Expected Management vs. D&C (Dilation and Curettage)

It has been awhile since I last posted and have been trying to find a semblance of consistency so you will have to bear with me 🤷🏾‍♀️

Today I wanted to talk a bit about the difference between expected management and D&C. Again, my hope is not to cast doom and gloom on what should be a joyous journey but to help spread information so that if you or someone you know does experience a pregnancy loss at any stage, they are better informed and could be a good advocate.

As mentioned in the previous post where I discuss the various types of miscarriages, it tends to occur before the 20th week of pregnancy, but truly can happen at any stage. Knowing that you have a choice after being informed of the pregnancy loss of either letting nature takes its course or having it medically handled can be a heavy decision to make at a very vulnerable time.

So, let’s discuss the difference between the two…

An expected management or expectant miscarriage management is an option given up to the 13th week of pregnancy. You are letting nature take its course and essentially means choosing to miscarry the baby at home. When informed of the loss, you should be given the choice, especially if you haven’t started bleeding. It can take anywhere from 1-3 weeks before bleeding occurs and there is no telling when it will occur. Ideally, you should be sent home with information to help you prepare, but definitely not always the case as most medical providers will either push for a D&C or medications such as misprostol to help speed up the process. Choosing expected management does come with a risk of having an incomplete miscarriage which can bring about issues especially if the pregnancy matter is still present in the uterus and would then need to be surgically removed.

A D&C or dilation and curettage, is another option given after the 10th week of pregnancy when there is a loss. This procedure is given due to the risk of having an incomplete miscarriage. It is an outpatient procedure and the whole process takes about 10 minutes. What occurs is the insertion of a speculum into the vagina, a clamp is used to keep the cervix in place while rods are inserted to open the cervix. A curette, which is like a small blade, is then inserted to suction or scrape the tissue away from the uterus. The pregnancy matter will then be removed in addition to the placenta. This can be a much easier or smoother process but there are risks as well with this procedure such as uterine infection, bleeding or perforation of the uterus.

Asherman’s syndrome is also another risk that can occur where adhesions or scar tissue can form in the uterus and cause the walls of the uterus to stick together causing infertility or irregular periods.

With any procedure or decision you make, it is important to know what the pros and cons consist of so you can make an educated and informed decision. Would love to know, how much of this is common knowledge for you?