If your pregnancycomes to an unexpected endbefore 20 weeks, your practitioner’s role is to help you recover from the experience both emotionally and physically. One of the first questions your doctor will try to answer is whether any part of the fetus or placenta — called the products of conception — remains in your uterus.
If an ultrasound shows your womb is empty, you canbegin the process of recovering emotionally. But if the uterus hasn’t emptied completely on its own, your doctor might recommend dilation and curettage, or a D&C.[1]
This brief surgical procedure clears the uterus of products of conception so yourmenstrual cycle can go back to normal within four to six weeks and you can try to get pregnant again if you choose to.
Why would you need a D&C after miscarriage?
A D&C isn’t always necessary after a miscarriage. Your doctor may recommend it 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.
Not every woman who has an incomplete miscarriage needs a D&C. Sometimes the 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.
Some women choose to have a D&C because they may not want to experience the bleeding, physical discomfort, and emotional distress that can come with a miscarriage at home.
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% of D&Cs, women develop scarring — called Asherman’s Syndrome[2] — inside the uterus or around the cervix. The risk is much lower when a D&C is performed for a first trimester pregnancy loss, as opposed to a loss later in pregnancy.
If severe adhesions form, you may need to have an additional surgery to remove the scarring. Fortunately, these procedures, combined with a brief course of hormones, are very successful, so the odds are in your favor that you’ll recover and be able to get pregnant again.
Uterine perforations
This type of complication occurs when surgical instruments poke through the uterine lining, creating a hole or tear.
Uterine perforation isn’t a common risk of a D&C, with rates of less than 1 to 5%, depending on the reason for the surgery. For early pregnancy loss, the rate is about 1%.
The good news is that almost all perforations will heal on their own without any further interventions and won’t affect your uterine health or future fertility. In a small number of instances, your surgeon could be concerned about an injury occurring inside the abdomen, and a diagnostic laparoscopy would be required for further exploration.
Cervical tears
Surgical instruments can cause tears in cervical tissue as tissue is manipulated to successfully complete the procedure. Applying simple pressure, placing topical medication that aids in blood clot formation, or using an absorbable stitch (that won't need to be removed) will stop the bleeding. It's highly unlikely that these tears 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. At the time of your procedure, it is standard care to give a single dose of antibiotic to help prevent an infection from occurring.
Should an infection happen, it’s likely to occur within a week of the procedure and will be marked by unusual discharge, cramping or a fever. They’re usually easy to treat with antibiotics provided you seek medical attention as soon as possible.
While all of the above 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.
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 your doctor 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, they 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 vagin* and then slowly dilate (or open) your cervix, the boundary between the vagin* and uterus. Your doctor 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 before filling a cavity. You may also be given a pill to take ahead of time to help prevent pain.
But if your cervix is tightly closed or your pregnancy was farther along, your doctor may suggest having the procedure in a surgery center or hospital, where you’ll be sedated under general anesthesia that’s 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 doctor’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 (Advil and others) before the procedure can help ease some of the discomfort, especially if you’re just getting a local numbing agent. Do make sure to get your doctor’s go-ahead prior to taking any pain medications before 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 level of pain tolerance and how much the cervix has to be opened. If you experience pain during the procedure, let your practitioner know so they 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, as well as exercise.
Ask your provider when it’s okay to go back to these things — you may need to steer clear for a week or two.
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, and consider sharing your feelings with supportive and trusted friends, a loving partner and family. A therapist or support group for parents who have experienced a pregnancy loss can also be helpful.
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 has an amazing ability to heal itself, and 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% 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. In one study, 90% of women who had undergone a D&C procedure were pregnant within a year of starting to try again.
Health practitioners once recommended that women wait three menstrual cycles before trying to get pregnant after a miscarriage. However, recent data hasn’t found any difference in live birth rates between women who get pregnant in the first three months after a miscarriage versus those who wait to try to conceive.
Ultimately, when your body is healed, you can consider all your options and make any decisions about a potential future pregnancy on your own and with your health care team.
From the What to Expect editorial team andHeidi Murkoff,author ofWhat to Expect When You're Expecting. What to Expect follows strict reporting guidelines and uses only credible sources, such as peer-reviewed studies, academic research institutions and highly respected health organizations. Learn how we keep our content accurate and up-to-date by reading ourmedical review and editorial policy.
