Dilation and curettage vs dilation and evacuation
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"Dilation and Curettage" AND "Dilation and Evacuation"
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ACOG dilation and curettage dilation and evacuation definitions abortion miscarriage
| Feature | Dilation and curettage (D&C) | Dilation and evacuation (D&E) |
|---|---|---|
| Basic method | Cervix is opened, then tissue from the uterine lining or pregnancy tissue is removed using a curette and/or suction. | Cervix is opened, then uterine contents are removed using suction plus surgical instruments, usually forceps. |
| Typical use | Evaluation of abnormal uterine bleeding, sampling the endometrium, and management of early miscarriage or first-trimester abortion. | Most often used for pregnancy termination or pregnancy-loss management after the first trimester, commonly from about 13 weeks onward. |
| Extent of cervical preparation | Usually modest dilation. | Usually requires more cervical dilation, often prepared with medication and/or osmotic dilators beforehand. |
| Tissue removed | Primarily endometrial or early-pregnancy tissue. | Larger-volume pregnancy tissue, including fetal and placental tissue. |
| Complexity | Generally less extensive procedure. | More technically complex and should be performed by an experienced clinician. |
Important terminology point: In modern practice, early uterine evacuation is often performed with vacuum aspiration. People may still call this a “D&C,” even though sharp scraping with a curette may not be the main technique.
Both procedures can involve cramping and bleeding afterward. Uncommon complications include heavy bleeding, infection, cervical injury, retained tissue, intrauterine adhesions, and uterine perforation. The reason for the procedure, gestational age, ultrasound findings, medical conditions, and local expertise determine which option is appropriate.
The ACOG D&C overview describes D&C as cervical dilation followed by removal of uterine tissue with a curette or suction. The ACOG abortion-care guidance describes D&E as a procedure after 12 weeks using dilation, instruments, and suction.
Which procedure is used at each stage of pregnancy?
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ACOG procedure abortion first trimester vacuum aspiration D&C second trimester D&E 12 weeks
For surgical uterine evacuation, the usual pattern is:
| Pregnancy stage | Common procedure |
|---|---|
| Early first trimester, up to about 12-13 weeks | Vacuum aspiration (also called suction curettage). It is often loosely called a D&C, although suction rather than sharp scraping is commonly used. |
| Later first trimester | Vacuum aspiration or D&C may still be used, depending on exact gestation, uterine size, bleeding, and local practice. |
| Second trimester, after about 13 weeks | Dilation and evacuation (D&E), involving more cervical preparation plus suction and instruments. |
| Later second trimester | D&E may still be an option where an appropriately trained service is available. Cervical preparation generally takes longer. Medical induction is another common option. |
| Third trimester / viable pregnancy | D&C and D&E are generally not routine methods. Management is individualized, often involving induction of labor or delivery for maternal or fetal indications. |
For miscarriage, the same broad distinction applies: early losses are generally managed with medication, expectant management, or vacuum aspiration/D&C; second-trimester loss may be managed with D&E or induction, depending on clinical circumstances and patient preference.
The exact cutoffs vary somewhat by country, clinician skill, and service availability. ACOG guidance states that vacuum aspiration is usually offered up to 13 weeks, while D&E can be used after 12 weeks and is the usual procedural method in the second trimester.
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