Uterine Curettage – D&C Explained

What is Uterine Curettage?

Uterine curettage (also known as abrasio uteri or dilation and curettage / D&C) is a gynecological procedure in which the lining of the uterus (endometrium) is scraped or suctioned using a spoon-shaped surgical instrument called a curette. The tissue obtained is then examined in a pathology laboratory. The procedure is performed for both diagnostic and therapeutic reasons.

Indications

Uterine curettage is used in a variety of clinical situations:

• Diagnostic curettage: To evaluate abnormal changes in the uterine lining, such as unexplained bleeding or suspected endometrial cancer.
• Therapeutic curettage: To treat excessively heavy or irregular menstrual bleeding (menorrhagia, hypermenorrhea).
• Removal of pregnancy tissue: After a miscarriage or incomplete abortion, to remove retained tissue and prevent infection or ongoing bleeding.
• Termination of pregnancy: As a medical method in the context of a legal abortion procedure.
• Removal of polyps: To remove benign growths of the uterine lining (endometrial polyps).

Procedure

Uterine curettage is typically performed on an outpatient basis under general anesthesia or local anesthesia. The cervix is first gradually dilated using a series of dilators to allow access to the uterine cavity. The uterine lining is then systematically scraped with the curette. Today, the procedure is often combined with hysteroscopy (direct visualization of the uterine cavity with a small camera), which allows the surgeon to perform the curettage under direct visual guidance, improving accuracy and safety.

Diagnostic Relevance

The tissue obtained during curettage is sent to a pathologist for microscopic examination. This allows for precise assessment of uterine lining changes, including the detection or exclusion of cancer or precancerous conditions (e.g., endometrial hyperplasia), as well as the diagnosis of inflammation or hormonal changes of the endometrium.

Risks and Complications

As with any surgical procedure, uterine curettage carries certain risks:

• Perforation: Accidental puncture of the uterine wall (very rare).
• Infection: Inflammation of the uterus or fallopian tubes (endometritis, salpingitis).
• Asherman syndrome: Formation of scar tissue (intrauterine adhesions / synechiae) that may, in rare cases, lead to menstrual irregularities or infertility.
• Postoperative bleeding: Heavier than expected bleeding after the procedure.
• Cervical injury: Injury to the cervix during dilation.

Aftercare

After uterine curettage, mild pelvic cramps and light spotting in the first few days are normal. Patients are advised to avoid sexual intercourse, tampon use, and baths during this recovery period to minimize the risk of infection. If fever, severe pain, or persistent bleeding occurs, medical attention should be sought promptly. Full recovery generally occurs within a few days.

References

1. Berek, J.S. (ed.) (2019). Berek & Novak's Gynecology, 16th ed. Wolters Kluwer, Philadelphia.
2. American College of Obstetricians and Gynecologists (ACOG): Practice Bulletin on Diagnosis of Abnormal Uterine Bleeding in Reproductive-Aged Women. ACOG, Washington D.C.
3. World Health Organization (WHO): Clinical Practice Handbook for Safe Abortion. WHO Press, Geneva, 2014.