Dilation and curettage (suction and fractionate)
Dilation and curettage reflects instrumental cervical opening and evacuation of uterine content. It may be necessary after incomplete miscarriage, to decrease an abnormal uterine bleeding or to explore the possibility of a uterine malignancy. However the mechanical dilation of the cervix without a reasonable indication may set the stage for cervical incompetency and pregnancy loss later on in life.
We reserve the suction D&C for medically resistant incomplete miscarriages with significant blood loss and the fractionate D&C with or without hysteroscopy for endometrial sampling to rule out malignancy after the simple endometrial biopsy was deemed unsatisfactory or a larger sample is required.