# Dilatation and Curettage

> NEET-PG Obstetrics and Gynaecology notes on dilatation and curettage: indications, contraindications, sounding and technique to avoid uterine perforation.

- Canonical URL: https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/dilatation-and-curettage
- Exam / course: NEET-PG · Subject: Obstetrics and Gynaecology
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-08
- Last updated: 2026-10-08
- Reference basis: Williams Obstetrics; D.C. Dutta's Textbook of Gynecology; Te Linde's Operative Gynecology
- How to cite: "Dilatation and Curettage", PrepElephant, https://prepelephant.com/topics/neet-pg/obstetrics-and-gynaecology/dilatation-and-curettage

## Direct answer

Dilatation and curettage is cervical dilatation followed by scraping of the uterine cavity, used diagnostically for endometrial sampling and therapeutically for evacuation of retained products after miscarriage. Its main hazards are uterine perforation and intrauterine adhesions, Asherman syndrome, after excessive curettage. Active pelvic infection is a contraindication. Perforation is avoided by sounding the uterus gently before any dilatation.

## What you must remember

- **Diagnostic indications:** abnormal uterine bleeding, postmenopausal bleeding and endometrial sampling, though hysteroscopy-directed sampling is increasingly preferred for focal lesions.
- **Therapeutic indications:** incomplete or missed miscarriage and retained products after abortion or delivery.
- **Contraindications:** active pelvic infection such as PID or cervicitis, and a cervix that cannot be safely dilated.
- **Perforation risk:** higher in a soft postpartum or lactating uterus, after previous caesarean, and with fibroids or uterine anomalies.
- **Asherman syndrome:** intrauterine adhesions after aggressive curettage, causing hypomenorrhoea and infertility or recurrent miscarriage.
- **Anti-D:** Rh-negative women need anti-D immunoglobulin after evacuation of a pregnancy, as per local protocol.
- **Histology:** all tissue removed should be sent for pathology.

## Evacuating an incomplete miscarriage

A 38-year-old with an incomplete miscarriage at 10 weeks has heavy bleeding and an open cervix. Evacuation is needed, and the greatest risk is perforation from a poorly sounded uterus. The steps below follow the safe sequence.

1. **Prepare:** confirm consent, empty the bladder, and check haemoglobin and Rh status before the procedure.
2. **Examine under anaesthesia:** bimanual examination establishes uterine size, position and cervical patency.
3. **Sound the uterus:** a uterine sound gently measures the depth and direction of the cavity, guiding safe instrumentation.
4. **Dilate the cervix:** graded Hegar dilators are used in sequence until the curette passes without force.
5. **Curette systematically:** a sharp or suction curette clears the cavity in controlled strokes, and tissue goes for histology.
6. **Confirm completion:** ultrasound or gentle re-exploration confirms an empty cavity and rules out perforation.

Perforation is suspected when the instrument passes with sudden loss of resistance, especially with pain, shock or bleeding, and it prompts immediate assessment for bowel or bladder injury.

## Where the exam tries to catch you

Curettage questions test the perforation hazard, the sequence of steps and the anti-D rule.

- **Trap:** using forceful curettage to speed evacuation — **Correct:** gentle, systematic strokes reduce perforation and Asherman syndrome risk.
- **Trap:** dilating the cervix without first sounding the uterus — **Correct:** sounding confirms direction and depth, which prevents perforation.
- **Trap:** forgetting anti-D status after evacuation — **Correct:** Rh-negative women need anti-D immunoglobulin, as per local protocol.

## Frequently asked questions

### What is the main risk of dilatation and curettage?

The main risks of dilatation and curettage are uterine perforation, infection and intrauterine adhesions after aggressive curettage. Perforation is more likely in a soft postpartum or lactating uterus. Gentle sounding and dilatation reduce these risks.

### When is dilatation and curettage contraindicated?

Dilatation and curettage is contraindicated during active pelvic infection, and it should be avoided when the cervix cannot be safely dilated. Ectopic pregnancy must be excluded before any evacuation. Urgent conditions take priority over the procedure.

### Why is the uterus sounded before curettage?

Sounding measures the depth and direction of the uterine cavity so that the curette is used within safe limits. It helps avoid perforation, especially in an enlarged or displaced uterus. Sounding is done gently before any dilatation.

### What is Asherman syndrome?

Asherman syndrome is intrauterine adhesion formation after trauma to the endometrium, most often after aggressive curettage. It causes reduced menstrual flow and can lead to infertility or recurrent miscarriage. Hysteroscopic adhesiolysis is the usual treatment.

### Does every woman after miscarriage need anti-D?

Only Rh-negative women need anti-D immunoglobulin after a pregnancy loss or evacuation, where the pregnancy may be Rh-positive. Rh-positive women do not need it. Local protocols set the gestational thresholds for giving it.