D & C: Why are they still performed blindly?

[RWinograd]

My baby stopped growing at 8 weeks.  I would have liked to have miscarried on my own, in my home, for the sake of closure. But when the 10 week exam happened, and the Doppler, pelvic, and high powered vaginal ultrasounds showed no heartbeat or movement, I was rushed into agreeing to an emergency D & C/vacuum aspiration (the doctor never did explain WHY she was concerned about the retained tissue, but I would assume it is because of the risk of infection.)  After the proceedure, I was having some complications, but my doctor swore up and down that she hadn't missed any tissue and that it had been a "textbook perfect" procedure (her words, not mine).  At no point did she actually do a beta draw. A second opinion from a different practice confirmed what I had suspected, that the HcG levels were not where they should have been at, and that I had a placental polyp.  They carefully monitored my HcG levels (which gradually dropped over a period of eight weeks), and watched as I proceeded to bleed heavily for 30 days.  It finally ended with the painful passage of a gelatinous and stringy golf ball sized clot.  Nearly three months after the initial D & C, I am still waiting for the return of a "normal" cycle and ovulation.  And all because, tissue was left behind.  So my question is, why do doctors continue to perform blind D & C's, without the visual aid of ultrasound or a hysteroscope? My advice to any woman who decides to have a dilation and curretage, or vacuum aspiration procedure done, is to demand that the procedure be visually assisted by one of these technological aids. Especially in light of potential complications such as Asherman's, or hemorrhaging, or infection.  I wonder if there was any point in having the D&C at all?  

[AnnieBrooke]

Our HMO will save a buck where it can, yet my last D&C was ultrasound-guided and the one I had before that was hysteroscopic.  I'd guess they only do them blind any more if it seems like there won't be any complications at all.  It's surprising that she didn't do follow-up monitoring of your hCG level.  If my cheap HMO is going over to guided D&C's, probably everyone is headed there.  They aren't the first to jump to a new, more costly process.

[nshapland]

I didn't think they did do it blind any more. I asked my dr and he said he used ultrasound to guide him.  I asked b/c I had read up on the d&c procedure and was freaked out about them doing it blind.
Anyway, I'm so sorry this happened to you. I'm glad you got a second opinion and I would not go back to the first dr