Dilation and curettage
Dilation and curettage (D&C), a commonly performed procedure in obstetrics and gynecology, refers to dilation of the cervix in order to introduce instruments into the uterus, with a curette being used to empty or sample the endometrial cavity.
The indication for a D&C may be diagnostic or therapeutic. Diagnostic D&C has largely been replaced by an office endometrial biopsy. However, certain scenarios, including (but not limited to) the inability to tolerate office biopsy due to pain or anxiety, insufficient sampling, the need to exclude endometrial cancer, and cervical stenosis, may necessitate an operative diagnostic D&C over office endometrial biopsy[1].
Indications for therapeutic D&C in the pregnant patient are: elective termination of pregnancy (< 14 weeks gestational age), treatment of early pregnancy failure (missed or incomplete spontaneous abortion), evacuation of suspected molar pregnancy, treatment for cervical stenosis, and removal of suspected retained products of conception[1].
Therapeutic D&C may be indicated as a temporizing measure in the non-pregnant patient with abnormal uterine bleeding[2].
| Anesthesia type |
General, sedation, regional or neuroaxial |
|---|---|
| Airway |
Spontaneous (for sedation, regional, or neuroaxial) LMA for general |
| Lines and access |
PIV |
| Monitors |
Standard Monitors |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative | |
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Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | |
| Respiratory | |
| Gastrointestinal | |
| Hematologic | Uncontrolled uterine bleeding |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
Paracervical or intracervical block: Lidocaine 1% placed by obstetrician in 5mL aliquots
Spinal anesthesia: Shorter acting agents including mepivicaine, chloroprocaine, or low-dose hyperbaric bupivicaine 0.75%.
Intraoperative management
Monitoring and access
Induction and airway management
Positioning
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
- ↑ 1.0 1.1 Cooper, Danielle B.; Menefee, Gary W. (2021), "Dilation and Curettage", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 33760550, retrieved 2021-05-08
- ↑ "Committee Opinion No. 557: Management of Acute Abnormal Uterine Bleeding in Nonpregnant Reproductive-Aged Women". Obstetrics & Gynecology. 121 (4): 891–896. 2013-04-XX. doi:10.1097/01.AOG.0000428646.67925.9a. ISSN 0029-7844. Check date values in:
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