Re: d+c

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A cervical Dilation and Curettage is a procedure where the uterine cervix is dilated in some fashion, and the uterine contents are extracted, either by scrapping with a curette, or by applying suction through a tube.

A D&C is not always necessary after a miscarriage, and in fact it is preferable to avoid the potential risks of surgery (even "minor surgery") and anesthesia if possible. A natural miscarriage is generally safer, with fewer risks of complications. On the other hand, a natural miscarriage can be a prolonged and potentially scary process, with increasing pain and cramping, associated with bleeding, sometimes very, very heavy bleeding as your uterus contracts to expell the products of conception. There is also the time factor, since the miscarriage is not likely to take place on any sort of schedule.

The only advantages that a D&C has over a natural miscarriage is that you know when it is going to happen, and the duration of the process is short. The risk of infection is about the same either way, but the surgery has complications, and so does the anesthesia. Admittedly, these risks are low, but they are still higher than with a spontaneous miscarriage.

I generally present both sides of the story and let the patient chose how she will go through this tragic time in her life. The split in my practice is about 75/30 in favor of natural miscarriage.

--
William D. McIntosh, MD

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