D&C After Miscarriage: Benefits and Complications

If You've Been Given a Choice, Learn the Pros and Cons of This Procedure

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It's natural to wonder about complications from a D&C if you've been informed that you need this procedure (or need to at least consider it) during or after a miscarriage.

A D&C - short for "dilation and curettage" - is a surgical treatment that is sometimes used to resolve a first-trimester miscarriage. In a D&C procedure, the woman's cervix is dilated and the doctor uses either a spoon-shaped surgical instrument (called a curette) or suction to remove tissue from the uterus.

In many cases, a D&C is medically necessary after a miscarriage diagnosis. For example, women with hemorrhages or dangerously heavy bleeding after a miscarriage diagnosis may need a D&C to make the bleeding stop.

However, if there is not an emergency indication like this, a D&C may be optional in an incomplete miscarriage. 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 (known as "expectant management").

Below, we'll discuss some pros and cons to keep in mind as you decide.

Benefits of a D&C After Miscarriage

A D&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 start. A D&C is a single, scheduled event that will complete the miscarriage process and possibly reduce bleeding and cramping.

Plus, many women find it easier to move forward with the grieving process when the physical part of the miscarriage is over quickly.

It's not very painful. You will probably be given anesthesia so you won't feel pain during the procedure. After a D&C, pain tends to be mild and most women get back to their normal physical routine in a day or two.

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&C, you probably won't see anything but light bleeding for a few days to two weeks afterward.

There is a reduced risk of needing additional treatment later. More than 80 percent of early miscarriages will complete without intervention. However, a percentage of natural miscarriages won't complete on their own without intervention, so having a D&C right away will eliminate the possibility that you might need one later anyway. If products of conception remain in your uterus after a miscarriage, you risk heavy bleeding and an infection.

Cons and Complications of a D&C

The procedure is invasive. Some women may find the concept of a D&C unsettling, preferring to let nature take its course. Others may simply prefer to avoid medical procedures whenever possible.

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 D&C complications. Occasionally a D&C can lead to heavy bleeding, an infection, a uterine or bowel puncture or the rare condition known as Asherman syndrome, in which adhesions (bands of scar tissue) form in the uterine cavity. These complications are uncommon, but the possibility does exist that they can occur.

Does Having a D&C Increase Risk of Preterm Birth in Future Pregnancies?

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.

What the Research Says About the Risk

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.

Frequently Asked Questions: Dilation and Curettage (D&C). American College of Obstetricians and Gynecologists. February 2016.

Butler, C., Kelsberg, G. St. Anna, L., et al. (2005). How long is expectant management safe in first-trimester miscarriage? Journal of Family Practice. 

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