Thanks for posting your query at DoctorSpring.com
You are theoretically right about the possible complications of a D and C.
Ashermans syndrome can result from over vigorous curetting ( scraping ) during the procedure.
The complication however occurs in less than 5 % of cases.
Theoretically there are complications such as injury to the uterus ( perforation ), infection, even death.
These are very very rare, and in more than 95 % of cases, if the D and C is done by a qualified expert, the patient can go home within a few hours of the procedure.
YOu should focus on the positive side, and not get stressed by the rare possibilities of adverse outcomes.
Yes, we do see patients with Ashermans , but that happens in patients with repeated intra uterine procedures, and those who consult quacks.
I am sure that you will come out unscathed.
Just ensure that it is done at an experienced, reputed and accredited centre.
Also, you should insist that the products of conception should be sent for a biopsy and chromosomal analysis to know the reason for the missed miscarriage.
If you conceived without difficulty the first time round, there should be no issues in conceiving again.
You can try to do so after 3 months of the D and C.
Meanwhile you should take daily 5 mg per day folic acid.
All the best
Please feel free to discuss further.
Patient replied :
Thank you for your reply! I am planning on doing it with local anesthesia. I'm a bit worried about general because I take a really low dose of anti-depressants and I am scared it will counteract with the anesthesia (although I've been practically off of them since the pregnancy). But also because I don't like the idea of being totally knocked out and not knowing what's going on. Do you think local is possible and can be tolerated for someone that has a pretty good tolerance for pain? Have you done this procedure on someone using local instead of general? How did they react? My doctor seems like a fine doctor but he is new to me so I don't know much about him. He has his own office here in LA and has quite a few years of experience from what i've read about him. But he doesn't give a thorough explanation of anything and doesn't stick around much to answer all my questions. I won't be returning to him after all this is over but don't have time to look for someone new. Unless there is someone you highly recommend in the Los Angeles area. Thanks in advance.
Thank you for your follow up. I can understand the concerns you may have regarding the D&C.
If your doctor is an expert, dont worry. Trust him.
Also, under local anesthesia, you would squirm and resist more, making it more difficult for the doctor.
Under general anesthesia, the relaxation is complete, thus making the procedure fast and smooth, fraught with less complications.
Since you have been off the antidepressants, there is no cause for concern there.
I have done D and Cs under local anesthesia, when either resources were not at hand in the peripheral centres, or the patient had complete contraindications to general anesthesia. If your situation does not fit either of the 2, I would really recommend general anesthesia.
Under local, it is definitely more difficult, tedious, longer and more prone to complications.
Hope this helps, feel free to discuss further