A D&C, short for dilation and curettage, is a procedure that removes tissue from inside the uterus. In pregnancy, it’s most commonly performed after a miscarriage to clear tissue that the body hasn’t fully passed on its own. The procedure takes about 10 to 15 minutes, has a success rate above 98%, and most people return to normal activities within five days.
Why a D&C Is Performed During Pregnancy
The most common reason for a D&C in pregnancy is early pregnancy loss. This includes several specific situations: a missed miscarriage (where the pregnancy has stopped developing but hasn’t passed), an incomplete miscarriage (where some but not all tissue has left the uterus), or what doctors call retained products of conception (tissue that remains after a miscarriage or delivery).
When a miscarriage happens, you typically have three options: waiting for the tissue to pass naturally, taking medication to help the process along, or having a D&C. Each approach works, but they differ in speed and reliability. Medication successfully completes the process in roughly 52% to 95% of cases, depending on the type of pregnancy loss. A D&C succeeds more than 98% of the time. For a pregnancy that stopped developing but shows no signs of passing (a missed miscarriage), the speed and predictability of a D&C can be a significant advantage, both physically and emotionally.
How the Procedure Works
A D&C involves two steps: opening the cervix and then removing tissue from the uterus.
To open the cervix, your doctor may insert a thin rod made of natural or synthetic material hours before the procedure. The rod absorbs fluid and gradually expands, gently widening the cervical opening. Medication to soften the cervix is sometimes used as well. During the procedure itself, the cervix can also be dilated using a series of small rods, each slightly larger than the last. Only a small amount of opening is needed, typically less than half an inch.
Once the cervix is open, tissue is removed from the uterus using one of two methods. The first is a curette, a thin, spoon-shaped instrument that scrapes the uterine lining. The second, and more commonly used today, is suction. A small tube connected to a vacuum pump draws tissue out of the uterus. This approach is called vacuum aspiration or suction curettage. Both manual and electric vacuum devices are safe and highly effective (98% to 99%), and they’re often used interchangeably. The manual version is smaller, quieter, and more portable. The electric version provides continuous suction without pauses.
What to Expect on Procedure Day
You’ll lie on your back with your feet in stirrups, similar to a pelvic exam. A speculum is placed in the vagina, and an instrument holds the cervix steady.
The type of anesthesia depends on your specific situation and your doctor’s recommendation. Options range from local anesthesia (an injection to numb the cervix), to sedation that keeps you relaxed but semi-awake, to general anesthesia where you’re fully asleep. Spinal or epidural anesthesia, which blocks feeling from the waist down, is another possibility. If you’ll be under general, spinal, or epidural anesthesia, you’ll need to stop eating and drinking after midnight the night before. Local anesthesia may have different fasting requirements.
The actual removal of tissue is quick. Most people spend more time in pre-procedure preparation and post-procedure monitoring than in the procedure itself.
Recovery Timeline
Mild cramping and light bleeding or spotting for a few days afterward is normal. Most people feel well enough to return to regular activities within five days or fewer. Sex is generally off-limits for about a week, until your doctor confirms it’s safe.
Your period will typically return within four to six weeks. Ovulation can happen before that first period, so it’s worth knowing that pregnancy is possible even before your cycle fully resumes.
Risks and Complications
A D&C is considered a low-risk procedure, but no surgery is completely without risk. The most significant complications include:
- Uterine perforation: A small tear in the uterine wall, which occurs in 0.1% to 4% of intrauterine procedures depending on individual factors. Most perforations heal on their own without further treatment.
- Infection: Bacteria can enter the uterus during or after the procedure, causing fever, pain, or foul-smelling discharge.
- Intrauterine adhesions (Asherman syndrome): Scar tissue that forms inside the uterus after the procedure. Up to 21.5% of women with a history of D&C develop some degree of these adhesions, according to Yale Medicine. Mild adhesions may cause no symptoms, while more extensive scarring can affect periods or future fertility. The condition is treatable.
- Heavy bleeding: Some bleeding is expected, but excessive blood loss during or after the procedure is uncommon.
Warning Signs After the Procedure
While mild cramping and light spotting are normal, certain symptoms need immediate medical attention. Contact your doctor or go to an emergency department if you experience heavy bleeding that soaks through a pad every 10 to 20 minutes, pass blood clots larger than a coin, develop a fever or chills, have lower abdominal pain that doesn’t respond to pain medication, or notice a foul-smelling vaginal discharge. These can signal infection, retained tissue, or other complications that need prompt treatment.
How a D&C Compares to Other Options
After a miscarriage, choosing between expectant management (waiting), medication, and a D&C is a personal decision. There’s no single right answer, and the best choice depends on how far along the pregnancy was, the type of loss, and your own preferences.
Waiting for the body to pass tissue naturally works for many people, but it’s unpredictable in timing and may take days or weeks. Medication speeds things up but has variable success rates: about 93% for incomplete miscarriages, 88% when embryonic or fetal development has stopped, and 81% for pregnancies where no embryo developed. If medication doesn’t fully work, a D&C may still be needed. A D&C offers the fastest resolution with the highest success rate, exceeding 98%, but it carries the small surgical risks described above. A meta-analysis published in Frontiers in Medicine found that surgical management had a meaningfully higher success rate than medical management overall, with a 26-percentage-point difference across the studies analyzed.
For some people, the certainty and speed of a D&C is a relief during an already difficult time. Others prefer to avoid a procedure and are comfortable with a less predictable timeline. Your doctor can help you weigh these factors based on your specific situation.