All About D&C for Miscarriage Treatment

Miscarriage treatment is one of the leading reasons for patients to undergo a D&C -- a dilation and curettage procedure. The other leading reason is for purposeful termination of the pregnancy. In some cases post partum women may require a D&C; if the placenta did not detach properly during birth and a small piece was left in the womb it will cause constant bleeding which may eventually be life threatening. Today we are looking at what will happen if you need to have a D&C for miscarriage treatment.

Why have a D&C?
There are several reasons when a miscarried pregnancy might need medical intervention to complete:

* If the embryo is not living, but has not detached properly it could cause excessive bleeding
* If a stillbirth was discovered by an ultrasound, but there is no sign of imminent spontaneous abortion
* If a doctor feels that the miscarriage might not ever complete naturally, and may become septic


Basically, having a D&C helps ensure that your body has the best possible chance to recover from the miscarriage without permanent damage to your reproductive organs.

If you have experienced repeated miscarriages in a relatively short period of time, your doctor might recommend that you have chromosomal testing done on a spontaneously aborted embryo. Having a D&C done means that it is possible to do that chromosomal testing. The tissue sample might not otherwise be retrievable.

Risks of having a D&C done
In the medical profession, these are generally accepted to be outweighed by the guaranteed benefits of the procedure. However, if the following minor risks are important to you it is always your choice whether to undergo the procedure.

* Slight risk of puncturing the uterus
* Slight risk of later cervical insufficiency -- which can cause problems in later pregnancies
* Risk of scarring in the uterus, which can cause heavy post partum bleeds in subsequent deliveries.


How is it done
D&Cs may be done in either a hospital or a doctor's office, and under general anaesthesia or local anaesthesia. You will need presurgical tests in some cases, and will have to take a pill to help dilate your cervix.

A speculum is inserted into the vagina, the cervix is manually dilated if necessary and a curette, or flat blade, introduced to scrape the uterine lining away.

You will most likely be able to resume your normal activities after your D&C with just a day's rest. Bleeding is usually mild to moderate, and cramping is not usually extensive either.

Introduction to Tubal Ligation

For those of you who are finished having children, tubal ligation and vasectomy can be an attractive, cost-effective option that minimally impacts on your health. Tubal ligation is not a guarantee of contraception, and there is also no guarantee that the procedure will be reversible, although from both points of view it is an extremely predictable and highly reversible procedure. You should ask your gynaecologist about how your particular surgery will be done - here we are looking at the standard methods and side effects of tubal ligation that you might encounter.

How it works
The principle upon which tubal ligation is based is that of preventing the egg from reaching the sperm. It is a barrier method -- although a much more permanent one than other barrier methods like condoms, diaphragms or inter-uterine devices. Rather than hormonal contraception methods, which usually prevent an egg being released, when you have a tubal ligation done the tubes are either burned, cut or otherwise closed so that the egg is still released, but it cannot meet the sperm. The egg is broken down and reabsorbed by the body.

How is tubal ligation done?
Your Fallopian tubes may be cut, burned, tied up with rubber bands, or clipped to ligate them. Alternatively, you may have tiny, flexible devices placed inside your Fallopian tubes which the body recognizes as foreign, and so forms scar tissue around them. This effectively blocks the tubes in a more natural way, but takes longer to effect.

The procedure
The procedure will differ from surgeon to surgeon, and patient to patient. You should ask your own gynecologist questions about how tubal ligation will be done in your case. However, a common scenario involves:

* You will be anesthetized
* One to three small incisions being made around the navel
* A laparoscope is inserted in the incisions -- a tiny camera which allows surgeons to see the internal organs with cuts as small as possible.
* The tubes are ligated by one of the methods above.
* Your belly will be stitched up by either dissolvable or non-dissolvable stitches.


Is it reversible?
In many cases, yes. In some cases, no. If your tubes have been burned or cut to ligate them, you have a much lower chance of being able to become pregnant following reversal surgery. If there is a greater than even chance you'll want to become pregnant after a tubal ligation, it is recommended that you explore alternative contraception options with your doctor.

Asking your Doctor Questions

After my third child was born, I decided that three kids was enough and made arrangements to have a tubal ligation to prevent any further pregnancies. I was lucky to have a doctor who was easy to talk to; some women are not so lucky and often their doctors are too busy to answer their many questions.

Ten years after my sterilization surgery I began experiencing the onset of terrible pelvic pain. My menstrual cycles became very heavy and would last for two weeks or longer. My doctor tried several different treatments to try to ease the pain and regulate my cycles. The treatments would work, initially, but then within three months the pain and heavy bleeding would return. My doctor was doing everything possible to keep me from having to have major surgery; she was exploring all the options before she made that suggestion.

About two years after the excessive pain began and all the treatments had failed, my doctor finally suggested that I have a partial hysterectomy; she would leave my ovaries but remove my uterus, which was the source of all my pain. I asked her countless questions before I agreed to have it done; I wanted to make sure this was the last option. She scheduled the surgery for the following month. I was nervous about having a major surgery such as this but my doctor reassured me that the procedure was very common these days and could actually be done on an outpatient surgery. Part of me was relieved that the source of my pain was going to be removed and another part of me was scared.

On the day of my hysterectomy my doctor came into the room where I was waiting before surgery and went over the procedure one more time. She answered any other questions I had and then wheeled me into the operating room. It took less than an hour to complete and I was home in my own bed by five o’clock that same afternoon. The pain from the surgery was minimal and by the second day after I was up walking around with very little discomfort. As far as surgeries go this was not such a bad experience.

After I completely healed from the surgery the pelvic pain was completely gone. I felt like a brand new person and had energy to do all the things I used to enjoy doing but couldn’t because I was always in such pain. I was very thankful to have such a great doctor who allowed me to ask lots of questions and kept me informed about what was happening to my body. It’s very important to feel comfortable with your doctor when dealing with such personal issues such as this.

A Quick History of Vaginal Hysterectomy

Your doctor may have recommended you have a very common surgery known as a "vaginal hysterectomy." As you're compiling your list of questions about that surgery, it would be good to know how long doctors have used it as a medical intervention. Vaginal hysterectomy, or the removal of a woman's uterus through an incision in the vagina, may seem like a modern procedure, but the truth is that it's been done in some fashion for hundreds of years. Here's a quick timeline of the medical history of vaginal hysterectomy.

As early as the mid-15th century, medical journals give detailed accounts of doctors doing vaginal hysterectomies. Even earlier than that, however, a doctor by the name Soranus of Ephesus wrote of one such procedure in the second century! These primitive surgeries were done primarily for treatment of gangrene, and there isn't much said again about them until the late 1700s.

A lot has been written about the vaginal hysterectomies being done during the 1800s, especially by a Dr. K.M. Langenbeck, whose work wasn't generally well received. Later efforts by others to improve on his methods resulted in widespread interest in the procedure later in that century. These surgeries were done for a number of reasons, most notably cervical cancer.

As with other gynecological procedures such as tubal ligation and D&C, advancements in surgical equipment, anesthesia and antiseptic techniques significantly lowered the risks involved.

In the late 1870s, another form of hysterectomy began to be explored, in which removal of the uterus was accomplished through an incision of the abdomen. By the beginning of the next century, several forms of this procedure, involving removal of not only the uterus but also the ovaries and/or the cervix, began to be used but vaginal hysterectomy was still preferred by most physicians.

From the 1950s to the 1980s, the use of laparoscopy, or inserting a scope through small incisions to assist in removal of organs through those incisions became highly developed. In 1989, these advancements brought about the first laparoscopic-assisted vaginal hysterectomy.

Hysterectomy is used today to relieve a wide variety of conditions including fibroids, several forms of cancer, and prolapsed uterus, and is still the second most common of all surgeries. Surgeons continue to improve the outcomes and safety of vaginal hysterectomy.

As you discuss your upcoming vaginal hysterectomy with your physician, don't be afraid to ask questions. Because the procedure has a long history of success, they'll be able to draw on a wealth of research to give you the answers you need.

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