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News1993April › D & c : dumb and careless › April 1993

D & c : dumb and careless

Dilatation and curettage the operation in which a woman's womb is scraped usually to determine the cause of menstrual problems may frequently be used inappropriately, particularly in Britain

Dilatation and curettage the operation in which a woman's womb is scraped usually to determine the cause of menstrual problems may frequently be used inappropriately, particularly in Britain.

Originally thought to help in cases of dysfunctional menstrual bleeding a belief that studies have failed to support the D & C is now mainly used for diagnostic purposes, particularly to rule out endometrial cancer.

An Oxford University study comparing D & C rates found a great disparity between those of different parts of Britain and also between the overall UK rate and those of other countries. In 1989-90 the rate was 71 per 10,000 women in England, six times higher than the 11 per 10,000 US rate.

The study also found that nearly 7000 women 39 per cent under 40 underwent the diagnostic D & C in the Oxford region alone, making it the most common elective operation in the area.

Nevertheless, the study found more than a twofold variation in the rates of D & C among the under 40s nationwide in Britain, with rates ranging from 22 per cent to 82 per cent.

These variations indicate that there are great differences in perception of its appropriateness, the study concluded. However, an accompanying editorial was more scathing. "Dilatation and curettage is diagnostically inaccurate and therapeutically ineffective," it said. "When performed on its own it will miss 10 per cent of endometrial lesions; one study found that less than half the uterine cavity was curetted in more than half the patients."

Besides its questionable use, the D & C carries considerable risks of trauma, including perforation of the uterus and laceration of the cervix. Women who haven't had children may suffer an "incompetent cervix", which means it can no longer hold a pregnancy to term.

Both reports called for a review of the procedure, with a view to replacing what could be a largely outmoded procedure with careful examination or endometrial biopsy, which can be taken in a clinic with softer, safer and smaller devices.


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