I am often asked whether or not a woman experiencing a miscarriage should have a D&C (dilation and curettage). I almost always tell them…it depends. It depends on many factors but women must also understand the risks, which are high, when choosing a D&C for miscarriage. This post will discuss just one of the three most common miscarriage options.
It is important to note that if you are beyond 12 weeks gestation, the doctor will likely perform a D&E; which is discussed here. This is a different procedure although carries similar risks. Your doctor may still use the term D&C to describe the D&E procedure; however, these are not the same procedures.
First, why do you want the D&C? Is it to get the miscarriage over with? Maybe you don’t have time to wait for the miscarriage to start? Maybe you can’t spend another moment knowing you have a dead baby inside you? Maybe you want testing done and this is the only way to ensure it? And then maybe, you want to be sure you get the baby so you can bury or cremate the baby?
D&C’s do not come without risk. One of the biggest risks is infertility (primary or secondary) due to scarring which is also referred to as Asherman’s Syndrome. If Asherman’s Syndrome occurs, you will need to have another surgical procedure to remove the scar tissue in order for you to conceive otherwise you will be at risk for further miscarriages.
A D&C procedure is the same procedure used in abortions although the baby has already died. The first part of making your decision to have a D&C is to be certain of your diagnoses. Has the baby really died? Believe it or not, this can be misdiagnosed and you could actually be performing a D&C on your living baby. It is imperative that a vaginal ultrasound (not abdominal) is used and coupled with blood tests to ensure that your baby has, in fact, passed away before moving on to a D&C. Your care provider would note no visible heartbeat and falling HCG levels.
It is recommended that a minimum of two ultrasounds are performed on different days. Keep in mind that if you are very early in pregnancy (less than six weeks) your baby might not be detectable on an ultrasound (living or dead). HCG blood levels typically need to be above 1500mIU in order to see a gestational sac and/or fetal pole and even then, the heartbeat might not be detectable until six weeks three days or longer.
Waiting to find out is very difficult during this already stressful time but this is the time where mistakes are most frequently made. Bleeding can be considered normal during very early pregnancy so bleeding alone is not a good indicator of an impending miscarriage. Bleeding coupled with cramping isn’t even a good indicator, especially very early in pregnancy. It is recommended that you wait until at least seven weeks of pregnancy and have two ultrasounds (at least 1 week apart) to confirm pregnancy loss before proceeding to the D&C. Even so, a miscarriage can take place and you might not even be sure if you passed the baby and placenta due to how early it was.
Besides the D&C, there are other options for delivering a miscarried baby; such as expectant management and medical management (miscarriage at home either naturally or using a medication to help speed things along).
Having a D&C is a surgical procedure. You will generally undergo a light form of general anesthesia. This procedure is done on an outpatient basis unless there are complications needing you to be admitted such as excessive bleeding. It is becoming more common for doctors to conduct a D&C in their own offices.
Risks to the D&C procedure are:
- Risks associated with anesthesia such as adverse reaction to medication and breathing problems
- Infection in the uterus or other pelvic organs
- Perforation or puncture to the uterus
- Laceration or weakening of the cervix
- Scarring of the uterus or cervix, which may require further treatment
- Incomplete procedure which requires another procedure to be performed
The above risks are located at American Pregnancy.
If you choose to have the D&C, it is highly recommended that the surgeon conduct an “ultrasound guided D&C” instead of the normal “blind D&C.” Using the ultrasound while performing this procedure helps the surgeon to see where they need to use the suction instead of just blindly scraping inside of the uterus and possibly damaging more areas. This also helps reduce the chances of needing a repeat procedure for failing to remove all of the “products of conception.”
Following the procedure, the surgeon may place a “balloon” inside the uterus for approximately two weeks. Some surgeons will refer to this as a splint. This is placed inside and has a catheter that runs out of the vagina allowing bleeding and fluids to come out. Placing this balloon inside the uterus may help prevent the layers of the uterus from binding to each other. The balloon helps to keep all the layers away from each other while they heal. If they are allowed to lay on top of each other, they will heal (scar) together causing Asherman’s Syndrome (which may cause recurrent miscarriage and usually requires surgical correction in order to conceive and carry a future baby to term).
In addition to the balloon, your surgeon may prescribe you estrogen therapy for 2-4 weeks. This helps encourage healing by slowing progesterone production, which builds the lining of the uterus. Normally, it is important to have progesterone to grow our uterine lining as it is an essential hormone needed to sustain a pregnancy but while the uterus is healing, it’s important to reduce the production of the uterine lining so that walls of the uterus do not scar together. Estrogen therapy is recommended in combination with the balloon/splint.
In summary, using the ultrasound while performing a D&C can help the surgeon “see” where they need to work inside the uterus; while adding estrogen therapy and placing a balloon/splint inside the uterus for 2-4 weeks following the procedure will help women have a better outcome and will reduce the chances of developing Asherman’s Syndrome.
Are you or someone you know battling with a miscarriage? Visit Dragonflies For Ruby for support!
– Breaking the silence of First Trimester Miscarriage
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