Dilation and Curettage (cont.)
What type of anesthesia is used for a D&C?
Most D&Cs are done under general anesthesia. The procedure is typically very short, and the general anesthetic can be quickly reversed, with the patient going home later the same day. Some patients prefer or require spinal or epidural blocks, but these forms of anesthesia take more time for the anesthesiologist to perform and require more recovery time for the patient. Occasionally, in a very motivated patient, the procedure can be done under a local anesthetic with or without intravenous pain medication or
twilight sleep. Overall, the choice of anesthetic is a generally determined by the anesthesiologist and the patient. The surgeon performing the procedure only requires that the patient not move during the surgery.
How is a D&C performed?
The actual procedure is done in an operating room, either in a hospital, surgery center, or a specially designated room in a physician's office. After adequate anesthesia has been administered, and with the patient in position (similar to that for a
Pap smear), the vagina and cervix are cleansed with an antibacterial scrub (usually Betadine). An instrument is used to grasp the upper portion of the cervix, and then the opening to the uterus is gradually widened with metal dilators to about the size of a large pencil.
Once the dilation has been completed, the curette, which is an instrument with a flat metal loop at the end, is inserted into the uterine cavity and is used to gently scrape the lining of the uterus. When the surgeon feels the gritty layer of cells just above the muscle of the uterus, then he/she knows that the scraping has gone deep enough to sample the tissue adequately. This scraping is done throughout the uterus, and the tissue that is removed is then sent to a pathologist for microscopic examination.
After the surgeon feels that enough tissue has been obtained, that the entire uterine cavity has been sampled, or that any abnormal growths that were seen on ultrasound were removed, then the procedure is stopped. Often, the doctor uses a viewing instrument to examine the uterus visually (hysteroscopy) prior to the D&C to make the procedure more complete. This is not, however, always necessary.
Next: What are possible complications of a D&C? »
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