Official reprint from UpToDate®
www.uptodate.com ©2018 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Dilation and curettage

Dale W Stovall, MD
Section Editor
William J Mann, Jr, MD
Deputy Editor
Sandy J Falk, MD, FACOG


The gynecologist has a variety of tools available for evaluation and treatment of women with abnormal uterine bleeding. Dilation and curettage (D&C) will be reviewed here. Office procedures for endometrial sampling and an overview of diagnostic approaches to endometrial evaluation, including both noninvasive and invasive assessment, are discussed separately. (See "Endometrial sampling procedures" and "Evaluation of the endometrium for malignant or premalignant disease".)


D&C has both diagnostic and therapeutic indications.

Diagnostic indications — The development of equipment and techniques for office based endometrial sampling has obviated the need for diagnostic D&C in most patients. Numerous studies have shown that the endometrium is adequately evaluated with sampling techniques. (See "Endometrial sampling procedures".)

However, there are still some indications for diagnostic D&C, such as in women:

With a nondiagnostic office biopsy who are at high risk of endometrial carcinoma. (See "Endometrial carcinoma: Epidemiology and risk factors", section on 'Risk factors'.)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Dec 2017. | This topic last updated: Jul 06, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2018 UpToDate, Inc.
  1. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration: Application to Healthy Patients Undergoing Elective Procedures. www.asahq.org/publicationsAndServices/practiceparam.htm. (Accessed on July 14, 2005).
  2. Zupi E, Luciano AA, Valli E, et al. The use of topical anesthesia in diagnostic hysteroscopy and endometrial biopsy. Fertil Steril 1995; 63:414.
  3. Cicinelli E, Didonna T, Ambrosi G, et al. Topical anaesthesia for diagnostic hysteroscopy and endometrial biopsy in postmenopausal women: a randomised placebo-controlled double-blind study. Br J Obstet Gynaecol 1997; 104:316.
  4. Trolice MP, Fishburne C Jr, McGrady S. Anesthetic efficacy of intrauterine lidocaine for endometrial biopsy: a randomized double-masked trial. Obstet Gynecol 2000; 95:345.
  5. Dogan E, Celiloglu M, Sarihan E, Demir A. Anesthetic effect of intrauterine lidocaine plus naproxen sodium in endometrial biopsy. Obstet Gynecol 2004; 103:347.
  6. Rattanachaiyanont M, Leerasiri P, Indhavivadhana S. Effectiveness of intrauterine anesthesia for pain relief during fractional curettage. Obstet Gynecol 2005; 106:533.
  7. Hui SK, Lee L, Ong C, et al. Intrauterine lignocaine as an anaesthetic during endometrial sampling: a randomised double-blind controlled trial. BJOG 2006; 113:53.
  8. Lau WC, Tam WH, Lo WK, Yuen PM. A randomised double-blind placebo-controlled trial of transcervical intrauterine local anaesthesia in outpatient hysteroscopy. BJOG 2000; 107:610.
  9. Frishman GN, Spencer PK, Weitzen S, et al. The use of intrauterine lidocaine to minimize pain during hysterosalpingography: a randomized trial. Obstet Gynecol 2004; 103:1261.
  10. Kozman E, Collins P, Howard A, et al. The effect of an intrauterine application of two percent lignocaine gel on pain perception during Vabra endometrial sampling: a randomised double-blind, placebo-controlled trial. BJOG 2001; 108:87.
  11. Edelman A, Nichols MD, Leclair C, et al. Intrauterine lidocaine infusion for pain management in first-trimester abortions. Obstet Gynecol 2004; 103:1267.
  12. Costello MF, Horrowitz S, Steigrad S, et al. Transcervical intrauterine topical local anesthetic at hysterosalpingography: a prospective, randomized, double-blind, placebo-controlled trial. Fertil Steril 2002; 78:1116.
  13. Chen SS, Lee L. Reappraisal of endocervical curettage in predicting cervical involvement by endometrial carcinoma. J Reprod Med 1986; 31:50.
  14. Hulka JF, Lefler HT Jr, Anglone A, Lachenbruch PA. A new electronic force monitor to measure factors influencing cervical dilation for vacuum curettage. Am J Obstet Gynecol 1974; 120:166.
  15. Molin A. Risk of damage to the cervix by dilatation for first-trimester-induced abortion by suction aspiration. Gynecol Obstet Invest 1993; 35:152.
  16. Hunter RE, Reuter K, Kopin E. Use of ultrasonography in the difficult postmenopausal dilation and curettage. Obstet Gynecol 1989; 73:813.
  17. Thompson JD, Rock J. Operative Gynecology, JB Lippincott, Philadelphia 1992.
  18. Gebauer G, Hafner A, Siebzehnrübl E, Lang N. Role of hysteroscopy in detection and extraction of endometrial polyps: results of a prospective study. Am J Obstet Gynecol 2001; 184:59.
  19. Stock RJ, Kanbour A. Prehysterectomy curettage. Obstet Gynecol 1975; 45:537.
  20. Ben-Baruch G, Menczer J, Shalev J, et al. Uterine perforation during curettage: perforation rates and postperforation management. Isr J Med Sci 1980; 16:821.
  21. Hefler L, Lemach A, Seebacher V, et al. The intraoperative complication rate of nonobstetric dilation and curettage. Obstet Gynecol 2009; 113:1268.
  22. Lowensohn RI, Hibbard LT. Laceration of the ascending branch of the uterine artery: a complication of therapeutic abortion. Am J Obstet Gynecol 1974; 118:36.
  23. Sacks PC, Tchabo JG. Incidence of bacteremia at dilation and curettage. J Reprod Med 1992; 37:331.
  24. Park TK, Flock M, Schulz KF, Grimes DA. Preventing febrile complications of suction curettage abortion. Am J Obstet Gynecol 1985; 152:252.
  25. Dajani AS, Bisno AL, Chung KJ, et al. Prevention of bacterial endocarditis. Recommendations by the American Heart Association. JAMA 1990; 264:2919.
  26. March CM. Intrauterine adhesions. Obstet Gynecol Clin North Am 1995; 22:491.
  27. Schenker JG. Etiology of and therapeutic approach to synechia uteri. Eur J Obstet Gynecol Reprod Biol 1996; 65:109.
  28. Twiggs LB, Phillips GL. Documentation of subclinical trophoblastic embolization with invasive cardiac monitoring in a woman with a molar pregnancy. A case report. J Reprod Med 1986; 31:277.
  29. Cohle SD, Petty CS. Sudden death caused by embolization of trophoblast from hydatidiform mole. J Forensic Sci 1985; 30:1279.