D&C After Miscarriage: Should You Have One?
After undergoing a miscarriage, a woman’s body will probably expel the fetal tissue on its own. But she might also have an “incomplete miscarriage,” where uterine bleeding fails to clear out the uterus. A missed miscarriage—in which the mother’s body neglects to realize that the fetus has died—is also possible.
RELATED: What Is a Missed Miscarriage?
In these circumstances, a woman typically has three choices: medication to induce the miscarriage, waiting to see if the miscarriage will happen on its own, or a dilation and curettage (D&C). The D&C procedure involves dilating your cervix and using a special tool to remove the contents of the uterus, and it helps prevent infection and complications after miscarriage. Here’s what you need to know about whether a D&C might be right for you.
What is a D&C?
According to G. Thomas Ruiz, M.D., an OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, there are actually two types of D&C procedures. One is commonly used during gynecologic exams when doctors are testing the uterus for abnormalities. The other is typically a suction dilation and curettage, known as a uterine aspiration, that’s reserved for missed miscarriages, incomplete abortions, and ending an unwanted pregnancy.
A D&C is used in about half of all miscarriages, says Dr. Ruiz. However, the choice between natural miscarriage, medication like Cytotec (misoprostol), and D&C is often personal, and women should choose whichever method suits them best.
For example, Kelly Burch, 28, a writer from New Hampshire, found out that she suffered a missed miscarriage at 9 weeks into her second pregnancy. The fetus had stopped growing at 6.5 weeks, but Burch had not yet physically miscarried. She waited three days to see if her body would start the process of physically miscarrying on its own. After experiencing no results, Burch knew that a D&C was the right option for her. “I couldn't take the emotional turmoil of waiting, especially knowing that my body had already been ‘waiting’ three weeks,” she explains. “At that point, I knew I needed the physical aspect done.”
D&C Procedure and Recovery
D&C is a quick procedure that can be performed in a doctor's office or an operating room in five minutes or less. The woman is usually put under general anesthesia, although she may also be put under regional or local anesthesia. The OB-GYN will open the cervix (the lower part of the uterus) with small instruments or medication. Then he’ll scrape or suction out the tissue with a curette.
Dr. Ruiz says that the total recovery time from a D&C procedure is about two weeks. Most women will experience postoperative pain and cramping that typically lasts 3 to 4 days, as well as spotting that can last up to two weeks. Pain is typically managed with a non-steroidal anti-inflammatory drug (NSAID). Dr. Washington typically advises her patients to avoid sexual intercourse for a few weeks after the procedure, but they can usually return to work the following day if they wish.
D&C Risks and Complications
The risks of a D&C depend on the duration of the pregnancy and how much tissue needs to be removed. In general, though, a D&C is very safe and effective, with less than 1 in 1,000 women undergoing a major complication, says Sierra Washington, M.D., MSC, FACOG, and the associate professor of reproductive medicine at the University of California San Diego.
RELATED: What Causes Miscarriage to Happen?
Some of the most common complications from a D&C procedure include postoperative infection, perforation in the uterus, or scarring of the uterus. And the more D&C procedures a woman has done, the higher her risk of complications gets. For example, the risk of Asherman's syndrome (infertility caused by uterine scarring) goes up with each D&C procedure.
Keep in mind that while many women fear that a D&C poses a risk to their fertility, some doctors actually believe it can more effectively ensure all contents of the uterus are removed cleanly. If a miscarriage happens on its own or medication is taken to induce a miscarriage, for example, there is a risk of tissue remaining in the uterus.
However, a June 2015 study out of Amsterdam indicated that having a D&C could be associated with preterm birth in future pregnancies. The scientists analyzed 21 different studies and discovered that the surgery is connected with a 29% greater chance of preterm birth (less than 37 weeks) and a 69% greater chance of very preterm birth (less than 32 weeks) in a subsequent pregnancy. Nearly 2 million women were included in the report and the risk of prematurity in future pregnancies was even higher in those with multiple past D&Cs.
But if you've had the procedure, don't worry too much: the overall risk was around 6% in women without a prior D&C and the procedure brought that figure up only slightly to 7.6%, the equivalent of 16 preterm births per 1,000 women with D&C.
