Why is curettage unsafe? New alternatives recommended by WHO
Dilation and Curettage (D&C) used to be the primary method for terminating pregnancies and treating incomplete miscarriages. However, the World Health Organization (WHO) no longer recommends this method due to its high risks and the availability of safer alternatives.
1. What is curettage and why was it once the primary method?
- It was a method used by doctors to terminate pregnancies and remove remaining tissue from miscarriages for a long time, so many medical facilities are familiar with the procedure.
- Used in cases where immediate removal of tissue from the uterus is necessary.
2. Why does WHO recommend discontinuing curettage?
Although curettage was once the standard, it has higher risks than other methods. WHO recommends discontinuing its use because:
- Risk of uterine injury → The scraping tool may cause cuts or perforations in the uterus.
- Risk of infection → Increases the chance of severe infections.
- Risk of future complications → Such as Asherman’s Syndrome, leading to infertility.
- Safer alternatives available → Such as medication abortion (Mifepristone + Misoprostol) or vacuum aspiration (MVA).
3. New alternatives recommended by WHO
| Method | Details | Safety |
| Medication abortion | Uses Mifepristone + Misoprostol. The medication works similarly to natural childbirth, causing uterine contractions, vaginal bleeding, and expulsion of the placenta and embryo through the vagina. | Highly safe. Can be used at home under medical guidance if under 12 weeks. |
| Vacuum aspiration (MVA) | Uses a vacuum syringe to remove the embryo and placenta from the uterus. | Safe and reduces the risk of uterine injury. |
| Dilation and Curettage (D&C) | Uses tools to dilate the cervix and scrape out tissue. | WHO recommends discontinuation due to high risks. |
4. Global changes in treatment guidelines
- In many countries, doctors have switched to using medication abortion or vacuum aspiration.
- Medical organizations such as WHO, FIGO (International Federation of Gynecology and Obstetrics) support discontinuing curettage.
Which method should be chosen for safety?
- Pregnancy under 12 weeks → Can choose either medication or vacuum aspiration
- If privacy is desired and no procedure is wanted → Choose medication.
- If a quick resolution is desired and to reduce the risk of heavy bleeding → Choose vacuum aspiration.
- Pregnancy over 12 weeks → Termination with medication, with hospital stay.
- Note: Both methods should be performed under medical guidance and follow-up examinations should be conducted after termination.
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