What is it? A dilation and curettage abortion is a surgical procedure and is known
more commonly as a D&C. This abortion can be done between 6 and 12 weeks from the
first day of your last period, although some doctors use the procedure up to the
14th week. A D&C abortion is usually done at an abortion clinic or a hospital setting
since it can require machinery and usually requires general anesthesia.
What happens? First a pregnancy test is given, a pelvic exam is performed, and an
ultrasound may be done as well. Once the pregnancy has been confirmed, you disrobe
and lie on an examining table with your feet in stirrups. You will most likely be
given either general or twilight anesthesia. Misoprostol may be given to help the
cervix dilate, and oxytocin may be given to make the uterus contract. The doctor
will then insert a speculum into your vagina and clamp it open so that your cervix
is in plain view. He or she will then swab your vagina with an antiseptic to prevent
infection. A tenaculum (which looks somewhat like long, skinny pliers) will be used
to grasp your cervix and hold it in place.
strong tugging sensation as the curette scrapes against the uterus. The cramping
and pain will lessen once the procedure is over. You may also feel nauseated or
faint, and you may break out in a sweat. The doctor will then remove the curette
and examine the contents of the bowl on a tray to be sure that everything has been
removed. If something is missing, he or she may continue with more curettage or
may use a tube attached to a suction machine to vacuum the surface of the uterus
a few times. Once the doctor has determined that everything has been removed, he
or she will remove the curette or tube from your uterus and cervix and then remove
the tenaculum and speculum. Your uterus will then be inspected by pelvic examination
to check for firmness and size.
Once the abortion is complete, you can expect to wait approximately 1 hour before
being sent home. Acetaminophen or ibuprofen will be given or recommended for use,
and antibiotics may be prescribed to prevent infection from occurring. You will
most likely continue to bleed or spot for the next 2 weeks off and on, as well as
experience cramping for the rest of the day and possibly for 2 to 3 days following
the abortion. You will be instructed to not have intercourse or use tampons for
at least 1 week. You can return to normal activities the next day if you feel up
to it. A follow-up exam will be scheduled for approximately 14 days after the abortion
in order to confirm that the abortion has been completed and that there are no complications.
An ultrasound or a pelvic examination, as well as blood work, should be done at this
appointment to verify that everything was removed.
What does it cost? A D&C abortion will cost between $350-600 but can cost as much
as $3000 in some hospitals. The price will depend on anesthesia used, the size of
the baby, and the location of the procedure (hospital versus clinic). Some insurance
policies will cover the cost of a D&C abortion.
What should I consider?
A D&C abortion can be done safely between the 6th and 12th weeks of pregnancy.
If done before the 6th week, there is a higher chance of a failed abortion, and if
done after the 12th week there is a higher risk of complications.
This method is the least-common first trimester surgical abortion procedure because
it is riskier than the other procedures
You should plan on taking the remainder of the day to relax and recover after having
a D&C abortion done.
A D&C abortion is successful in ending the pregnancy 98% of the time, and if it should
fail, either another D&C or a vacuum aspiration will be done with your approval.
If, upon hearing the abortion has failed and the baby is still developing, you do
not want another abortion, contact a local pregnancy center to help you find an OB/GYN
to examine you. As always, the decision to abort is up to you.
This method is sometimes used when a medical abortion has failed, but a vacuum aspiration
There is less bleeding with this procedure than with a medical abortion, since most
of the blood is removed during the procedure.
A D&C abortion can only be done after the 6-7th week from the first day of your last
period, so if you want an abortion any earlier than that you will either have to
wait or choose a different form of abortion (RU-486, methotrexate, or manual aspiration).
As with any abortion procedure, there is a chance that you could become pregnant
immediately following the abortion, so take precautions to prevent another unplanned
You can request to have anesthesia for a D&C abortion, and if you choose to do so
you must bring someone to the clinic to drive you home.
A D&C abortion may be offered if your physician is in a rural area, does not have
up-to-date equipment and information, or is not highly experienced with abortion.
A D&C abortion cannot be compared to D&Cs done for therapeutic reasons when referring
to risks because the pregnant uterus is much softer than one being operated on for
What are the risks? Side effects are common and normal, and consist of abdominal
cramping, pain, nausea, sweating, and feeling faint during the procedure if not having
anesthesia, cramping and pain for 2-3 days following the procedure, as well as bleeding
for up to 2 weeks. True complications occur in approximately 5% of D&C abortions.
Allergic reactions to anesthesia or other medications given can occur. It is very
important that you report any over-the-counter or prescription medications as well
as illegal drugs so that the anesthetics can be adjusted accordingly.
Bacterial infection can occur during the procedure when surgical tools enter the
uterus, while symptoms won't occur for 2 to 3 days after the procedure. This happens
most frequently when there is an underlying STD that is not diagnosed at the time
of the abortion. Therefore, it is vitally important that you be tested for STDs
prior to the abortion. Infection is the most common post-abortion complication.
Hematometra (a uterine blood clot) can occur if the uterus does not contract (cramp)
to expel all of the lining. There will be severe abdominal cramping and nausea if
Heavy bleeding can occur if the uterus fails to contract and may lead to a uterine
blood clot, as mentioned above. Heavy bleeding may require medication, a repeat
abortion, surgery, and/or transfusion.
Heavy blood loss can also occur during the procedure itself, since the placenta is
separated from the uterine wall too slowly during a D&C. This can require a blood
A cut or torn cervix can occur when the doctor grabs the cervix with the tenaculum
or inserts the curette into the uterus. This may lead to a weakened cervix - making
carrying a future child to term difficult.
Cervical damage can also occur with the excessive dilating required for a D&C, also
leading to a weakened cervix. The cervix needs to be dilated much less if having
a vacuum aspiration.
The uterus may be perforated (punctured) during the abortion when the doctor presses
the curette against the walls of the uterus, causing heavy abdominal bleeding and/or
infection. You may require surgery to repair the puncture, and rarely you may need
a hysterectomy (removal of the uterus) to stop the bleeding. The risk of this happening
with a D&C abortion is considerably higher than with a vacuum aspiration, since the
pregnant uterus is extremely soft and easy to pierce with the sharp curette.
Scarring of the uterus may occur, resulting in "Asherman's Syndrome." This scarring
can occur as the doctor scrapes the curette against the walls of the uterus and can
cause future fertility problems.
An incomplete abortion, where the pregnancy has been terminated but the baby or other
tissue does not get expelled, can occur in an additional 1% of cases, especially
those done before 6 weeks since only 50-60% of the uterine wall is scraped during
a D&C. This causes severe cramping and excessive bleeding that continues for over
a week following the abortion.
Emotional or psychological distress can occur after the abortion, including depression,
guilt, regret, anger, and/or sleep disturbance.
Maternal death occurs in a reported 1 out of every 100,000 abortions (this includes
all types of abortion).
Once your cervix is open, the doctor will insert cervical dilators into the opening
of your cervix. These dilators are pictured at right. This process takes 5-10 minutes
and consists of the doctor inserting the smallest rod and progressively inserting
larger rods until reaching the largest, which is about the width of a dime. You
will most likely experience mild to strong cramping throughout dilation if you choose
to be awake for the procedure. The doctor will then take measurements of your uterus
to be sure that he or she uses the correct curette size. Then he or she will insert
a metal instrument called a curette (one type is pictured at right). A curette is
a long steel rod with a loop at the tip. This loop has sharp grooves on it, which
are used to scrape away the lining of the uterus. The doctor will begin to press
the tip of the curette along the surface of your uterus to dislodge the placenta
and the sac that contains the baby. The lining of your uterus, the placenta, and
the developing human will be removed in pieces and collected in a bowl just under
your vagina. The process takes approximately 10 minutes once the curette has been
inserted. If you choose to be awake for the abortion, you can expect moderate to
strong cramping and abdominal pain throughout the procedure and a