Dilation And Curettage (D&C)
- The gradual enlargement of the cervical os and the curetting (scraping) of endometrial or endocervical tissue for histologic study.
- The procedure is usually performed to:
- To diagnosed cervical or uterine malignancy.
- To control dysfunctional uterine bleeding.
- To complete an incomplete abortion.
- To aid in evaluating infertility.
- To relieve dysmenorrheal.
- Fractional D&C procedures can assist in differentiating between endocervical and endometrial lesions.
- Lithotomy; arms may be extended on armboards.
- Gynecologic pack
- D&C tray
- Padded stirrups
- Perineal pad
- A weightened speculum is placed in the vaginal vault.
- The cervix is grasped with a tenaculum.
- A graduated sound is passed through the cervical canal into the uterine cavity to determine its depth and angulation.
- Using Hegar or Hank dilators, the surgeon begins to dilate the cervical opening, increasing the size of each dilator.
- A Telfa sponge is placed over the bill of the weighted speculum, and the uterus is gently curetted, allowing the tissue specimen to collect on the Telfa sponge.
- The small serrated curette is used to scrape the uterine walls again or when the D&C is performed to remove retained placental tissue, while the large, blunt curette and forceps are used to remove the tissue.
- If a fractional D&C is performed, endocervical curettings are obtained before the uterus is sounded, to avoid bringing endometrial cells into the cervical os.
- The weighted speculum is removed, and the perineum is dressed with a perineal pad.
Perioperative Nursing Considerations
- Stirrups should be padded, and a coccygeal support placed on the table to protect the lower sacral area.
- Raise and lower the legs together and slowly to prevent disturbances caused by rapid alterations in venous return and/ or injury to the rotator hip joint.
- Instruments are set up on the black table in order of usage, a scrub person may not be necessary during the procedure.
- If a fractional D&C is performed, multiple specimens may be obtained. They should be placed in separate containers, and labeled accordingly.