Clinical Uses
D&Cs are commonly performed for the diagnosis of gynecological conditions leading to 'abnormal uterine bleeding'; to resolve abnormal uterine bleeding (too much, too often or too heavy a menstrual flow); to remove the excess uterine lining in women who have conditions such as polycystic ovary syndrome (which cause a prolonged buildup of tissue with no natural period to remove it); to remove tissue in the uterus that may be causing abnormal vaginal bleeding, including postpartum retained placenta; to remove retained tissue (also known as retained POC or retained products of conception) in the case of a missed or incomplete miscarriage; and as a method of abortion that is now uncommon. In contrast, D&C remains 'standard care' for missed and incomplete miscarriage in many countries despite the existence of alternatives currently used for abortions.
Because medical and non-invasive methods of abortion now exist, and because D&C requires heavy sedation or general anesthesia and has higher risks of complication, the procedure has been declining as a method of abortion. The World Health Organization recommends D&C as a method of surgical abortion only when manual vacuum aspiration is unavailable. According to the Centers for Disease Control and Prevention, D&C only accounted for 2.4% of abortions in the United States in the year 2002, down from 23.4% in 1972. Most D&Cs are now carried out for miscarriage management and other indications such as diagnosis.
Hysteroscopy is a valid alternative to D&C for many surgical indications from diagnosis ot uterine pathology to removal of fibroids and even retained products of conception. It is less risky due to the ability of the doctor to view inside the uterus during surgery, unlike with blind D&C.
Medical management of miscarriage and medical abortion using drugs such as misoprostol and mifepristone are safe, non-invasive and cheaper alternatives to D&C.
Read more about this topic: Dilation And Curettage