D&C in India: When It's Needed, the Procedure, Risks and Cost

• A D&C opens the cervix with dilators and removes the uterine lining or contents with a curette (sharp or blunt) or suction, usually under general anaesthesia in an operating theatre.
• For first-trimester abortion or early miscarriage, MVA or medicines are now preferred over D&C because they carry a much lower risk of perforation and uterine scarring.
• D&C is still the right choice for second-trimester evacuation (D&E), molar pregnancy, large amounts of retained tissue, and a few specific situations.
• The main long-term risk is Asherman syndrome (intrauterine adhesions), around 4–8% after D&C versus under 1% after MVA — the single biggest reason to ask about alternatives if you want future pregnancies.
• In India, D&C is free at government hospitals under JSSK and PMJAY, and typically costs Rs 8,000–30,000 in private hospitals (more for second-trimester or combined procedures).
• Always ask your doctor: “Is MVA or hysteroscopy an option for me, and if not, why is D&C the right procedure in my case?”

A D&C has two steps. Dilatation means the cervix (the neck of the womb) is opened using a series of progressively larger metal rods — usually Hegar or Pratt dilators, going up from about 3 mm to the size needed. Curettage means a curette (a spoon- or loop-shaped instrument) is then passed into the uterus to scrape or suction out the lining (endometrium) or its contents. The tissue removed is often sent to the lab for examination (histopathology). Most D&Cs are done in an operating theatre under general anaesthesia, and the actual procedure takes only 10–20 minutes — though with anaesthesia and recovery you should plan for half a day at the hospital.

What has changed is how often it is used. Until the 1990s, sharp D&C was the universal method for early abortion, miscarriage management, removing retained tissue after delivery, and investigating abnormal bleeding. Today, three things have moved it aside for most of those jobs: safer alternatives exist, complication rates with D&C are higher than once assumed, and national and international guidelines have updated accordingly. The World Health Organization, FIGO, and India's FOGSI and ICOG now recommend MVA over sharp D&C for first-trimester evacuation, and hysteroscopy over blind curettage for investigating the uterine cavity.

The modern D&C itself has also evolved. Many doctors now use a blunt curette or combine curettage with suction to reduce trauma to the uterine lining. Increasingly, hysteroscopy is done first so the cavity can actually be seen and any polyp, fibroid or scar tissue is targeted directly, rather than scraped blindly. And what was once an inpatient operation is now usually a day-care procedure with same-day discharge.

Despite the shift, D&C remains widely available in India — far more so than MVA, which needs specific training and equipment. That availability is a genuine advantage in many settings, but it also means D&C is sometimes done where MVA would have been the better choice, simply because the provider is more comfortable with it. Knowing the difference is what lets you ask the right questions.

D&C still has clear, legitimate uses where it is the appropriate choice. It is also frequently performed in situations where a gentler alternative would be preferred. The honest distinction matters, because choosing the right procedure for your specific situation protects both your safety and your future fertility.

D&C is the right choice for: second-trimester surgical abortion as part of dilatation and evacuation (D&E); incomplete Miscarriage: Types, Recovery and Care in India with a large amount of retained tissue that MVA cannot adequately clear; evacuation of a molar pregnancy (where thorough removal and tissue for the lab are essential); significant retained placenta or products of conception after delivery; evacuation of a septic abortion alongside antibiotics; and endometrial sampling when an office biopsy is not adequate.

An alternative is usually preferred for: first-trimester abortion or early/missed miscarriage (MVA or medical abortion with tablets carries lower risk); and investigation of heavy menstrual bleeding, bleeding between periods or postmenopausal bleeding, where hysteroscopy with directed biopsy is the modern standard. Blind D&C misses focal lesions such as uterine polyps in roughly 10–20% of cases that hysteroscopy would catch.

If a D&C is recommended, a short, calm conversation with your doctor helps you understand whether it is the best procedure for your situation or simply the one most familiar to that provider. There is nothing rude about asking — good doctors expect it.

Listen for legitimate clinical reasons (second trimester, molar pregnancy, very large amount of retained tissue) versus reasons that reflect provider preference or equipment limitations. If the answers leave you uneasy, a second opinion or referral to a centre with MVA and hysteroscopy is entirely reasonable.

Knowing the sequence in advance takes a lot of the fear out of the day. A D&C has three phases: preparation, the procedure itself, and recovery.

Before the procedure. You will have a pre-anaesthesia check, an ultrasound to assess the uterus, and blood tests (such as haemoglobin, blood group and Rh). You will sign informed consent (an MTP Form C if the D&C is for a legal abortion). For general anaesthesia you must fast for 6–8 hours (clear fluids are usually allowed up to 2 hours before). You may be given a prophylactic antibiotic, and sometimes misoprostol vaginally or under the tongue a few hours earlier to soften and slightly open the cervix — this is especially helpful for women past menopause or with a tight cervix, and it reduces the trauma of dilatation.

The procedure itself. You are positioned with your legs in stirrups and cleaned with antiseptic. After an examination under anaesthesia, the doctor passes a speculum, steadies the cervix, and measures the depth of the uterus with a thin sound. The cervix is then dilated step by step. A curette — or a suction cannula, or both — is used to clear the cavity systematically. The doctor confirms the uterus is empty (a characteristic gritty feel, less bleeding, and in some cases a quick hysteroscopic look). Tissue is collected and, where relevant, sent for histopathology. If you are Rh-negative, you are given anti-D immunoglobulin within 72 hours.

After the procedure. You wake in the recovery room and are monitored for an hour or two. Most women go home the same day once they are fully awake, vital signs are stable, they have passed urine, and bleeding and pain are under control. You will be given pain relief, an antibiotic course if needed, clear warning signs to watch for, and a follow-up appointment in about two weeks.

The most important long-term risk of D&C is Asherman syndrome — scar tissue (intrauterine adhesions) forming inside the uterus after the procedure. The scarring can range from thin filmy bands to dense tissue that sticks the uterine walls together and partly or fully blocks the cavity. This is the single most fertility-relevant reason guidelines favour MVA over D&C when both are possible.

The risk after D&C is about 4–8% overall, but it is not uniform. A D&C done on a pregnant uterus carries a higher risk than one done outside pregnancy, and a postpartum D&C (for retained tissue after delivery) carries the highest risk of all. Repeated D&Cs, aggressive sharp curettage, and infection at the time of the procedure all push the risk up. By contrast, MVA carries an Asherman risk of under 1%, because the soft plastic cannula and minimal dilatation are far gentler than a sharp metal curette.

How to recognise it. Symptoms usually appear weeks to a few months after the D&C. The most common sign is your periods becoming much lighter than before — sometimes just a day of spotting, or stopping altogether. Others include unusually painful periods, difficulty conceiving when you were fertile before, or recurrent miscarriage. If your periods change noticeably after a D&C, see a gynaecologist with hysteroscopy expertise — don't wait.

Diagnosis and treatment. Asherman syndrome is confirmed with ultrasound, a hysterosalpingogram (HSG, Rs 2,500–5,000), saline infusion sonography, or — the gold standard — hysteroscopy, which can diagnose and treat in the same sitting. Treatment is hysteroscopic adhesiolysis: the adhesions are carefully divided, then measures such as a course of oestrogen and a temporary balloon or device help keep the cavity open while it heals. Mild cases do well; severe cases may need more than one procedure.

Prevention is better than cure: prefer MVA over D&C for first-trimester evacuation, prefer hysteroscopy over blind curettage, avoid repeated D&Cs for the same problem, use gentle technique and prophylactic antibiotics, and avoid postpartum D&C where medical management or careful MVA is possible.

Most D&Cs in India are done under general anaesthesia, so you are fully asleep and have no memory of the procedure. Two alternatives are sometimes used: spinal anaesthesia (you stay awake but feel nothing below the waist) and paracervical block with sedation (local numbing of the cervix plus light sedation). General anaesthesia is the most common because it provides muscle relaxation and complete unawareness, but it adds cost, requires fasting and an anaesthetist, and means a slightly longer recovery (sore throat, nausea or grogginess that usually settle within a day).

Which one is used depends on how long and complex the procedure is, your medical history, the surgeon's preference, what the centre can offer, and cost. Routine first-trimester procedures can sometimes be done under spinal or sedation; second-trimester D&E usually needs general anaesthesia. A pre-anaesthesia assessment is mandatory before general anaesthesia.

For pain afterwards, paracetamol and ibuprofen control the cramping well for most women, with a heat pack on the lower abdomen helping too. Worth knowing: with MVA under a paracervical block, you feel more cramping during the brief procedure but very little afterwards; with D&C under general anaesthesia, you feel nothing during it but recover from the anaesthesia itself. Overall pain across recovery is broadly similar — the trade-off is mostly about the anaesthesia, not the cramping.

D&C is one of the more widely available gynaecological procedures in India, offered at government hospitals, private clinics and hospitals, and several NGO providers. Cost varies enormously by setting.

Government facilities: essentially free under Janani Shishu Suraksha Karyakaram (JSSK) at government hospitals, which covers assessment, investigations, the procedure, anaesthesia, stay, medicines and follow-up. Free transport via the 102 ambulance is included.

Private hospitals and clinics: typically Rs 8,000–30,000 for an uncomplicated first-trimester D&C, and Rs 20,000–80,000 for second-trimester D&E or a D&C combined with hysteroscopy. The biggest cost drivers are the anaesthesia (general anaesthesia adds Rs 3,000–10,000), the tier of hospital, and whether you stay overnight.

NGO providers such as FPAI, MSI Reproductive Choices and Janani offer subsidised rates (roughly Rs 3,000–10,000) with strong counselling support.

Serious complications from D&C are uncommon, but they are more frequent than with MVA, and recognising them early matters. They fall into three groups.

During or within hours: the main risk is uterine perforation — an accidental hole in the uterine wall, occurring in about 0.3–0.5% of D&Cs (versus under 0.1% with MVA), most often during dilatation. Many small perforations heal with observation; larger ones may need keyhole or open repair. Less common are cervical injury, heavier-than-expected bleeding (managed with uterotonics, fluids and rarely transfusion), and anaesthesia-related effects such as nausea or sore throat.

In the following days to weeks: infection (endometritis) in under 1% with prophylactic antibiotics — watch for fever, increasing pelvic pain and foul-smelling discharge, treated with antibiotics. Incomplete evacuation with retained tissue can cause ongoing bleeding and cramps and is managed with misoprostol or a repeat evacuation.

Months to years later: Asherman syndrome (covered in detail above) is the most important late complication. Rarely, cervical injury during dilatation can lead to cervical weakness in a future pregnancy, which may need a cervical stitch (cerclage).

When to seek emergency care after a D&C: very heavy bleeding (soaking more than two large pads an hour for two hours in a row), fever above 101°F lasting more than a day, severe abdominal pain not eased by your painkillers, foul-smelling discharge, or signs of shock such as dizziness, fainting or a racing heart. Go to the nearest hospital emergency department and take your D&C records with you.

These three procedures overlap but each has a job it does best. Understanding the broad logic helps you follow your doctor's reasoning.

MVA (manual vacuum aspiration) is the preferred method for first-trimester surgical abortion, completing an incomplete medical abortion, and early or missed miscarriage. It has lower perforation and far lower Asherman risk, can be done under local anaesthesia as a single-visit day-care procedure, costs less and recovers faster. Its limits: it needs a trained provider and equipment, and it is not suited to very large retained tissue or molar pregnancy. (See manual vacuum aspiration in India.)

D&C is the preferred method for second-trimester evacuation (D&E), molar pregnancy, large retained tissue, postpartum retained products, and septic abortion. It is widely available and allows thorough clearance, but usually needs general anaesthesia and carries a higher complication and Asherman risk. Where MVA is available, D&C is the second choice for first-trimester evacuation.

Hysteroscopy with directed biopsy is the modern standard for investigating abnormal bleeding and treating focal problems — polyps, fibroids, a septum or adhesions — because the doctor sees the cavity directly and can sample or treat exactly the right spot, with much lower scarring risk. Diagnostic hysteroscopy can be done in an office setting; operative hysteroscopy needs anaesthesia and costs more. (See hysteroscopy in India.)

The practical summary: for first-trimester evacuation, prefer MVA or medicines; for second-trimester or molar pregnancy, D&C/D&E; for investigating bleeding, hysteroscopy. If you want future children, this preference for the gentler option matters most.

Physical recovery from a D&C usually takes one to two weeks — a little longer than after MVA because of the general anaesthesia. Mild to moderate cramping and period-like bleeding ease over the first few days. By the end of the first week most women feel substantially better and return to normal activity. Your next period usually arrives in about four to six weeks and may be heavier, lighter or slightly irregular before settling.

For about two to four weeks, use pads rather than tampons or menstrual cups, avoid douching, swimming and baths (showers are fine), skip heavy lifting and strenuous exercise, and avoid sex until bleeding has stopped and your doctor clears you. A follow-up at around two weeks checks your recovery, reviews any pathology results, confirms contraception, and gives space to talk about how you are coping.

Future fertility is the question most women care about most. For the great majority — roughly 92–96% who do not develop Asherman syndrome — fertility after a D&C is essentially unchanged. If you notice very light or absent periods, painful periods, or trouble conceiving afterwards, ask to be checked for Asherman syndrome rather than assuming the worst. If future fertility is a priority for you, MVA is the strongly preferred surgical option, so raise it before the procedure. When you are ready to try again, start folic acid at least a month ahead and follow standard pre-conception care.

Emotional recovery can take longer than physical recovery, and that is normal. After a miscarriage, grief for a wanted pregnancy is the dominant feeling for most women; after an abortion, responses range from relief to sadness to ambivalence — all valid. The strongest protector of mental wellbeing afterwards is support, not silence. For the grief framework, see pregnancy loss and grief; if you become pregnant again, pregnancy-after-loss anxiety is common and manageable. India's free, multilingual helplines include Ipas India (1800-274-7227), iCall (9152987821) and Vandrevala Foundation (1860-2662-345).

• WHO — Abortion care guideline (recommends vacuum aspiration over sharp curettage)
• FIGO — Recommendations on uterine evacuation and post-abortion care
• Ministry of Health and Family Welfare, India — Comprehensive Abortion Care (CAC) training and MTP guidance
• ACOG — Practice resources on dilation and curettage and intrauterine adhesions (Asherman syndrome)
• NHS — Miscarriage: treatment (surgical management/ERPC and D&C)