Q: I want to know about the Dilatation and Curettage (D&C) procedure done routinely by gynaecologists?

A:Dilatation and Curettage (D&C) is a procedure in which the uterine lining (endometrium) is sampled with a metal device (curette) in order to find if there is any abnormality in it. This operation is usually performed for two reasons. The first is to try to make a diagnosis, most commonly to help find the cause of abnormal uterine bleeding or it may be done to treat something that is wrong such as polyps, scar tissue, or overgrowth. The end of a normal menstrual cycle or period (in the absence of a pregnancy), is marked by shedding of the endometrium along with blood. In the first half of the cycle, the ovaries make a hormone called oestrogen, which makes the endometrium grow thicker. After ovulation (release of the egg from the ovary), the ovaries make a second hormone called progesterone. If the egg is not fertilized, the endometrium is shed and the whole cycle then starts again. If a woman bleeds too often, too much or too little, she may have a hormone problem or an abnormality inside the uterus itself. A sample of some of the endometrium obtained by a D&C can be examined under the microscope and one can learn about the hormones and see if there are any polyps or abnormal build-up of cells (hyperplasia) or cancerous change in the tissues. The procedure is performed in an operation theatre under general anaesthesia. The patient is put in position and the vagina and cervix are cleansed with an antibacterial agent. An instrument is used to grasp the upper portion of the cervix and then the opening to the uterus is gradually widened with metal dilators to about the size of a large pencil. Once this dilatation has been completed, the curette, which is an instrument with a flat metal loop at the end, is inserted into the uterine cavity and is used to gently scrape the lining of the uterus. This scraping is done throughout the uterus and the tissue that is removed is then sent to a pathologist for microscopic examination. The procedure is usually very uncomplicated and the most common complication that can occur is perforation of the uterus with either the dilators or the curette. Other complications include bleeding and infection. Most bleeding is rather self-limiting while infection (also rare) can be treated with antibiotics.