Dilation and curettage

The most common complications associated with D&C are infection, bleeding, or damage to nearby organs, including through uterine perforation.[15] Aside from the surgery itself, complications related to anesthesia administration may also occur.

Infection is uncommon after D&C for a non-pregnant patient, and society practice guidelines do not recommend routine prophylactic antibiotics to patients.^[16] However, for curettage of a pregnant patient, the risk of infection is higher, and patients should receive antibiotics that cover the bacteria commonly found in the vagina and gastrointestinal tract; doxycycline is a common recommendation, though azithromycin may also be used.^[16]

Another risk of D&C is uterine perforation. The highest rate of uterine perforation appears to be in the setting of postpartum hemorrhage (5.1%) compared with a lower rate in diagnostic curettage in non-pregnant patients (0.3% in the premenopausal patient and 2.6% in the postmenopausal patient).^[17] Perforation may cause excessive bleeding or damage to organs outside the uterus. If the provider is concerned about ongoing bleeding or the possibility of injury to organs outside the uterus, a laparoscopy may be done to verify that there has been no undiagnosed injury.

Another potential risk is Asherman’s syndrome, a condition where intrauterine adhesions lead to subfertility, amenorrhea, or recurrent pregnancy loss. Although older studies^[18][19][20] described a high (25-30%) risk of developing this condition after dilation and curettage for treatment of miscarriage, these procedures were likely done using sharp curettage, which is no longer routinely performed in modern miscarriage and abortion care. Newer studies^[21][22] reflect the common technique of suction curettage and demonstrate a much lower risk of Asherman’s syndrome, with incidence in large prospective trials ranging from 0.7-1.6%. A history of multiple (>3) procedures^[21] and sharp curettage^[22] were identified as risk factors for developing clinical Asherman’s syndrome. A systematic review in 2013 concluded that recurrent miscarriage treated with D&C is the main risk factors for intrauterine adhesions.^[23] There are currently no studies linking asymptomatic intrauterine adhesions and long-term reproductive outcomes, and similar pregnancy outcomes have been found after miscarriage regardless of whether surgical treatment, medication management, or conservative management (i.e. watchful waiting) was chosen.^[23]

See also

• Dilation and evacuation
• Menstrual extraction
• Vacuum aspiration

References