Signs You Need a D&C After Miscarriage

If you've experienced a missed or incomplete miscarriage, your doctor might recommend a D&C. Here are some signs you may need one.

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When you have a miscarriage, all the fetal tissue must leave your body for it to fully heal. There are a few treatment options for miscarriage, including letting this process happen naturally (known as expectant management). Often, a pregnant person's body will expel the fetal tissue on its own or medication can be used to speed the process along. However, a medical procedure known as a dilation and curettage (D&C) may sometimes be needed.

The treatment a health care provider will recommend for miscarriage will depend on several factors, such as whether the body is passing the pregnancy tissue on its own, how far along the pregnancy was, and the person's personal preference. Your doctor will help you decide which route is best for you to take after a miscarriage.

Learn about the signs you may need a D&C after a miscarriage, the risks of the procedure, and what recovery from a D&C looks like.

What Is a D&C?

A D&C refers to the terms dilation and curettage, which describe the process of dilating the cervix and removing the contents of the uterus with a spoon-shaped tool known as a curette or a vacuum instrument (suction D&C or uterine aspiration).

According to G. Thomas Ruiz, MD, an OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, California, there are two types of D&C procedures: diagnostic and therapeutic.

Diagnostic D&Cs are used to obtain samples of the uterine lining for testing and diagnosis of abnormalities. Therapeutic D&Cs are used to remove the contents of the uterus as part of miscarriage treatment or for abortion care. The most common type of D&C used for miscarriage is a suction D&C.

Dr. Ruiz explains that the choice between "natural" miscarriage (also called expectant management), medication like Cytotec (misoprostol), or D&C is often personal, and people can choose the method that suits them best assuming there are no complications to consider.

For example, Kelly Burch, 28, a writer from New Hampshire, found out that she had a missed miscarriage 9 weeks into her second pregnancy. The fetus had stopped growing at 6.5 weeks, but Burch had no signs of miscarriage like bleeding or cramping. She waited three days to see if her body would complete the process of 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."

Signs You May Need a D&C After Miscarriage

D&Cs are one of the most common procedures in the US, and while every person and pregnancy is different, there are certain signs that a D&C may be the right miscarriage treatment for you:

  • You had a missed miscarriage, and the miscarriage process doesn't begin on its own
  • You had an incomplete miscarriage or abortion
  • You had a miscarriage after 10 weeks
  • There are miscarriage complications, such as infection or tissue left in the uterus
  • You have a personal preference for the procedure

One of the most common reasons someone may need a D&C after a miscarriage is when miscarriage bleeding fails to clear out the uterus and some tissue remains. This is called an "incomplete miscarriage." Fetal tissue may also remain in the uterus in the case of a missed miscarriage, which is when the pregnant person's body does not start releasing the pregnancy tissue even though the fetus has died.

The D&C procedure can help prevent infection and complications after miscarriage.

D&C Procedure and Recovery

A D&C is a quick procedure that can be performed in a doctor's office or an operating room in 15 minutes or less. The pregnant person is usually put under general anesthesia, although it's possible to do the procedure under regional or local anesthesia.

The OB-GYN will open the cervix (the lower part of the uterus that opens to the vagina) with small instruments or medication. Then, they'll scrape out the tissue with a curette or use a vacuum instrument with suction to remove the contents.

Dr. Ruiz says that the total recovery time from a D&C procedure is about two weeks. Most people will experience some postoperative pain and cramping that typically lasts three to four days, as well as spotting that can last up to two weeks. Pain is typically managed with a non-steroidal anti-inflammatory drug (NSAID) like ibuprofen.

Sierra Washington, MD, MSC, FACOG, the associate professor of reproductive medicine at the University of California San Diego, typically advises her patients to avoid sexual intercourse and vaginal penetration for a few weeks after the procedure, but they can usually return to work the following day if they wish.

Risks and Complications of D&C

The risks of a D&C depend on how far along the pregnancy was and how much tissue needs to be removed. In general, a D&C is very safe and effective, with fewer than 1 in 1,000 people undergoing a major complication, says Dr. Washington.

Some of the most common complications from a D&C procedure include postoperative infection, perforation in the uterus, retained fetal tissue, or scarring of the uterus. And the more D&C procedures someone has done, the higher the risk of complications gets. For example, Asherman's syndrome, a type of infertility caused by uterine scarring, is a rare complication associated with D&Cs.

A 2015 study out of Amsterdam found that having a D&C could be associated with preterm birth in subsequent pregnancies. Nearly 2 million women were included in the report and the risk of prematurity in future pregnancies was highest in those who had multiple previous D&Cs.

But if you've had or are going to have the procedure, don't worry too much: The number of people who had a preterm birth and a history of D&Cs was only 1.6% higher than in those who had never had a D&C. In other words, the association found in the study is not conclusive.

Additionally, it may be helpful to keep in mind that while many people fear that a D&C poses a risk to their fertility, some doctors believe that the procedure could help prevent complications like infections that could impair future fertility. A D&C can more effectively ensure all contents of the uterus are removed fully and cleanly.

Key Takeaway

There are different miscarriage treatment options, but some of the signs you may need a dilation and curettage (D&C) include experiencing a missed miscarriage or incomplete miscarriage. Talk to your doctor about whether a D&C might be the right treatment for you.

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Sources
Parents uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Trends of Patients' Preferences in the Management of First and Early Second Trimester Pregnancy Loss Towards the Choice of Medical or Surgical Termination of Pregnancy in a Tertiary Care Center in Oman. J Reprod Infertil. 2019.

  2. Patient education: Dilation and curettage (D&C) (Beyond the Basics). UpToDate. 2023.

  3. Dilation and Curettage. StatPearls Publishing. 2023.

  4. Dilation and Curettage (D&C). American College of Obstetricians and Gynecologists. 2022.

  5. Asherman SyndromeStatPearls Publishing. 2023.

  6. Dilatation and curettage increases the risk of subsequent preterm birth: a systematic review and meta-analysisHum Reprod. 2016.

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