Post D&C Recovery: What to Expect & Infection Prevention

Question
Hi Dr. Rappaport,

You have been extremely helpful to me in the past and I am hoping you can answer a couple of questions for me. I had to have a d&c to remove remaining tissues from a miscarriage.

What is involved in a post d&c follow up exam, particularly, what is done or how is one examined to make sure there is no infection? Is it just feeling with the fingers?

Also, the morning after the d&c I experienced very painful cramping for a few hours followed by heavy bleeding. The cramps subsided throughout the day and eventually stopped.Is this normal?  The bleeding lightened and stopped in the next few days.  I was most concerned about the painful cramping as I read it may have been a sign of infection.  Is that possible?  Since they didn't last long, and I didn't experience any fever, and have not had any cramping since, does that mean it was just part of the recovery?

The reason I ask is that I met with my doc today for my follow up and I forgot to tell her about the painful cramps the day after the procedure. She said there is no infection so I just wanted to make sure how she was able to tell.

Thanks for your help,
Geri

Answer
During an post-D&C exam, we check to see if the cervix is, indeed, closed and if the uterus is back to normal size (bimanual exam). That indicates that all is back to normal. If you had any infection, you would have fever or have a foul smelling discharge and/or pus in the vagina. If you still had tissue in the uterus, you would continue to bleed and the cervix would remain dilated somewhat. There is nothing else to do. It is also common, after a D&C, to have some painful cramping and heavy bleeding for a few days.  As the uterus gets back to its normal size, the cramps and bleeding stop. It sounds like all is perfectly fine with your post operative exam.