D and C
The following has been developed to assist you in preparation for your upcoming surgery
Of all the surgical procedure we do, D&C (Dilation & Curettage) is among the most straightforward and routine. For us, that is. For you as a patient, it can be just as scary as having a major operation. Hopefully, a brief description of the procedure will make you more comfortable with the process.
PRIOR TO SURGERY
On the night before surgery, eat a light meal. Do not eat or drink anything after midnight on the day of your surgery if your surgery is in the morning. If it is in the afternoon, don’t eat or drink anything 8 hours prior to the scheduled time of your surgery.
THE DAY OF SURGERY
When you arrive at the surgery center (either the outpatient surgery center or main hospital – we’ll tell you exactly which location), you will need to register. At John Muir Medical Center, you may register in the main hospital lobby. Sometimes in the very early morning, the registration area is closed. In this case, walk over to the Emergency Room and register there. If you are having your procedure at Aspen Surgery Center located on the first floor of the new parking structure on the side of John Muir Medical Center, enter through the main entrance and turn left down the hallway. You will see the signs to the registration area on the left. You will then proceed to the “pre-op” area where you will be asked to fill out paperwork, change into a hospital gown, and recline in a hospital gurney. Labs may or may not be drawn, depending on the reason for the D&C and whether or not they were drawn previously. An I.V. line will be placed into a vein in your hand or arm either in the “pre-op” area or the operating room itself.
Next you will be interviewed briefly by your attending nurse and subsequently the anesthesiologist. I will arrive just when we are scheduled to go back to the Operating Room. Feel free to ask any last minute questions at that time. Next, it’s time to head into the Operating Room, where you will notice it to be quite chilly. We will move you from the gurney to the operating table and will cover you with warm blankets. The anesthesiologist will place a blood pressure cuff around an arm, and place EKG electrodes on your chest to continuously monitor your blood pressure and heart rate and rhythm throughout the surgery. At this time the anesthesiologist will give you a medication through your I.V. that will make you very sleepy and you will drift off to sleep.
HOW THE PROCEDURE IS DONE
Once you are asleep under anesthesia, your legs will be placed in supportive stirrups and the vaginal area will be cleansed with an iodine containing solution. A speculum will be placed into the vagina and the cervix is grasped with a clamp to stabilize it. Smooth tipped metal rods of incrementally increasing diameter are inserted into the cervix, dilating the cervix to allow the main device, a stiff suction tube, to be inserted into the uterus. Contents are then evacuated through the plastic tubing into a container, which following the procedure will be sent to the pathologist for evaluation. The procedure is quick, usually lasting about 5 minutes (about 20 minutes of “under anesthesia” time including going to sleep and waking up).
Following the procedure you will be taken to the recovery room where you will remain for about 1 – 1 ½ hours. When you are discharged to home, you will still feel groggy and should go directly to bed. The effects of the anesthesia will where off in about 24 hours. The post-operative course following this procedure is variable, but in general you can expect to be fully recovered within 2-3 days. It may take longer if the procedure was complicated. You will need to restrain from vigorous physical activity for 24 hours following the procedure.
We will discharge you from the surgery center with instructions to take medication designed to minimize postoperative bleeding. This medication (methergine) will be called into a pharmacy for you to pick up or we will have given you the prescription in advance of the surgery. The bleeding you will experience should be no more than a normal period and will last for about 4-5 days. Anything more than this should prompt you to call my office. Additionally, call if you have a temperature greater than 100.4 degrees or increasing abdominal or pelvic pain. Please call my office several days after the procedure for a follow-up examination to be performed 2 weeks following the D&C.
RISKS ASSOCIATED WITH D&C
Every time we perform surgery on a patient, and even though for us this is routine, we are always cognizant of the risks involved. When we perform a D&C, the risks are straightforward: We are putting sharp instruments into a “blind” cavity, and are doing so by feel, not by direct visualization. As such, the greatest risk present is the risk of perforation of the uterus. That means placing the dilators or curettes through the wall of the uterus. When this happens, there is a risk of damaging other pelvic structures such as bowel, bladder, or blood vessels. Although extremely rare, any surgeon who has performed enough procedures will invariably encounter this complication. Usually, there is no significant sequela. If perforation of the uterus occurs, laparoscopy (placing a camera through a small incision in the navel to inspect the pelvic structures) is performed and if all is normal, the patient is still discharged to home from the recovery room. Additional risks associated with this procedure is infection and increased blood loss. Both are managed with medications. If bleeding is profuse, blood transfusion would be considered. I must emphasize that these risks are very uncommon but should, in the course of providing information, be included in discussion.