A D and C, often spelled D&C and short for "dilation and curettage," is a type of surgical treatment for first-trimester miscarriage. In a D and C procedure, the woman's cervix is dilated and the doctor uses either a surgical curette or vacuum aspiration to clear the uterus.
In many cases, the D and C is medically necessary after a miscarriage diagnosis. For example, women with hemorrhages or dangerously heavy bleeding may need a D and C to make the bleeding stop. Without emergency indications, however, the D and C may be optional and the doctor may leave the choice up to you whether you want to have the procedure or wait to see if the miscarriage will finish without intervention. Here are some pros and cons to keep in mind as you decide.
Pros of a D and C
A D and C will end the physical process of the miscarriage quickly.
A natural miscarriage can be drawn out over days or weeks, with prolonged bleeding or even prolonged waiting for bleeding to even start. A D and C is a single, scheduled event that will complete the miscarriage process and may even mean reduced bleeding and cramping. And many women find it easier to move forward with the grieving process when the physical part of the miscarriage is over quickly.
You won't have to see the pregnancy remains.
Many women are disturbed at seeing the gestational sac or the recognizable remains of the developing baby, which is a possibility in a natural miscarriage depending on how far along the pregnancy was. With a D and C, you probably won't see anything anything but light bleeding for a few days to two weeks afterward.
There is a reduced risk of needing additional treatment later.
A small percentage of natural miscarriages won't complete on their own without intervention, so having a D and C right away will eliminate the possibility that you might need one later anyway. More than 80% of early miscarriages will complete without intervention, however, for women who do choose that option.
Cons of a D and C
The procedure is invasive.
Some women may find the concept of a D and C unsettling, preferring to let nature take its course. Others may simply prefer to avoid medical procedures whenever possible. If it is discomfort with the idea of undergoing a D and C that is disturbing, note that many healthcare providers offer sedatives, or sometimes general anesthesia, during the procedure that can minimize your memory of it.
There is a slight risk of complications.
Occasionally a D and C can lead to uterine puncture or adhesions and scarring, and potentially even the rare condition known as Asherman's syndrome. These complications are uncommon, but the possibility does exist that they can occur.
Sources:
ACOG Education Pamphlet AP062. American College of Obstetricians and Gynecologists. Accessed: July 22, 2009. http://www.acog.org/publications/patient_education/bp062.cfm
Butler Charles, Gary Kelsberg, Leilani St. Anna. "How long is expectant management safe in first-trimester miscarriage?" Journal of Family Practice, Oct 2005.
