Talk:Dilation and curettage

How
How long should a person wait until having sexual intercourse, after a dilationa and curettage is performed
 * Our doctor said wait 3 weeks before having intercourse and wait 3 months before trying to have another baby --Chadrack 17:06, 15 July 2006 (UTC)

Should the first external link below be removed? It has nothing to do with D&C, but rather abortion, which is rarely in the form of D&C. It's also a site promoting illegal, unsafe DIY abortions.--Dub8lad1 20:15, 30 May 2006 (UTC)


 * I visited it a while ago and I remember it as a detailed explanation of how D&C's are performed. I don't think the site promotes illegal, unsafe DIY abortions.  If anything, reading about the procedure has reminded me that even a relatively safe and simple surgical procedure requires special skills and tools.  I'd be less likely to want to perform a D&C now that I was before, and that's despite being entirely unlikely in the first place.  So, in short, no, I don't think the l ink should be removed. Al 21:04, 30 May 2006 (UTC)


 * But it's called an "abortion manual for the women of South Dakota", and tells laypeople how to perform abortions in their own homes. Sounds like a DIY abortion to me, which surely can't be safe? Or legal. But no matter, my point was more that it was off-topic. It doesn't talk exclusively about D&Cs (which are rarely used for abortions and much more for medical reasons anyway), so maybe it should be moved to the abortion article (which is admittedly already groaning under the strain of text, even before you get the discussion page!) or to the backalley abortion article?--Dub8lad1 23:22, 30 May 2006 (UTC)

It gives full directions to how a D&C is performed. That's a lot of relevant information. It belongs here. Al 23:26, 30 May 2006 (UTC)

I totally agree. The first link needs to be removed because it is dangerous to women. I'm also not sure that the statistics on the prevalence of D&C abortions are correct. The surgery complication at the end of the article also seems biased because it does not mention how extremely rare a complication like that is. An abortion is the safest medical procedure on the planet.

Is it just me, or does this article seem to be focused on abortion. AS far as I know, a D&C is not often, if at all used for removal of a live fetus at least not in this day and age. This proceedure is used primarily for removal of products of conception from a miscarriage, and is a life saving medical proceedure. I think this article may not fairly represent the primary use of this proceedure, and may cause undue grief for women having to go through this proceedure if the article focuses on removal of a living fetus. rmosler 22:23, 7 November 2006 (UTC)

Kuro5hin link removal
Hi all,

I'd like to hear opinions about the removal of this link.

Especially from who has removed it and from who objects its removal.

Thank you and happy editing,

 Snowolf (talk)CONCOI  -  21:36, 5 March 2007 (UTC)


 * The text at that link is "Sorry. I can't seem to find that story." Joie de Vivre 21:43, 5 March 2007 (UTC)


 * Sorry, I've done a formatting error, it should be fixed now.
 * I've read here that User:Ti dave claims that the article is from Army's Field Manual. Can he/she provide sources for this claim?  Snowolf (talk)CONCOI  -  21:48, 5 March 2007 (UTC)
 * The PD source material that I abridged (US Army Special Forces Medical Handbook, ST 31-91B, 1 March 1982) can be found, in electronic format, on page 17 of the PDF file found at this location http://www.fas.org/irp/doddir/milmed/sfhandbook-pt2.pdf
 * I used a dead-tree format when I wrote the piece. Ti dave 23:47, 5 March 2007 (UTC)
 * Additionally, I would like to mention that the link in question had been in place for nearly 3 years, without complaint, before the edit in question. Ti dave 02:26, 6 March 2007 (UTC)


 * Remember to focus on contents, rather than how ;-) Happy editing,  Snowolf (talk)CONCOI  -  22:25, 5 March 2007 (UTC)


 * 1) Does the other editor confirm that the text written here is much the same of what is written here?  Snowolf (talk)CONCOI  -  00:01, 6 March 2007 (UTC)


 * Why is it important to compare the two? Joie de Vivre 17:50, 11 March 2007 (UTC)


 * I'm going to guess that Snowolf is trying to ascertain if I pulled the source material from my nether regions, or if it is based upon legitimate medical references. However, I'll wait for his response. As an aside, I'm not sure that answering a question with yet another question is helpful in this sort of situation.Ti dave 06:20, 15 March 2007 (UTC)


 * Sorry, I didn't notice Joie de Vivre's question. Ti dave guessed right, I was trying to determinate if kuro5hin's article was medically all right or not. I've also suggest that we can link to the manual, instead.  Snowolf (talk) CON COI  -  14:02, 15 March 2007 (UTC)

(undent) I object to including this information at all. Anyone who wants to search the web for it can do so. However, in the wrong hands, this information could be extremely dangerous. We don't have do-it-yourself surgery links at any of the other articles regarding surgical procedures that I checked, we shouldn't link such instructions here either. Joie de Vivre 19:12, 21 March 2007 (UTC)
 * I can't believe that you have yet to object to the WHO link, which leads directly to DIY information for the procedure! How long has that link been present, with nary a peep from you?
 * I suspect that your problem isn't with the information, your problem is with me, and that makes your removal of the Kuro5hin link based upon your bias and not upon facts. Ti dave 00:14, 29 March 2007 (UTC)


 * The WHO link is included as a reference to support the statement that "dilatation and curettage should be used only if manual vacuum aspiration is not available", presumably because D&C is more invasive and more dangerous. If I could find a comparable source that made that statement without including instructions on how to perform the procedure, I would support using that instead.


 * I don't think it's in the interest of public safety to include a link that provides do-it-yourself instructions for how to perform dilation and curettage. If someone wishes to learn how to perform the D&C procedure, they are free to search for it online.  I have not found any other Wikipedia article that includes a link to instructions on how to perform a risky surgical procedure.


 * I disagree with the suggestion that I am somehow biased against you. I had never heard of you until you showed up on my talk page with an immediate request that I email you directly with an explanation of my edit.  I didn't find that suggestion to be entirely savory, and, frankly, I would prefer to limit such interactions, not encourage more.  Joie de Vivre 15:49, 29 March 2007 (UTC)
 * You must be joking! "In the interest of public safety"? Take a look at the entries on nitroglycerin and Dynamite. Explicit directions on how to prepare the former, then the latter from the nitroglycerin. Of course, it's not your pet topic, so the information persists.
 * I'm sure I can spot several other examples of potentially hazardous activities on WP, but the point remains- I am galled by your efforts to make this topic safe for 8-year old children.
 * Your position is antithetical to the cause of providing information to the reader and it smacks of censorship. Ti dave 00:39, 30 March 2007 (UTC)


 * "Of course, it's not your pet topic". I don't communicate with people who make personal attacks.  You owe me an apology for that snide comment before we can move on.  Joie de Vivre 15:15, 2 April 2007 (UTC)


 * Please take note of the following guideline, as it pertains to my original complaint about your edit. Ti dave 00:07, 3 April 2007 (UTC)


 * To be fair, the linked article does have a disclaimer stating that the surgery should not be performed unless there is no possible access to a doctor. In the spirit of information, I believe the link should be present on the page as it contains a good deal of information on the topic and removing it would be censoring information that could be vital to readers in the future. The purpose of wikipedia is to provide information, not to decide whether that information might be dangerous in the hands of some people. Edmund Lake 14:12, 3 April 2007 (UTC)


 * Further to that, Wikipedia is full of information which could be used in a dangerous manner by anyone so wishing to do so. Subjects include Napalm, Pipe bombs and Gunpowder, the latter page containing an external link to Ulrich Bretschler's Gunpowder Chemistry page, a very informative site with numerous recipes for making gunpowder. None of these articles nor their external links are considered to promote the intentional abuse or misuse of the information provided.


 * Censoring basic informational links like this one smacks of elitist thought police action: "Well, of course you and I know it's dangerous and would never use this information except in the most dire of circumstances, but other people might not be so knowledgeable." In the context of the initial complaint, I'd suggest that in order to be consistent all articles on bombs and gunpowder (including ~/Black_powder) be immediately deleted. Everything necessary to make such dangerous items is considerably more common and easier to obtain than Hegar dilators and Tenaculum forceps. BadDoggie 08:57, 5 April 2007 (UTC)

Should I close the mediation as failed? It doesn't seems that the party can found a mediation.  Snowolf (talk) CON COI  -  15:25, 2 April 2007 (UTC)


 * Yes, I think you should. The other user used a link to refer to me as "disruptive" instead of apologizing for their rudeness.  Joie de Vivre 14:41, 3 April 2007 (UTC)


 * Actually, I provided that link in order to show that your edit was disruptive, not necessarily your personality. Have you taken Ownership of this Article? Ti dave 19:46, 3 April 2007 (UTC)


 * It seems as though one user is taking a 'how dare he!' stance, while the other is being relatively crude. I would recommend taking the middle road and linking to the PDF, though if the text is exactly like the text on the kuno5ir article, linking to a text source might not be a bad idea. Edmund Lake 02:32, 4 April 2007 (UTC)


 * Having read the article, the contents of both the k5 and PDF links, and this talk, I also find the editing out of the Kuro5hin.org (a.k.a. "k5") link disruptive. While I have nothing against the inclusion of the PDF under external sources, that document is comparatively huge and references many other subjects. Further to the subject of abortion, finding the information in the PDF is difficult (it's not free text but rather scanned) and the language unclear to those who have had no formal medical training. The k5 story explains the procedure clearly using easily understood language. Any woman facing the procedure should be able to easily ascertain exactly what occurs.


 * Dilation and curettage is uncommon these days as an abortion method in the Western world. It is, however, one of the simplest (albeit more dangerous) methods available, especially to those unable to obtain health care, whether due to lack of proximity, emergency or local/national laws. BadDoggie 11:35, 4 April 2007 (UTC)

Thank you all for expressing your opinions. I have to say that mediation is an informal process, nothing mandatory. Wikipedia isn't censored. The text is from a reliable source. I cannot help further. Also, nobody must do an apology. You apology if you think you should. I'll monitor the dispute and start contributing to the article as normal editor, not as mediator. Unfortunately, I have to close the case, since the parts cannot come to a compromise.  Snowolf (talk) CON COI  -  09:21, 6 April 2007 (UTC)

Procedure names and use for miscarriage vs. abortion
There is some discussion at Talk:Dilation and evacuation about procedure names, and what they are used for (abortion vs. miscarriage) that might end up being relevant to this article. Lyrl Talk C 17:40, 10 March 2007 (UTC)

WikiProject class rating
This article was automatically assessed because at least one WikiProject had rated the article as start, and the rating on other projects was brought up to start class. BetacommandBot 16:25, 10 November 2007 (UTC)

Asherman's syndrome
I've altered this section in several ways:
 * I removed the bolded statement about Asherman's occuring most often from pregnancy-related D&C: most D&C's are pregnancy-related, so it is unsurprising that a larger absolute number of complications occur in that group. I see no reason for this statement to be notable enough for inclusion, much less bolded.


 * This information about D&C's and risks on a recently pregnant uterus is available in any published scientific article about Asherman's. Obviously you haven't read any, although you purport to be knowledgible about it. The reason that the pregnant uterus is esp vulnerable to damage by a D&C is because it becomes very soft. I find it incredible that you feel it's right to remove a statement which have not one but dozens of references to support it.Floranerolia (talk) 12:16, 16 March 2008 (UTC)


 * I am not knowledgeable about Asherman's, and apologize if I have implied that I am. My only prior knowledge of the condition was the long-standing statement in this article (which you just corrected today, thank you) that Asherman's syndrome was "adhesions... result[ing] in the uterus being sealed shut, resulting in infertility".


 * The way the 90% statement was worded and placed in this article, it implied that 90% of Asherman's cases were caused by pregnancy-related D&C, and the remaining 10% were caused by D&Cs that were not pregnancy related. As around 90% of D&C procedures are pregnancy-related, I found this statement rather uninformative.
 * I see by reading the Asherman's article that you actually meant that most cases of Asherman's are caused by D&C procedures, and a small percentage have other causes such as infection. Perhaps the article could state, "D&C procedures are the most common cause of Asherman's syndrome.  When D&C is performed for gynecological reasons (non-pregnancy related), the risk of adhesion formation is lower than when performed on a pregnant uterus."  (Or similar wording.) LyrlTalk C 16:27, 16 March 2008 (UTC)


 * If I was able to find the citation on PubMed, I converted the reference to citejournal format


 * There is only one reference I provided that does not have a pubmed abstract (and FYI, not every journal is carried by Pubmed). I've since replaced the article in question with another citation from a review article which refers to the original paper.Floranerolia (talk) 12:16, 16 March 2008 (UTC)


 * I apologize if this statement came across as critical: I did not intend it that way. I like using the citejournal format (it makes consist formatting of references easier), and there is a tool that will automatically make a citejournal reference from a PMID.  If I didn't have a PMID number, I was just too lazy to convert the reference into the citejournal template.  This was not intended as a criticism of articles not indexed by PubMed, just as an explanation of my actions. LyrlTalk C 16:27, 16 March 2008 (UTC)


 * One of the references I found on PubMed (Incidence of post-abortion intra-uterine adhesions... ) turned out to be talking not about Asherman's syndrome, but about a much less severe form of the same condition, intrauterine adhesions. I reworded the paragraph to make this clear, and reorganized it to talk about adhesions before talking about Asherman's.


 * You are completely incorrect- Asherman's syndrome IS intrauterine adhesions. How can you change content when it is clear that you have no understanding what Asherman's is? There are different classifications of Asherman's from mild to severe adhesions, or Asherman's grade I-IV. Floranerolia (talk) 12:16, 16 March 2008 (UTC)


 * Seeing that reference being misquoted really shook my faith in the other references claiming high incidences of Asherman's syndrome from D&C procedures. Because I could not find even abstracts of these studies, the claims are dubious (that the medical profession makes routine use of a procedure that makes 1 out of 3 women sterile), and at least one study was misinterpreted, I deleted or made very vague the claims of high incidences of Asherman's.


 * The reference was not misquoted, and besides even if it were this would not be justification to remove other unrelated references. Your next sentence shows that you completely misunderstood what I wrote about the risks- which was again, from a reliable scientific paper (which happen to be written by scientists and doctors who actually do research). There is indeed a 1 in 3 chance of developing Asherman's after a curette for missed miscarriage, and a 1 in 4 chance of developing it after a d&c 1-4 weeks after delivery. This certainly does not mean, as you somehow misinterpreted, that 1 in 3 women are sterile!! It is however a significant risk for women who fall in these categories and it's for this reason I feel very strongly that this information should be included. Medical abortion (ie drugs like misoprostol) are a safer and less invasive alternative to d&c albeit not quite as successful in terms of evacuation. Floranerolia (talk) 12:16, 16 March 2008 (UTC)


 * The previous version of this article stated that Asherman's syndrome was scarring that sealed the uterus shut and resulted in infertility. I appreciate your correction of this error, and hope you can understand my objection to an article that defined Asherman's that way and then went on to talk about how 1 in 3 women who had this procedure would develop the condition. LyrlTalk C 16:27, 16 March 2008 (UTC)

LyrlTalk C 22:56, 8 March 2008 (UTC)

Edits march 16th
I'm not sure where to begin, there is so much to say. First of all, Asherman's syndrome IS the same thing as intrauterine adhesions. It is very disconcerting to say the least, that people making edits about this do not even know this.

Actually, D&C refers to a range of techniques from sharp curette to manual vacuum aspiration, as is mentioned in the article itself!As I mention below, most Drs use both sharp and suction curette to perform an evacuation.

The Weeks article is not talking about MVA- the study is about MVA, however they stats they provide in the Intro for worldwide induced abortion is a combination of D&Cs, definitely not MVA since this technology is not available in many countries.

Please do not remove citations which support scientific data. It is not ok to remove something someone has added just because you are not able to access the references which support the statements, or because you felt I was mistaken about a separate issue. As a scientist I have access to these articles with statistics on Asherman's. I've re-added the stats.

Just so you all know, I have no political agenda (pro choice or life) but I do want to raise women's awareness about the risks of D&C/suction D&C/MVA regardless of what situation is was used in. Asherman's sydrome is certainly not the rare condition it has been made out to be, and the highly credible statistics that I've quoted support this statement. I'm sure you are all realize there are alternatives to D&C such as misoprostol etc. which can be used in all situations a D&C is used in.

I can't understand why the subheadings for clinical uses have been removed. According to this entrance the only thing D&C is/was used for is abortion (elective abortion) which is complete nonsense.

Lastly, there is no evidence that suction D&C or MVA are safer in terms of Asherman's risks than sharp curette. I've added one reference. The rate of Asherman's is actually increasing even though sharp curette has mostly been replaced by suction D&C. Most Drs also use a variety of techniques for the same procedure. Again, if anyone has any doubts about this info I'm happy to forward emails from top world experts on Asherman's syndrome who personally answered this question last week. Floranerolia (talk) 06:46, 16 March 2008 (UTC)


 * Regarding the definition of D&C: when I started making changes to this article, it was already set up as an article about sharp curettage, with a separate article about suction curettage. I'm not particularly attached to this format, but if changes are made, they should be made with both articles in mind.  One possibility, as I suggested above, would be to rename this page sharp curettage, and make the current name a disambiguation page with links to both procedures.  A second possibility would be to propose a merge of these two article, redirecting vacuum aspiration to this title.


 * Drs usually use a combination of instruments, from suction to scalpels to forceps. I'm not sure what should be done about this, I'll let you know if I have any ideas. User:Floranerolia|Floranerolia]] (talk) 04:33, 18 March 2008 (UTC)


 * I'm also bothered by the frequent, immediate use of D&C procedures for miscarriage, although for a different reason: a small percentage of pregnancies diagnosed as miscarried turn out to be viable pregnancies . So advising D&C immediately upon diagnosis causes some number of accidental induced abortions. The relative merits of different management options for miscarriage diagnosis is more of a subject for the miscarriage article than for this one, though.


 * The section on indications lists several distinct uses for the procedure, not just abortion. I'm guessing the abortion heading was put there to emphasize that sharp curettage is now only rarely used for abortion, but I see where it could imply that abortion was the only use.  I've removed it: the "clinical uses" section seems too short to warrant subheadings.


 * I had added short paragraphs about the use of D&C in different situations and you removed it which is unfortunate. I would like to add them back again. It is important that people understand that D&C, whether sharp, blunt, suction, whatever, are used in situations other than induced abortion and why it is used. D&C should not become synomymous with induced abortion.Floranerolia (talk) 04:33, 18 March 2008 (UTC)


 * My concern with the paragraphs was that they were more focused on describing the conditions than with describing how D&C is used to treat them. Wikipedia has entire articles on those conditions.  While working in links to those articles would be useful here, I'm not sure they should be summarized here. LyrlTalk C 01:05, 21 March 2008 (UTC)


 * The reference you added on vacuum aspiration and Asherman's was a case study of three women, which is not an accepted way to define the exact or even relative level of risk for a procedure. I'm assuming the article's introduction refers to another study that compared rates of Asherman's in women who had sharp curettage vs. suction curettage, or at least referenced rates from independent studies of these two procedures.  It would be more authoritative if this study or studies were also referenced, or if a dedicated review article (instead of the introduction to a tangentially related study) were referenced.  Lacking these, it is possible a consensus on the relative risk of sharp vs. suction procedures has not yet developed among doctors who work with the condition; in that case, we should state that "Dalton, et al hold that use of vacuum aspiration instead of sharp curettage does not reduce the risk of developing intrauterine adhesions."  This clarifies that this is an opinion of one group and not (yet) the consensus of all those who work with the condition.


 * This is minor compared to the other issues I've brought up, however I've now clarified it.Floranerolia (talk) 04:33, 18 March 2008 (UTC)


 * Your efforts in communicating with experts on Asherman's syndrome are appreciated, but Wikipedia's policy is to rely on published sources only. Personal communications do not conform to Wikipedia's guidelines. LyrlTalk C 17:08, 16 March 2008 (UTC)


 * I was suggesting to send it to you, as it seems that you're unable to either access or understand a lot of scientific articles which discuss Asherman's. I don't feel that WebMD is a good source for citations and have not seen this done on other scientific wikipedia articles. First hand reports as citations are superior to second hand interpretations such as WebMD. Also, may I suggest we use another reference for the WHO citation which is not a guide on performing D&Cs? I found a good one on the WHO website. It can be found at: http://www.who.int/reproductive-health/publications/safe_abortion/safe_abortion.pdf

See page 32 of document: The preferred surgical technique for abortion up to 12 completed weeks of pregnancy is vacuum aspiration.
 * I would add that MVA is recommended as a preferred surgical method. The WHO is actually promoting the use of medical abortion including misoprostol. WHO has included misoprostol in its List of Essential Drugs in spring 2005. Floranerolia (talk) 04:33, 18 March 2008 (UTC)


 * Review articles are much less susceptible to being used to do original research or introduce bias into Wikipedia articles than individual research studies. I'm more comfortable with implying things are widely accepted in the scientific community if it comes from a recently written review article than if if comes from just a few studies.  I consider the articles at WebMD to be review articles, although that is certainly not the only source for reviews on medical topics.


 * The change to the WHO citation would be find by me. LyrlTalk C 01:05, 21 March 2008 (UTC)

'Missed Miscarriage'
"The risk of Asherman's syndrome was found to be 30.9% in women who had D&C following a missed miscarriage"

What is meant by 'missed miscarriage'? 71.111.23.79 (talk) 01:44, 23 January 2009 (UTC)
 * I'm thinking it should be "incomplete miscarriage," but I don't know. I'll post a tag seeking a medical expert. BeenAroundAWhile (talk) 13:57, 19 September 2016 (UTC)

Foreign-language video
Any idea what language the recently added videos are in? I don't recognize the alphabet that is used, although the narration sounds Asian. LyrlTalk  C  15:39, 30 August 2009 (UTC)

Why are there no pictures?
Most wikipedia pages have a nice picture at the top to give you a visual of the subject matter so I don't have to waste my time reading. I'm sure there is a tasteful picture that could be included in this article. —Preceding unsigned comment added by 68.227.254.193 (talk) 13:37, 21 November 2010 (UTC)

Citations broken
WebMD citation is broken. There may be others. I don't know enough about the topic to correct them or find new ones. BeenAroundAWhile (talk) 13:56, 19 September 2016 (UTC)

Template
I need consensus on my addition of the medical definition of an incomplete miscarriage and whether that merits the deletion of the template for it. (Note: I have left the template on the top of the page until at such time as I get a consensus on the matter). 2607:FCC8:9008:7E00:340E:FED3:5670:62E8 (talk) 04:24, 7 March 2017 (UTC)
 * Looks good to me. I will remove the template. I am not a medical expert, but I don't think a medical expert is needed to provide a simple definition like this. Thank you for your edits. Clayoquot (talk | contribs) 19:14, 4 October 2017 (UTC)

Updates August 2020
- Added clarification that D&C is also performed for diagnostic purpose. FamPlanMD08 (talk) 03:45, 2 August 2020 (UTC)FamPlanMD08

- Shall we merge this page into the "dilation and curettage" article? FamPlanMD08 (talk) 17:25, 10 August 2020 (UTC)FamPlanMD08

Rearranging sections
I propose rearranging the sections to start with "Clinical uses" and then "Procedure." Many other medical procedure pages are ordered this way, with Medical Uses first followed by a description of the procedure. Lukascolashop (talk) 01:00, 24 August 2020 (UTC)