Pros and Cons of a D&C After a Miscarriage

Weighing the Benefits and Possible Risks

Patient sitting on hospital bed waiting
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Dilation and curettage, known simply as D&C, is a surgical procedure sometimes used after a miscarriage or abortion to remove any remaining tissue from the uterus. It involves the use of a spoon-shaped device called a curette which gently scrapes the lining of the uterine wall.

In some cases, a D&C may be considered a medical necessity, particularly in women experiencing heavy bleeding following the miscarriage.

It is the quickest way to stop such bleeding and avoid the development of hypovolemia (excessive blood loss) and anemia.

With that being said, a D&C may not be considered a necessity in certain non-emergency situations, including an incomplete miscarriage. In instances like these, you may be given the option to have a D&C or to let nature take its course by allowing the miscarriage proceed at its own pace.

Weighing the Benefits

There are pros and cons to each approach. To make the appropriate choice, you would need to consider the medical advice of your doctor to ensure that your decision is both informed and safe.

With regards to a D&C, there are a number of benefits to consider, namely that:

  • It will end the physical process of the miscarriage quickly. By contrast, a natural miscarriage can be drawn out over days and even weeks. A D&C is a single, scheduled event that will complete the process and may also help reduce bleeding and cramping. Some women will opt for a D&C as a means to overcome the immediate trauma of a miscarriage. While it may not offer complete closure, it can provide them the means to gradually work through the emotions without the constant, physical reminder of the event.
  • It is not very painful. The D&C is typically performed under anesthesia. Moreover, the subsequent pain tends to be mild with most women able to return to their normal routines in a day or two.
  • It reduces the risk of certain complications. As with any surgical procedure, a D&C does have its share of complications but is generally considered safe, particularly when performed with an ultrasound. By contrast, with an incomplete miscarriage, any remnants of the pregnancy may result in prolonged bleeding and an increased risk of infection.
  • You won't see the pregnancy remains. As distressing as the miscarriage can be, the additional trauma of seeing the pregnancy remains during the remainder of the miscarriage can be equally traumatic. These may include the remnants of the gestational sac as well as recognizable remains of the fetus itself.
  • It reduces your risk of having to come back. If you choose to go through a natural miscarriage, there is a chance that you will have to return for a D&C later if the bleeding persists, the birth tissues haven't entirely shed, or an infection has set in.
  • There is no evidence it will affect future pregnancies. Studies have typically found that a D&C is not associated with any greater risk of pregnancy complications compared to women who haven't undergone the procedure. This includes the risk of preterm delivery, preeclampsia, placental abruption, malpresentation, first trimester bleeding, or miscarriage.

Weighing the Risks

Women who experience a miscarriage will grieve differently with some having less of an emotional response than others. While neither response is wrong nor right, the feelings do factor into which course of treatment may be appropriate in non-emergency situations.

Among the possible risks and complications of a D&C:

  • The procedure is invasive. Because of this, some women will opt to let nature take its course rather than undergoing a procedure that may feel is "too clinical" or subjects them to unwanted anesthesia.
  • The procedure may be too quick for some women. There will be those who would rather not let go of their loss so quickly and feel that a D&C effectively erases all evidence that a child was even there. They will instead choose to go through a natural miscarriage, however long as it takes, to gradually let go of the loss in tandem with the shedding of birth tissues.
  • There is a risk of serious complications. Occasionally a D&C can lead to heavy bleeding, infection, a uterine or bowel puncture, or a rare condition known as Asherman syndrome in which adhesions (bands of scar tissue) form in the uterine cavity. While uncommon, complications like these need to be considered.
  • There is a small but potential risk of cervical insufficiency. Cervical insufficiency, also known as an incompetent cervix, is used to describe the weakening of the cervical muscles and tissues. It can cause the premature dilation of the cervix in future pregnancies, increasing the risk of preterm birth or miscarriage. With that being said, it is a condition more associated with repeated D&C procedures. Most studies, in fact, are dubious about the relationship with regards to the use of D&C following a miscarriage.

A Word From Verywell

A miscarriage can be an emotionally devastating time for many women, so making a clear decision may not always be easy. As such, you need focus on safety first when assessing the pros and cons of a D&C versus a natural miscarriage.

If avoiding a D&C can cause you harm, you may need to put your natural instincts aside and address your physical needs first. It may not be easy, but, with time and support, you will get through it.

Sources:

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

Lohmann-Bigelow, A.; Longo, S.; Jiang, Z. et al. "Does Dilation and Curettage Affect Future Pregnancy Outcomes?" Ochsner J. 2007; 7(4):173-76. PMCID: PMC3096409.