

Norm of Dilation and Curettage (D & C)

No abnormal cells.

 

Usage of Dilation and Curettage (D & C)

Acquired and congenital cervical stenosis, cancer, diagnosis and treatment of abnormal uterine bleeding, dysmenorrhea, insertion of an IUD, insertion of a radium device for treatment of cancer, pedunculated leiomyomas, preceding a hysterography or hysteroscopy, and uterine polyps.

 

Description of Dilation and Curettage (D & C)

A widening of the cervical canal with a dilator and then a scraping of the uterine canal with a curette. The test is performed for diagnostic purposes less frequently than in the past because other modalities, such as endometrial biopsy, hysteroscopy, and pelvic ultrasonography, have become available for use. D & C is usually performed therapeutically after an incomplete abortion or miscarriage.

 

Professional Considerations of Dilation and Curettage (D & C)

Consent form IS required.

Risks
The primary complication is perforation of the uterus. If a perforation occurs and the client is stable, a laparoscopy can be performed to evaluate the perforation. If a perforation is suspected during a suction curettage, a laparoscopy must be performed to continue the procedure to be sure that bowel is not aspirated into the uterus. If the client becomes unstable, emergency surgery is necessary. Arthralgias, though uncommon, can be painful side effects.
Contraindications
Clients with coagulopathies or active vaginal infections.

 

Preparation

1. Ascertain any drug allergies.
2. Perineal shave may be preferred.
3. The client should void before the procedure.
4. An enema may be prescribed before the procedure.
5. An intravenous line may be initiated.
6. Obtain containers of 10% formalin solution for tissue specimens.
7. Measure and document baseline vital signs.
8. Just before beginning the procedure, take a “time out” to verify the correct client, procedure, and site.

 

Procedure

1. Regional or general anesthesia (thiopental-isoflurane most cost-effective) is initiated.
2. The cervical canal is dilated with a dilator, and the uterine canal is scraped with a curette.
3. Tissue specimens are placed in containers of 10% formalin and sent to the laboratory for analysis. If an infection is suspected, part of the specimen should be placed in a sterile container without fixative and sent to the laboratory for culture and sensitivity.

 

Postprocedure Care

1. Assess vital signs every 15 minutes until stable and then every hour × 4 after general anesthesia. Additional monitoring after general anesthesia typically includes continuous ECG monitoring and pulse oximetry, with continual assessments (every 5–15 minutes) of airway, vital signs, and neurologic status until the client is lying quietly awake, is breathing independently, and responds appropriately to commands spoken in a normal tone.
2. After regional anesthesia, assess vital signs when the procedure is completed and continue to monitor if unstable.
3. Assess the perineal pad for color and amount of drainage.
4. Assess for postanesthesia sensation.
5. Assess and medicate for cramping.
6. Dexamethasone 8 mg IV is an effective antiemetic for preventing postoperative nausea and vomiting 0–24 hours after propofol-based anesthesia after D & C.

 

Client and Family Teaching

1. The procedure takes approximately 45 minutes.
2. The procedure is accompanied by cramping similar to menstrual cramps. Medications will be given to keep this tolerable.
3. Call the physician for signs of infection: temperature higher than 101 degrees F (38.3 degrees C), pelvic or vaginal pain, purulent vaginal drainage, or excessive bleeding.

 

Factors That Affect Results

1. None found.

 

Other Data

1. Hysteroscopy does not improve the sensitivity of D & C in detecting hyperplasia or endometrial carcinoma but is superior in detecting focal lesions of the uterine cavity in postmenopausal bleeding.