If your pregnancy comes to an unexpected end before 20 weeks, your practitioner’s role is to help you recover from the experience both emotionally and physically. One of the first questions he or she will try to answer is whether any part of the fetus or placenta — technically called the products of conception — remains in your uterus.
If an ultrasound shows your womb is empty, you can begin the process of recovering emotionally. But if the uterus hasn’t emptied completely on its own, your doctor might recommend dilation and curettage, often called a D&C.
This brief surgical procedure clears the uterus of products of conception so your menstrual cycle can go back to normal and you can try to get pregnant again if you choose to.
Why would you need a D&C after miscarriage?
Is a D&C necessary after a miscarriage? Not always. Your doctor may recommend a D&C after what’s called an incomplete miscarriage — a miscarriage where some pregnancy tissue still remains in the uterus.
This lingering tissue, which is often accompanied by continued pain and bleeding, can keep your periods from returning to normal. It can also prevent you from being able to get pregnant again, if you want to, and can sometimes lead to infection.
Not every woman who has an incomplete miscarriage needs a D&C. Sometimes remaining products of conception will pass naturally within a week or two. Your doctor might also prescribe medicine that encourages your cervix to open and your uterus to contract so the lingering tissue can be expelled.
But if those two options haven’t worked, you may need a D&C.
You may also need a D&C if you have a medical termination of a pregnancy, in which you choose to end it because of health risks for you or your baby.
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What are the risks of a D&C?
Though the experience is anything but typical for you, D&Cs are routine procedures that are considered very safe. But just like any other surgical procedure, a D&C still comes with some possible risks, including:
Scarring
In an estimated 16 to 19 percent of D&Cs, women develop scarring — called Asherman’s Syndrome — inside the uterus or around the cervix. The risk is much lower when a D&C is performed for a first trimester pregnany loss as opposed to a loss later in pregnancy.
It can take a second surgery to get rid of those scars, but fortunately, the odds are in your favor that you’ll recover and be able to get pregnant again.
Uterine perforations
Surgical instruments can potentially poke the uterine lining, causing a hole or tear. This is also extremely uncommon when the D&C is performed for early pregnancy loss.
Most perforations will heal on their own, but sometimes a second surgery is needed to help the damaged tissue heal.
Cervical tears
Surgical instruments can cause possible tears in cervical tissue too. Applying simple pressure, placing topical medication or using an absorbable stich (that won't need to be removed) will stop the bleeding. It's highly unlikely that this will have any impact on future fertility or delivery.
Infection
As with other surgeries, it’s possible to develop an infection after a D&C. Most infections occur within a week of the procedure and are marked by unusual discharge, cramping or a fever. They’re usually easy to treat with antibiotics provided you seek medical attention ASAP.
While these risks are generally rare, some women may be at higher risk than others. Scarring, infections and perforations are more likely to occur in D&Cs for pregnancy losses that occur later than 20 weeks gestation.
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Having a retroverted (or tilted) uterus — which around 1 in 5 women have — can make it trickier for your health care practitioner to perform the procedure and may increase some risk factors. But he or she will be aware of this from your ultrasounds and will talk with you in advance about your risks.
Where and how is a D&C done?
D&Cs aren’t always performed right after a miscarriage is diagnosed. If your doctor suspects remaining pregnancy tissue or sees it on a scan, he or she may recommend waiting to see if the tissue passes naturally or offer medication to help expel the tissue before ordering a D&C. That process can take a few weeks.
However, you may prefer getting a D&C sooner, and that's okay.
If you do end up needing the procedure, it typically takes 15 to 30 minutes. You’ll begin in a position you’re probably used to at your OB/GYN: flat on your back with your legs in stirrups.
Following anesthesia, usually given intravenously, there are two main parts to the D&C procedure:
- Dilation. To access the uterus, your practitioner will place a speculum in your vagina and then slowly dilate (or open) your cervix, the boundary between the vagina and uterus. He or she will likely use a combination of numbing medication, a slender rod and small medical instruments.
- Curettage. Once your cervix is about a half inch dilated, your practitioner will use an instrument called a curette and a suction device to carefully clear your uterus. Sometimes this is performed under ultrasound guidance.
If your pregnancy was only a few weeks along and your cervix is already partially open, you’ll likely have the procedure in your doctor’s office. Your practitioner will administer local anesthetics — similar to the numbing agents your dentist uses to fill a cavity. He or she may also give you a pill to take ahead of time that can help prevent pain.
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But if your cervix is tightly closed or your pregnancy was farther along, your practitioner may suggest having the procedure in a surgery center or hospital while you’re sedated under general anesthesia given intravenously.
If you’re concerned about the procedure or anxious about how it will go, talk to your practitioner about which setting will work best for you.
How to prepare for a D&C
Your provider will give you specific instructions based on the details of your procedure. But here are some general things to keep in mind to help you prepare for both before and after the surgery.
- Follow your provider’s instructions about eating and drinking. You may need to avoid food or liquid for a certain number of hours beforehand if you’re getting anesthesia.
- Ask about prepping with a pain med. Taking an over-the-counter pain reliever such as ibuprofen before the procedure can help ease some of the discomfort, especially if you’re just getting a local numbing agent. Always get permission from your doctor before taking any pain medications before your surgery.
- Arrange for a ride home. You’ll need one if you were fully sedated for your surgery. But even if you were awake, you still might not feel up to driving yourself.
- Bring some supplies. You’ll have some discharge after the procedure, so have a pad ready to wear. Pack a snack and some water too — it’s normal to feel a little lightheaded shortly after the surgery.
- Plan to take it easy. You might feel worn out, both physically and emotionally, so clear your schedule to give yourself time to rest and recover.
What to expect during a D&C
Because you’ll be under some form of anesthesia that — at a minimum — numbs your uterus, you likely won’t feel a lot during a D&C. Dilation can cause cramping, and some pressure and discomfort are normal during curettage.
Whether you feel any pain depends on your personal levels of pain tolerance and how much the cervix has to be opened. If you experience pain during the procedure, let your practitioner know so he or she can try to make you more comfortable.
Recovering after a D&C
When the D&C procedure is over, you should be able to go home after a few hours. It’s common to experience mild cramping and light bleeding for the next few days. If you’re uncomfortable, your doctor may recommend taking an over-the-counter pain reliever.
Since your cervix remains open for a few days after the procedure, it’s important to avoid sex, tampons and douching, since they can all introduce bacteria into the uterus that can potentially cause infection. You may also need to skip baths and swimming for the time being.
Ask your provider when it’s okay to go back to these things — you may need to steer clear for a week or two.
As soon as you feel better, however, you can resume most exercise besides swimming. Your usual menstrual cycle should return within four to six weeks. If you’re planning on trying to get pregnant again, your doctor can help you determine the right time to start.
Know that after a D&C, you’ll likely still be coming to terms with your lost pregnancy. Feeling sad, angry, alone and even jealous of friends with babies are all normal responses. Take time to grieve, share your feelings with your partner if you have one and reach out to others who you think can help support you.
When to call your doctor
As with any surgery, you are at risk of infection as well as retained tissue after a D&C. If you have heavy bleeding, foul-smelling discharge, severe abdominal pain or a fever over 101 degrees Fahrenheit, let your practitioner know right away.
These could be signs of an infection or retained tissue, and they need to be treated quickly.
Can you have a successful pregnancy after a D&C?
Your body is amazing at healing itself, which means that having a D&C likely won’t harm your chances of having a healthy pregnancy in the future.
Among women with unexplained recurrent pregnancy loss (defined as two or more miscarriages with no found cause), around 65 percent can expect a successful next pregnancy, according to the American College of Obstetricians and Gynecologists (ACOG).
The odds of pregnancy after a miscarriage appear to be similarly positive if you’ve had a D&C. Nearly 90 percent of women who had undergone a D&C procedure were pregnant within a year of starting to try again, one study found.
Most health care practitioners recommend waiting three menstrual cycles before trying to get pregnant after a D&C. This gives the uterus time to rebuild its lining in order to support another baby. But depending on how early your miscarriage or pregnancy termination was, your practitioner might recommend waiting more or less time.
A D&C might be the last step of physically recovering from a miscarriage. But you may still need time to recover emotionally — and that’s okay. If and when you feel like your body and your heart are ready, you can start trying to get pregnant again.
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