A D&C, short for dilation and curettage, is a surgical procedure used to remove pregnancy tissue from the uterus after a miscarriage. It’s one of three standard options for managing early pregnancy loss, alongside waiting for the body to pass the tissue naturally or taking medication to help the process along. A D&C is often recommended when the miscarriage is incomplete, when the pregnancy has stopped developing but the body hasn’t recognized the loss, or when there are signs of infection.
Why a D&C May Be Recommended
Not every miscarriage requires a D&C. In many cases, the body passes pregnancy tissue on its own within a few weeks. But there are specific situations where a D&C becomes the preferred or necessary option.
The most common reason is an incomplete miscarriage, where some pregnancy tissue remains in the uterus after bleeding has started. Left in place, retained tissue can cause prolonged bleeding or infection. A D&C is also used for what doctors call early pregnancy failure, sometimes referred to as a missed miscarriage. This is when the embryo has stopped developing but the body hasn’t begun the process of passing it. An ultrasound typically reveals the loss before any symptoms appear. In cases of infection (septic miscarriage), removing the tissue promptly is considered urgent because the infection can spread and become dangerous.
The American College of Obstetricians and Gynecologists notes that expectant management, medication, and surgical evacuation are all reasonably effective, and there’s no evidence that any approach leads to different long-term outcomes. When there’s no medical urgency, the choice often comes down to patient preference.
D&C vs. Medication for Miscarriage
The main alternative to a D&C is medical management, which typically involves a medication called misoprostol that triggers the uterus to contract and expel tissue. In a study comparing the two approaches for first-trimester missed miscarriage, the medication succeeded about 81% of the time, while the surgical approach had a 100% completion rate. When the medication doesn’t fully clear the uterus, a D&C may still be needed as a follow-up.
The tradeoff is straightforward: a D&C resolves the situation in a single procedure, usually the same day, while medication can take hours to days and involves heavier bleeding and cramping at home. Some people prefer the control and privacy of managing the process at home. Others prefer the certainty that comes with a procedure. Neither choice is wrong.
What Happens During the Procedure
A D&C is typically performed under general anesthesia or deep sedation, meaning you’ll be asleep or heavily sedated and won’t feel pain during the procedure. The entire process usually takes about 15 to 30 minutes.
The first step is dilation, where a series of thin rods of increasing diameter are inserted into the cervix to gradually widen the opening. Sometimes a medication or a small device called a laminaria is placed hours beforehand to soften the cervix and make dilation easier. Once the cervix is open, a spoon-shaped instrument called a curette is inserted into the uterus. The curette’s edges are passed along the uterine lining to gently scrape away the remaining tissue. In some cases, suction is used instead of or alongside the curette to remove the tissue more efficiently. A thin instrument may also be used beforehand to measure the length of the uterus, which helps the surgeon work safely.
Recovery After a D&C
Most people can return to normal activities within about five days. Mild cramping and light bleeding or spotting for a few days afterward is normal. The bleeding is typically lighter than a period and tapers off gradually.
You’ll likely be told to avoid inserting anything into the vagina for a period of time after the procedure, including tampons, to reduce the risk of infection. Strenuous exercise is usually fine to resume once the cramping subsides. Your next period may arrive anywhere from two to six weeks after the procedure, though the timing varies.
Risks and Complications
A D&C is considered a safe, routine procedure, but like any surgery, it carries some risks. The most common complication is heavier-than-expected bleeding. Uterine perforation, where the surgical instrument creates a small hole in the uterine wall, occurs in roughly 0.5% of first- and second-trimester procedures. Most perforations heal on their own without further treatment, though in rare cases they require additional intervention.
Infection is another possible complication. Signs to watch for in the days after the procedure include fever, foul-smelling discharge, and worsening pain rather than improving pain.
The most significant long-term concern is Asherman syndrome, a condition where scar tissue (adhesions) forms inside the uterus. This is relatively uncommon after a single, uncomplicated D&C, occurring in up to 13% of first-trimester procedures. The risk rises substantially in specific situations: up to 30% in women who have a D&C after a late miscarriage, and as high as 23% when a second procedure is needed within two to four weeks of the first. Asherman syndrome can affect future periods and pregnancies, but it is treatable. Awareness of this risk is one reason many doctors try to limit the number of D&C procedures when possible.
Genetic Testing on the Tissue
One benefit of a D&C is that the tissue removed can be sent for genetic analysis. Chromosomal abnormalities are the cause of the majority of spontaneous miscarriages, and testing the tissue can confirm whether this was the case. This is especially valuable for people who have experienced two or more losses, where understanding the cause becomes more important for planning next steps.
Finding out that a miscarriage was caused by a random chromosomal error can be reassuring in a difficult way. It means the loss was likely a one-time event rather than a sign of an underlying condition that could affect future pregnancies. For couples experiencing recurrent loss, genetic results from each miscarriage help build a clearer picture over time and guide decisions about additional testing or treatment. If you’ve had prior losses, it’s worth asking whether tissue from those pregnancies was tested, as that information remains useful for future care.