All You Need to Know About Raspa or Dilation and Curettage Procedure

Dilation and curettage procedure or raspa is a type of surgery wherein the cervix is opened (dilation) and an instrument, commonly a curette, is inserted into the uterus. Then, the curette is used to scrape or remove the tissues from the uterine lining (curettage). Here’s what you need to know about raspa.

The Female Pelvic Organs

To better understand the dilation and curettage procedure, let’s first briefly discuss the female pelvic organs:

• Uterus. Commonly called matris or bahay-bata in Filipino, the uterus is the woman’s womb. It is a hollow, pear-shaped organ at the lower abdomen. This is where the fetus grows and develops.
• Endometrium. The endometrium is the lining of the uterus. If a woman does not get pregnant, the endometrium will “shed off” resulting in the monthly menstrual period.
• Cervix. The cervix is the narrow part at the end of the uterus. This connects the uterus to the vagina.
• Ovaries. Known as obaryo, ovaries are where the egg cells develop. They also produce hormones, estrogen, and progesterone.
• Fallopian tubes. These are thin tubes that connect the ovaries to the uterus.
• Vulva. The vulva encompasses the external genital organs of a woman.
• Vagina. Also called the “pwerta” or  “birth canal” where the baby passes during delivery. It also connects the cervix to the vulva.

Understanding the basic anatomy of the female reproductive organ will make it easier for you to learn about raspa.

Reasons for Dilation and Curettage

The dilation and curettage procedure has a two-fold purpose: diagnosis and treatment.

Endometrial Sampling for Diagnosis

Endometrial sampling is a type of D&C procedure where the doctor takes only a small sample from the lining of the uterus. This is commonly done if the patient:

• Experiences abnormal uterine bleeding
• Has thickened endometrium
• Has vaginal bleeding even after menopause
• Develops abnormal endometrial cells. This may be reported in a Pap smear result when seen. 

Therapeutic D&C for Treatment

A woman also needs to undergo a therapeutic dilation and curettage procedure to treat certain conditions. Unlike endometrial sampling where the doctor only takes a small sample, therapeutic D&C would need to remove contents from the uterus. Therefore, D&C is done to:

• Remove a molar pregnancy. A molar pregnancy happens when a tumor develops in the womb instead of a normal pregnancy.
• Prevent further bleeding and infection. D&C clears out the tissues and other remnants of a miscarriage or abortion. If these tissues remain in the womb, infection and bleeding may happen.
• Clear out “afterbirth.” After successfully giving birth, placental remains may stay in the womb of the mother, causing abnormal bleeding. D&C removes these placental remains.
• Remove polyps. Benign or noncancerous polyps sometimes develop in the cervix and uterus. The dilation and curettage procedure can remove these polyps.

Overview of the D&C Procedure

A doctor may perform D&C in the clinic, hospital, or health center. Generally, the procedure will follow the steps below.

1. You’ll be asked to empty your bladder and the staff will give you a hospital gown to wear.
2. On the examination or operating table, you will be asked to lie on your back. A stirrup will support your legs.
3. The doctor may start an IV line and  insert a urinary catheter.
4. You will receive either regional anesthesia (spinal anesthesia) or intravenous sedation. 
5. An instrument called a speculum will be inserted into your vagina to expose the cervix. Additionally, the doctor will also clean the cervix with an antiseptic solution.
6. Another instrument, the tenaculum, will straighten the cervical canal. A cervical dilator will be inserted to open the cervix. 
7. If tissue samples from the cervix are needed, a small curette will collect the sample.
8. The doctor will insert another curette to scrape the tissues from the endometrium. Sometimes, the doctor may also use suction to remove the contents of the uterus. 
9. To determine the length of the uterus, an instrument called a uterine sound may be inserted. If you have local anesthesia, you will feel cramping. After measuring, the doctor will remove the uterine sound.
10. Finally, once the dilation and curettage procedure is over, the instrument will be removed. After this, the doctor will send the tissue samples to the laboratory for testing.

Recovery

Recovery from D&C depends on the type of procedure and the administered anesthesia. In general, for those who undergo IV sedation, the doctor may ask you to rest for about 2 hours before sending you home. If the doctor administered a regional or general anesthesia, the staff will bring you to an observation room. When your vital signs are stable, they may make you stay in a regular room or allow you to go home and rest. Either way, it is best to have someone with you after the procedure, especially for regional or general anesthesia.

Reminders after D&C Procedure

• It is normal to experience light vaginal bleeding or spotting after the surgery. For this reason, you may want to stock up on sanitary pads beforehand.
• Mild pain or cramping is also normal. It may persist for a couple of days.
• The doctor will probably prescribe pain medication for cramping. Moreover, do not take anything unless recommended by the physician, especially not aspirin as it may increase the risk of bleeding.
• The doctor will advise you on the dos and don’ts after D&C. For instance, the physician may ask you to stop using tampons for a while.  Additionally, you may also be advised to refrain from sexual intercourse for a couple of days.
• As much as possible, avoid strenuous activities for the first few days after D&C.
• After that, expect your monthly menstrual period to be earlier or later.
• A dilation and curettage procedure typically will not affect your diet. In other words, unless the doctor advises you otherwise, no food restriction applies.

When to Go Back to Your Doctor

Most importantly, immediately go back to your doctor after a D&C procedure if you:

• Experience heavy vaginal bleeding
• Develop fever
• Have foul-smelling vaginal discharge
• Feel abdominal pain

The dilation and curettage procedure poses some complications like infection and scar tissue formation. However, when done properly in a hospital setting, doctors deem raspa procedures generally safe.

Learn more about Women’s Health here.