Dilatation and curettage or evacuation
Two of the most commonly performed gynecologic procedures, dilatation and curettage (D&C) and dilatation and evacuation (D&E), involve cervical expansion (dilatation) to allow access to the endocervix and uterus. In a D&C, a curette is used to scrape endometrial tissue; in a D&E, suction is applied to extract the uterine contents.
A D&C provides treatment for an incomplete abortion, controls abnormal uterine bleeding, and can secure an endometrial or endocervical tissue sample for cytologic study. A D&E can also be used for an incomplete or a therapeutic abortion, usually up to 12 weeks of gestation but occasionally as late as 16 weeks.
Procedure
After receiving a local or general anesthetic, the patient is placed in the lithotomy position. The physician will then perform a preliminary bimanual pelvic examination, after which he exposes the cervix and checks the depth and direction of the uterine cavity (in a D&E, this confirms gestational size). He then dilates the cervical canal.
In a D&C, metal dilators of increasing size are used to dilate the cervix. Next, the physician explores the uterine cavity, removing any polyps. If he suspects cervical or uterine cancer, he will obtain specimens for biopsy from the endocervical canal. He will then perform standard curettage to remove the superficial layer of the endometrium, taking tissue specimens from the four quadrants of the cervix. If he performs a D&C to treat an incomplete abortion, he also removes the remaining products of conception.
In a D&E, the physician uses a suction curette to extract the contents of the uterus. He then explores the uterine cavity to ensure complete removal of the products of conception.
