Unfortunately, miscarriage is the most common type of pregnancyloss, according to the American College of Obstetriciansand Gynecologists (ACOG). Studies reveal that anywhere from 10-25% of all clinically recognized pregnancieswill end in miscarriage, and most miscarriages occur during the first 13 weeksof pregnancy. Pregnancy can be such an exciting time, but with the great number of recognized miscarriages that occur, it is beneficial to be informed on miscarriage in the unfortunate event that you find yourself or someone you know faced with one. The main goal of treatment during or after a miscarriage isto prevent hemorrhagingand/or infection. The earlier you are in the pregnancy, the more likely that your body will expel all the fetal tissue by itself and will not require further medical procedures. If the body does not expel all the tissue, the most common procedure performed to stop bleeding and prevent infection is a D&C. What is a D&C Procedure? D&C, also known asdilation and curettage, is a surgical procedure often performed after a first trimester miscarriage. Dilation means to open up the cervix; curettage means to remove the contents of the uterus. Curettage may be performed by scraping the uterine wall with acurette instrument or by a suction curettage (also called vacuum aspiration), using avacuum-type instrument. Is a D&C necessary after a miscarriage? About 50%of women who miscarry do not undergo a D&C procedure. Women can safely miscarry on their own, with few problems in pregnancies that end before 10 weeks. After 10weeks, the miscarriage is more likely to be incomplete, requiring aD&C procedure to be performed. Choosing whether to miscarry naturally (called expectant management) or to have a D&C procedure is often a personal choice, best decided after talking with your health care provider. Some women feel comfort in going through a miscarriage in their own home, trusting their own body to do what it needs to. Some see this as a vital part of the healing process, eliminatingthe question of “what if?” about the health of the pregnancy. There are also many women who miscarrywho have ahistory of gynecological problemsand don’t want to risk the possibility of anymore complications occurring from having a D&C procedure done. For most first trimester miscarriages, expectant management should be a viable option. For some women, the emotional toll of waiting to miscarry naturally is just too unpredictable and too much to handle in an already challenging time. Healing for them may only start once the D&C procedure is done. A D&C may be recommended for women who miscarrylater than 10-12 weeks, have had any type of complications, or have any medical conditions in which emergency care could be needed. How is a D&C procedure done? A D&C procedure may be done asan outpatient or inpatient procedure in a hospital or other type of surgical center. A sedative is usually given first to help you relax. Most often, general anesthesia is used, but IV anesthesia or paracervical anesthesiamay also be used. You should be prepared to have someone drive you home after the procedure if general or IV anesthesia is used. 1) You may receive antibiotics intravenously or orally to help prevent infection. 2) The cervix is examined to evaluate if it isopen or not. If the cervix isclosed, dilators (narrow instrumentsin varying sizes) will be inserted to open the cervix to allow the surgical instruments to pass through. A speculum will be placed to keep the cervix open. 3) The vacuum aspiration (also called suction curettage) procedure usesa plastic cannula(aflexible tube) attached to a suction device to remove the contents of the uterus. The cannula is approximately the diameter in millimeters as the number of weeks gestation the pregnancyis. For example, a 7mm cannula would be used for a pregnancy that is 7 weeks gestation. The use of acurette (sharp edged loop)to scrape the lining of the uterus may also be used, but is often not necessary. 4) The tissue removed during the procedure may be sent off to the pathology lab for testing. 5) Once the health care provider has seen that the uterushas firmed up and that the bleeding hasstopped or is minimal, the speculum will be removed and you will be sent to recovery. What are the possible risks and complications of a D&C procedure? Risksassociated with anesthesia such asadverse reaction to medication and breathing problems Hemorrhage or heavybleeding Infection in the uterus or other pelvic organs Perforation or puncture to the uterus Laceration or weakeningof the cervix Scarring of the uterus or cervix, which may require further treatment Incomplete procedure which requiresanother procedure to be performed