If your pregnancy ends unexpectedly before the twentieth week, it is your doctor’s duty to assist you in both physical and emotional recovery from this experience.
One of the first questions your doctor asks is whether there are any parts of the fetus or placenta — the products of fertilization — left inside your uterus.
If the ultrasound turns out to be empty, you can begin your emotional recovery.
However, if the uterus is not completely empty, your doctor may recommend that you undergo a dilation and curettage: a short surgical operation that frees the uterus from any product of conception, so that you can start having a regular menstrual cycle again and, if you want, attempt a new pregnancy.
How, and where curettage is performed
This procedure takes on average 15 to 30 minutes to complete and is carried out with the patient in a position similar to that of a gynecological examination: supine with legs raised by supports.
After anesthesia, the curettage procedure takes place in two stages.
- Dilation. To gain access to the uterus, your doctor will open your vagina and slowly dilate your cervix, which is the part where the vagina and uterus join. He will likely employ a combination of anesthetic medicines and various medical instruments.
- The scraping. Once the cervix has been opened by about one centimeter, the doctor will use a special instrument called a curette, combined with aspiration, to thoroughly clean the inside of the uterus.
If the pregnancy lasted only a few weeks, and if the cervix is already partially open, you can probably undergo this procedure directly in your doctor’s office.
You will be given local anesthetics, the same as dentists. It is possible that you will be given an analgesic a priori to prevent pain.
If, on the other hand, your cervix is very closed or if the pregnancy was already ahead, your doctor may suggest that you undergo this procedure in a hospital, where you will be given general anesthesia.
If you are worried or if you are afraid of the outcome, talk to your doctor to try to live the thing as serenely as possible, within the limits of anxiety and stress that this situation inevitably brings with it.
Is curettage painful?
Since you are given anesthesia during curettage that anesthetizes your uterus, you probably won’t feel anything.
Dilation can cause cramping. However, the pressure, the scraping itself and the feeling of discomfort are perfectly normal.
Whether the procedure will be painful or not depends on your personal level of pain tolerance and the level of opening of the cervix. If you feel bad, tell your doctor so he can help you feel better.
After the scraping operation
When the curettage is complete, you should already be able to go home after a few hours. It is very common that -after- in the following days, you have cramps and light bleeding. In that case, if you don’t feel well, take ibuprofen.
Since after this procedure the cervix still remains dilated for a few days, it is important to avoid having sex, inserting tampons or doing vaginal washes in the following week, since all these practices could introduce bacteria into the uterus and cause an infection.
When you start to feel normal again, you can resume normal activities. The menstrual cycle should return to normal within 4-6 weeks.
Know that after curettage, you will probably still have to deal with the pregnancy you lost: feeling sad, angry, lonely or even jealous of friends with children are all normal responses.
Take your time to get through this moment, share your feelings with your partner and seek the closeness of those you think can help you.
Alternatively, consider talking to a psychotherapist as well.
The risks associated with this operation
As with any surgery, after a curettage you are at risk of an infection. Then call your doctor if you notice,
- bleeding that takes longer than normal menstruation,
- leaks with a bad smell,
- abdominal pain or high fever.
In 16% of curettage cases, the patient may develop scarring within the uterus or cervix ( Asherman’s syndrome ).
A second surgery may be necessary to treat them, but – fortunately – the chances are more favorable for you to fully recover and get pregnant again.
If you have undergone curettage later than 20 weeks of gestation due to an abortion, you have a higher risk of having these scars and other complications, such as infections and uterine perforations, as this has dilated and thinned during pregnancy.
Nevertheless, the risk of complications from a curettage is minimal even later in pregnancy.
Having a retroverted uterus, which about a third of women have, can make it harder for the doctor to perform curettage and may increase some risk factors.
In any case, your doctor will be able to verify this by ultrasound and will tell you about the risks.
The consequences of curettage on future pregnancies
The human body is extraordinary in its ability to regenerate itself. This means that a scrape does not preclude your future chances of having a baby.
According to the American College of Obstetrics and Gynecology ( 1 ), even among women who have had four unexplained miscarriages, about 65 percent of them are able to carry a pregnancy to term with the birth of a live baby.
The chances of getting pregnant after an abortion are similar to those after a curettage (in fact, a 2005 study showed that 87% of women who underwent a curettage became pregnant within a year of trying again).
Most doctors recommend trying to get pregnant again after at least three menstrual cycles, in order to give the uterus time to rebuild its inner layer so that it can house an embryo.
Depending on when the miscarriage occurred, your doctor may advise you to wait longer or shorter.
Katherine Johnson, M.D., is a board-certified obstetrician-gynecologist with clinical expertise in general obstetrics and gynecology, family planning, women’s health, and gynecology.
She is affiliated with the Obstetrics and Gynecology division at an undisclosed healthcare institution and the online platform, Maternicity.com.