In a D & C procedure, the doctor dilates the cervix and removes the contents of the uterus. The procedure is used both for elective abortions and treatment of miscarriages. The possible link between D & C procedures and future health risks has been the subject of much research throughout the years. Most research has found no lasting health risks from D & C, except for the rare risks of uterine puncture or scarring.
Some research finds that repeated D & Cs can weaken the cervix, causing a condition called cervical insufficiency. Cervical insufficiency, sometimes called incompetent cervix, means that the cervix has a tendency to begin dilating too early in pregnancy, ending in preterm delivery of the baby and sometimes pregnancy loss.
This research is controversial, however, and different studies have different verdicts on the exact association. Some studies have found a strong link between having a D & C and risk for preterm delivery, and other studies have refuted the link.
One 2008 study conducted by researchers at Virginia Commonwealth University looked at data from a large population and found that women who had one D & C were 67% more likely to have a future preterm birth, and the risk increased for women with a greater number of D & Cs. However, variables in the study suggest that a mechanism other than cervical insufficiency might play a role in birth outcomes. Their research found increased risk of low birth weight in full-term deliveries after a D&C; they predicted that the association would be stronger in preterm births had cervical insufficiency been responsible.
The researchers concluded that women should be informed that having a D & C may carry a risk for preterm delivery. The study did have weaknesses in that it did not differentiate among D & Cs for elective abortion and miscarriages, and it used relatively old data from 1959 to 1966. (Techniques and medical circumstances may have changed since then.)
So, right now, the exact answer to this question is still unresolved. D & Cs may or may not cause cervical weakness or risk of premature birth in future pregnancies. Today, most doctors would probably conclude, however, that the proven benefits of D & C for miscarriage -- either due to emergency or for prevention of miscarriage complications -- probably outweigh the unproven risks.
Sources
American Pregnancy Association, "D&C Procedure After a Miscarriage." Jul 2006. Accessed 1 Jan 2008.
Brown, J.S., T. Adera, and S.W. Masho, "Previous abortion and the risk of low birth weight and preterm births." Journal of Epidemiology and Community Health 2008. Accessed 1 Jan 2008.
