Dilation and Curettage (D&C)

  1. Assisting the MD with D&C
  2. Perform hand hygiene and apply gloves.
  3. Verify patient's identity in accordance with institutional policy.
  4. Before the procedure, take a thorough history, including last menstrual period, estimated gestational age, symptoms of pregnancy, degree of bleeding, duration of bleeding, presence of cramps, pain, or fever.
  5. Assist in the performance of a pelvic examination to ascertain uterine position and size.
  6. ssess the patient's vital signs.
  7. Ensure informed consent has been obtained.
  8. Call or participate in a "time out" before initiating an invasive procedure, in accordance with institutional policy.
  9. Teach the patient active relaxation techniques.
  10. Prepare the patient for what to expect during the procedure, such as cramping and the noise of the vacuum machine.
  11. Have the patient empty her bladder before the procedure. Insert an indwelling urinary catheter if needed.
  12. Insert an intravenous catheter, preferably 16 G or larger.
  13. Obtain blood samples for ABO and Rh typing, complete blood count, beta-hCG level, and coagulation studies.
  14. Administer analgesia or sedation as prescribed.
  15. Place the patient in the dorsal lithotomy position.
  16. Remain at the side of the patient while the advanced practice nurse or the physician performs the examination.
  17. The physician or advanced practice nurse may administer an anesthetic or perform a paracervical block.
  18. The physician or advanced practice nurse cleanses the vagina and the perineum with antiseptic solution.
  19. The physician or advanced practice nurse drapes the pubic area and the inner thighs and places a sterile towel under the buttocks.
  20. The physician or advanced practice nurse uses a speculum to visualize the cervix.
  21. The physician or advanced practice nurse grasps the anterior lip of the cervix with the tenaculum at the 10- or 12-o'clock position.
  22. The physician or advanced practice nurse brings the cervix down toward the vaginal opening, using gentle traction, and visualizes the cervix to examine it thoroughly for tears.
  23. The physician or advanced practice nurse gently inserts the uterine sound into the cervix and advances it into the uterine cavity. This is accomplished using information about the size and position of the uterus found on pelvic examination.
  24. The physician or advanced practice nurse begins to dilate the cervix, starting with the largest dilator the cervix can accommodate, inserting progressively larger dilators until adequate dilation is achieved.
  25. The physician or advanced practice nurse evacuates the uterus using a curette and scrapes the walls of the uterus until a grating sensation is felt.
  26. The physician or advanced practice nurse inspects the evacuated material for products of conception and quantity of material. The tissue obtained should be placed in preservative and sent to pathology.
  27. Wash antiseptic and blood from the perineal area. Place a perineal pad, and lower the patient's legs gently to the table.
  28. Assess the patient's vital signs in comparison to baseline findings.
  29. Administer Rho (D) immune globulin (RhoGAM) if prescribed.
  30. Send the tissue to the pathology laboratory.
  31. Discard supplies, remove gloves, and perform hand hygiene.
  32. Document the procedure in the patient's record.