D and C

Question 1

What is a D&C and for what purposes is it

performed?

Answer 1

A dilatation and curettage (D&C) is a surgical procedure in
which the endometrial lining of the uterus and any lesions, such
as polyps or myomas, are removed. It is performed to complete
a missed or incomplete spontaneous abortion, as a treatment of
cervical stenosis, to diagnose and treat bleeding caused by
cervical and uterine lesions, and as a method for pregnancy
termination to a lesser extent.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 802.

Question 2

What are the common preoperative diagnoses seen

in patients presenting for D&C.

Answer 2

Abnormal uterine bleeding; cervical stenosis; pregnancy
termination; missed, incomplete, or induced abortion; or
uncontrolled uterine bleeding (this is seen in young women in
which hormone therapy has proven ineffective).
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 802.

Question 3

How is a patient positioned for a D&C?

Answer 3

Dorsal lithotomy position
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 802.

Question 4

What two medications can be used during a D&C to

help manage blood loss?

Answer 4

Methylergonovine maleate and oxytocin
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 804.

Question 5

How is methylergonovine maleate administered?

What is the dose?

Answer 5

Methylergonovine maleate is administered as an IM injection of
0.2 mg.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 804.

Question 6

List possible causes of severe postoperative

bleeding following a D&C.

Answer 6

Cervical injury, uterine atony, uterine perforation, and retained
product of conception (POC).
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 807.

Question 7

How does oxytocin aid in decreasing blood loss

during a D&C?

Answer 7

By causing contraction of the uterus.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 806.

Question 8

Upon dilatation of the cervix, a patient experiences
bradycardia and hypotension. What accounts for
this response? What is the treatment?

Answer 8

The patient is experiencing a vasovagal response. This is
treated by immediate cessation of the stimulation (grasping and
dilatation of the cervix), and atropine 0.4mg IV or glycopyrrolate
0.1-0.2 mg IV if so warranted.
Jaffe RA, Schmiesing CA, Golianu B. Anesthesiologist’s
Manual of Surgical Procedures. 5th ed. Philadelphia, PA:
Wolters Kluwer Health, 2014: 807.