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What is a D&C?

A dilation and curettage (D&C) is a surgical procedure that is used to remove tissue from the uterus. It involves dilation of the cervix, which allows for entry into the uterus. A small instrument, known as a curette, is inserted through the cervix into the uterus, and from there is used to remove tissue such as the products of conception.i

Why are D&Cs performed?

D&C procedures can be categorized as diagnostic or therapeutic.  

Diagnostic D&C procedures are used to diagnose a medical condition in a non-pregnant patient, such as performing a biopsy for abnormal uterine bleeding to rule out endometrial cancer. In this case, the tissue that is removed from the uterus is examined under a microscope so a diagnosis can be made.ii In addition, a diagnostic D&C can be used in the case of a pregnancy with unknown location, to rule out ectopic miscarriage.iii  

A therapeutic D&C is used to treat a medical condition or problem and is usually performed in a pregnant or recently pregnant woman. In pregnancy, a D&C is typically used following a miscarriage or for elective termination of a pregnancy; however, it may also be used to remove either a molar pregnancy (when there is a problem with a fertilized egg that effects development after conception) or retained pregnancy tissue following delivery or incomplete miscarriage – this will remove the products of conception from the uterus.  

Symptoms of a miscarriage include pelvic cramping and vaginal bleeding, or it may be asymptomatic (no symptoms). Doctors also examine beta human chorionic gonadotropin (hCG) using bloodwork, and if beta-hCG is not rising appropriately, this may indicate a miscarriage. For example, if the b-HCG level is greater than 1500-3000 mIU/mL, but a viable pregnancy is not seen on ultrasound, a miscarriage may be suspected.iv Patients and providers may choose a D&C to manage the miscarriage.  

D&C is classified as surgical management of a miscarriage. However, there are other approaches to the management of a miscarriage: medical management and expectant management. Medical management involves the use of medications, such as taking misoprostol. Expectant management may also be used, in which a patient is given time to pass the pregnancy spontaneously without treatment. In this case, the patient is monitored, and medical or surgical management may ultimately be necessary if the termination does not occur spontaneously.v These alternatives to D&C are discussed below.  

Before a D&C

Prior to the surgery, the healthcare provider may give the patient medication to help prepare the cervix to be dilated. This is known as “cervical priming”. The most used priming agent is misoprostol, which is placed in the vagina prior to surgery. A medication called laminaria may also be used but is typically used in more advanced T The healthcare provider may also complete bloodwork prior to the D&C to check hemoglobin levels, blood type, or other routine tests for a surgical procedure.

During a D&C

A D&C is completed in the Operating Room (OR), or in an outpatient clinic outside of the hospital. It is typically completed as a day surgery, and the patient may return home a few hours after but will require someone to drive them home since anesthesia is typically used.vii This procedure generally takes between 15-30 minutes, during which a nurse will likely put an intravenous (IV) line in the patient's arm to administer medications and anesthetic agents, which may be either general anesthesia, or local anesthesia.viii Normally, this procedure is painless for patients.  

During the D&C, the patient will lie on her back and her legs will be placed in footrests.  A speculum will be placed into the vagina to visualize the cervix, similar to what happens during a Pap test. A surgical instrument known as a tenaculum is then used to hold the cervix in place, while a dilator is passed through the opening in the cervix into the uterus. Progressively larger cervical dilators are used sequentially, until the cervix is sufficiently dilated. The dilator is then removed, and a curette is inserted into the uterus in order to remove the contents inside. Most often this involves removal of the products of conception (i.e., pregnancy tissue), but other times the D&C is used for other reasons, as described above.ix  

After a D&C

After the procedure, the patient will be moved from the OR to the recovery room, where they will be monitored for some time in case there are any post-surgery complications. Some patients may experience nausea or vomiting as a result of the anesthetic medications, and this will be treated in the recovery room.

Following a D&C, it is normal to have mild cramping, alongside some light vaginal bleeding. This can be treated with Tylenol or Advil. However, a patient experiencing pain that is getting worse rather than better, heavy bleeding soaking more than two pads per hour for two consecutive hours, or fever or abnormal vaginal discharge, should consult a clinician as these may be signs of possible complications.x  Normal activities can generally resume within 1-2 days after a D&C, and menstruation typically resumes within 2-6 weeks of D&C in the case of a miscarriage.xi

What are the alternatives to a D&C?

Following a pregnancy loss, a D&C is not the only option available. An individual who has experienced pregnancy loss may instead choose expectant management (waiting for pregnancy tissues to expel naturally) or medical management (use of medicine). One of the most common and effective forms of medical management for early pregnancy loss is Mifepristone/misoprostol. This involves taking 200 mg of mifepristone orally, followed by 800 mcg of misoprostol vaginally (or orally) 24-48 hours later. In some geographical locations these medications are combined into one formulation (Mifegymsio).xii  

  • Pros: Medical management is less invasive than surgery. It can be completed as an outpatient, with follow-up with a clinician.  
  • Cons: Bleeding may last for 1-3 weeks afterwards. The passage of tissue occurs gradually, whereas a D&C is quicker. These medications can cause intense cramping, and bleeding is typically heavier than a period. There is a risk that medical management may be unsuccessful, and that a D&C may still be required afterwards.xiii

Known colloquially as “suction curettage”, a vacuum aspiration (MVA) is like a D&C in that the cervix is still progressively dilated. Instead of using only a curette to remove the uterine tissue, an instrument with suction is used to remove the contents. Suction is commonly added in the setting of fertility treatment, either with an MVA device or electric suction. Compared to a D&C, it is similar in terms of risks and efficacy.xiv,xv  

An additional instrument that may be used during a D&C is a hysteroscope. This is a camera that allows the physician to see the inside of the uterus and may be used to aid in the removal of uterine contents. This procedure is known as hysteroscopic D&C.

D&C vs D&E

D&C and D&E (dilation and evacuation) are similar procedures but have some key differences due to their timing and which instruments are used; because the D&E is typically performed later in pregnancy, it often takes longer and requires the usage of more specialized instruments.  

A D&C is typically used prior to 12-14 weeks gestation (within the first trimester of the pregnancy), while a D&E is typically used after 14 weeks gestation (in the second trimester of pregnancy). D&E is most used for induced termination or for intrauterine fetal demise but is like D&C in that it may involve cervical priming, followed by progressive cervical dilation. It is then followed by aspiration of uterine contents, often requiring other instruments such as forceps to remove the uterine tissue.xvi  

How soon after a D&C can a woman get pregnant?

After a D&C, your clinician may discuss theoretical concerns of infection and recommend avoiding placing anything in the vagina for a certain period of time. For example, it is generally recommended to abstain from sexual intercourse for 1-2 weeks after a miscarriage to prevent possible infection.xvii  

Patients often ask how long they need to wait before trying to conceive (TTC) after a D&C for miscarriage. The amount of time in between pregnancies is called the interpregnancy interval. In the past, patients were counselled to wait three months after miscarriage to begin trying to conceive in order to reduce the risk of recurrent miscarriage. However, recent research has indicated that this may not be necessary. In a study published in Obstetrics & Gynecology, of the 514 patients who had recently miscarried, the lowest rate of repeat miscarriage (7.3 percent) occurred within the patients who conceived again within three months of miscarrying.xviii  

Other recent research has shown that live birth outcomes are similar in women who choose to wait over three months to conceive, versus those who did not wait. A study by Wong et al (2015) found that the overall live birth rate was 76.5 percent in women following pregnancy loss. The live birth rate was 80.4 percent in the group with an interpregnancy interval ≤ 3 months, and a rate of 74.6 percent in the group with an interval > 3 months. Therefore, the live birth rate was similar in both groups; there was no statistically significant difference between the groups.xix  

Another study focused specifically on patients undergoing D&C for miscarriage and evaluated patients who conceived again within six months of the D&C, compared with patients who underwent medical management (with misoprostol) or expectant management (no intervention). They found that there was no significant difference in the rate of preterm delivery, premature rupture of membranes, placental abruptions, or any other complications if the patient underwent D&C vs. medical or expectant management.xx In fact, there is no quality data to support delaying conception after miscarriage to prevent another miscarriage, or pregnancy complications, according to ACOG guidelines.xxi  

Even though there may not be a physiological need to wait before TTC after a D&C, patients may choose to wait in order to maximize their emotional wellbeing. Some individuals require time to adequately process the loss, grieve, and emotionally heal before they feel ready again. Each person is different and there is no right or wrong way to approach the timing of TTC again after a D&C for miscarriage.

What are the risks of a D&C?

As with any surgical procedure, there are certain risks associated with a D&C. Some of these include infection, uterine perforation, scar tissue, and retained products of conception.  

Infection. Since the cervix is dilated during a D&C, it is possible for bacteria to enter the uterus and cause an infection. To prevent this, prophylactic antibiotics are recommended in pregnancy. When a patient is not pregnant and the D&C is being completed for diagnostic purposes, prophylactic antibiotics are not usually required. There is a 1-2 percent chance of infection following a D&C.xxii  

Perforation of uterus. There is a small chance of uterine perforation, or perforation of other structures, such as the bladder and bowel.xxiii A uterine perforation occurs when an instrument passes through the top of the uterus, known as the fundus, during a D&C. In a study of over 11 000 patients, the risk of uterine perforation following a D&C was 0.19 percent.xxiv While this is an older study, it is unlikely that risks have increased, and if anything may have diminished with improvements in technology.  

Scar Tissue. Asherman’s syndrome (AS), the formation of scar tissue (adhesions) within the inside of the uterus, has been linked to D&C. Asherman’s syndrome can potentially cause changes to menstruation (decrease in frequency, or stop entirely), decrease fertility, and lead to abnormal placentation in future pregnancies.xxv Some studies have shown that AS can occur in up to 13 percent of patients who undergo elective termination of pregnancy during the first trimester, and up to 30 percent who undergo D&C of a late miscarriage.xxvi The estimated frequency of Asherman’s syndrome linked to D&C does vary between studies, with a higher risk associated with repeated D&C procedures. Furthermore, the severity of AS is highly variable between individuals.

Bleeding. Spotting or light bleeding after a D&C is common.xxvii,xxviii,xxix  More severe cases of bleeding (hemorrhage) are a rare,xxxi,xxxii

Retained tissue. If a D&C is incomplete, and all the tissue from a pregnancy is not removed from the uterus, it is known as retained products of conception (RPOC). This often requires a repeat D&C to remove the remaining tissue. Incomplete D&C occurs in approximately 6 percent of patients who undergo elective termination or miscarriage.xxxiii

Can a D&C affect future fertility?

Evidence suggests that most of the time, D&C will not negatively impact future fertility. The most significant complication of a D&C that can affect fertility is through Asherman’s syndrome, as discussed above. It is estimated that patients with moderate to severe Asherman’s syndrome have a 19 percent combined rate of miscarriage, stillbirth, or preterm delivery.xxxiv In many patients, Asherman’s syndrome can be treated with a procedure called “adhesiolysis,” in which the uterine scarring is broken up to restore the inside of the uterus. In a retrospective study of patients with Asherman’s syndrome treated with adhesiolysis, 95 percent of patients had restoration of the uterine cavity, with approximately 29 percent having recurrence of uterine adhesions afterwards.xxxv

In most women, future fertility is not affected after a D&C. As part of a meta-analysis, reproductive outcomes following miscarriage were analyzed; across five studies involving a total of 511 women who underwent D&C after miscarriage, 75-98 percent were able to conceive. The range of ongoing cumulative pregnancy rates after conception was 72-87 percent.xxxvi However, the same review also suggested that treatment strategies to minimize the number of D&Cs should be employed, in order to reduce the potential for intrauterine adhesions.xxxvii  

Those hoping to conceive following a D&C should certainly consult their doctor to determine the best path forward but should also feel reasonably assured that having had a D&C is generally not a major impediment to being able to conceive again.

Tissue (embryonic and placental) testing after D&C

Following a D&C, the removed uterine tissue is often sent for examination under a microscope, known as “histopathologic” examination. This can be useful to identify potential embryonic or uterine tissue abnormalities.xxxviii  

In some geographical locations, clinicians or patients can request a genetic analysis of the uterine tissue removed after a D&C in order to potentially identify a cause of the miscarriage.xxxix In some locations this is done routinely, while in other regions (especially with universal health care) it will only be done in the cases of recurrent miscarriages. Genetic analysis of the uterine tissue removed after a D&C involves looking for chromosomal differences in the embryonic/fetal tissue, to investigate whether the cause of miscarriage was related to chromosome aneuploidy (abnormality). In a large retrospective study of IVF patients that looked at the cytogenetic analysis of products of conception after blastocyst transfer, it was found that 19.4 percent were genetically normal embryos, while 80.6 percent had an abnormal number of chromosomes (aneuploid).xl  Understanding whether the cause of miscarriage was related to aneuploidy in the embryo or not may help patients undergoing fertility treatment, and their providers, with future treatment planning.


Whether necessary because of a miscarriage, a diagnostic procedure, or another reason, a D&C can be indicated during extremely traumatizing periods of a woman's life. Understanding this procedure and the risks, as well as potential alternatives, can help patients determine how to navigate these challenging scenarios. Evidence suggesting that an individual need not wait significantly long after a miscarriage before trying to conceive again may also help guide the next steps after a loss, though emotional factors should be considered before continuing as well. Anyone concerned about conceiving again after a D&C should speak with a clinician to map out a plan most appropriate to their individual circumstances.