Dilation and curettage is among the most common gynecological procedures performed worldwide, used for both diagnostic endometrial sampling and therapeutic evacuation. The instrument set is compact compared to a hysterectomy tray, but each component has a specific function — using the wrong dilator size or curette design can lead to uterine perforation or incomplete tissue removal.
D&C Instrument Set — Complete Contents
Specula
- Auvard weighted speculum — posterior vaginal wall retraction; the integral weight keeps the speculum in position without an assistant holding it, freeing both the surgeon’s hands for the procedure
- Sims speculum (small and medium) — alternative to the Auvard in narrower vaginal canals or in patients who tolerate weighted instruments poorly
Tenaculum Forceps
- Pozzi single-tooth tenaculum — grasps the anterior lip of the cervix to stabilize the uterus during dilation; the single-tooth design causes minimal cervical trauma compared to multi-tooth designs
- Museux double-tooth tenaculum — used for larger or more mobile cervices where a single-tooth grip is insufficient
Uterine Sound
- Sims uterine sound (malleable, graduated) — measures uterine cavity depth before dilator selection; graduated in centimeters from 6 cm to 14 cm; the malleable design allows adjustment for anteverted and retroverted uteri
Hegar Dilators — The Most Important Component
Hegar dilators are graduated solid-bar instruments that progressively dilate the cervical canal. The series runs from 3 mm to 20 mm, with each dilator 1 mm wider than the previous. The configuration used depends on the indication:
- Sizes 3 to 9 mm — standard diagnostic D&C (endometrial biopsy, post-menopausal bleeding workup); sufficient for most office and day-case procedures
- Sizes 3 to 13 mm — therapeutic D&C for early pregnancy evacuation (up to 10 weeks), incomplete miscarriage, or retained products of conception
- Sizes 1 to 20 mm (full obstetric set) — for second-trimester procedures, cervical ripening, and cervical incompetence treatment
Each Fizza Surgical Hegar dilator is turned from solid 316L stainless steel bar stock and polished to eliminate surface burrs. Burred dilators — common in lower-cost sets — can lacerate the cervical canal even when used at the correct diameter.
Uterine Curettes
Curette selection depends on the clinical indication:
- Sharp curettes (sizes 1 to 6) — diagnostic endometrial sampling; the sharp serrated edge collects intact tissue strips for histopathological examination
- Blunt curettes (sizes 1 to 6) — post-partum retained products or in patients at elevated perforation risk (thin atrophic endometrium, prior uterine surgery)
- Thomas posterior-angled curette — specifically designed for sampling the posterior uterine wall in retroverted uteri where standard curettes cannot reach the posterior fundus
Sponge-Holding Forceps
- Rampley sponge-holding forceps (2 pcs) — for cervical and vaginal antiseptic preparation, and for intrauterine packing with antiseptic gauze at procedure end
Evacuation Forceps — The Component Most Sets Omit
Dilators and curettes get specified carefully. Evacuation forceps get left off the instrument card, and then somebody has to go looking mid-case.
The omission has a logic to it that does not survive contact with a busy list. A curette works along a plane, removing what is attached to the surface it is drawn across — correct for the endometrial layer, and correct for a diagnostic sampling. Retained products of conception are not a layer. They are discrete masses, sometimes free in the cavity and sometimes adherent to a patch of decidua, and a curette drawn across one either misses it or shreds it into fragments that are harder to retrieve than the original mass was.
Ovum forceps solve that. Fenestrated, serrated jaws close around a mass and hold it firmly enough for traction without transecting it, because the fenestration lets the tissue bulge into the window and spreads the grip. The conventional sequence is forceps first to clear the bulk, then the curette to check the cavity walls and confirm the gritty endpoint. Reversing it makes the job longer.
Three patterns cover the ground. Sopher forceps have flat fenestrated jaws in 9 to 16 mm widths — narrow enough closed to pass a less-dilated cervix, which makes them the first-trimester default and the pattern that belongs on a standard D&C tray. Bierer forceps are heavier, with deeper jaws at 16 to 22 mm, taking more tissue per pass but needing more dilatation to pass safely. Winter placenta and ovum forceps are the outlier: spoon-shaped concave jaws with a sharpened rim, intended for large placental fragments at caesarean or postpartum rather than blind transcervical use.
One specification decision is worth making deliberately rather than by default. Ratcheted forceps hold without sustained hand pressure, which helps when a mass needs steady traction while it separates — but the ratchet locks at a fixed jaw pressure and removes the tactile feedback that distinguishes a free mass from the uterine wall. Grasping myometrium and pulling is the mechanism behind most perforations in this procedure. If the department stocks one version, stock the unratcheted one; a ratchet cannot be un-had mid-case.
Pattern differences, jaw widths, length selection against sounded depth and the inspection points that matter are covered in detail in our guide to ovum forceps: Bierer vs Sopher vs Winter.
2026 update: the dilator and cervical-stabilisation components of this set are now covered in their own guides — see Hegar uterine dilators: sizes, sets and safe dilation for the full size chart and dilatation sequence, and uterine tenaculum forceps: Schroeder vs Duplay vs Jacobs for the cervical grasping patterns.
Set Configurations for Different Use Cases
For a routine diagnostic D&C (endometrial biopsy, RPOC), most surgeons use Hegar sizes 5 to 9, a sharp curette in size 3 to 4, a Pozzi tenaculum, and an Auvard speculum. For first-trimester incomplete miscarriage or retained products, dilation to Hegar 11 to 12 is typical, followed by blunt or sharp curettes in sizes 4 to 5.
Our standard combined set covers both use cases: Hegar sizes 3 to 13, both sharp and blunt curettes in sizes 1 to 4, Pozzi and Museux tenaculum, both speculum types, and Rampley sponge forceps. Custom configurations (full obstetric Hegar range, additional curette sizes) are available on request.
Dilator Quality — What Fails First in Budget Sets
Hegar dilators are under bending stress each time they are inserted against cervical resistance. Budget dilators manufactured from 304 stainless steel or with hollow-bar construction deform over time, developing surface roughness and dimensional drift. After 200 to 300 sterilization cycles, a deformed dilator may not accurately represent its size marking, leading to over-dilation.
Fizza Surgical manufactures Hegar dilators from solid-bar 316L stainless steel. Dimensional tolerance is maintained to plus or minus 0.1 mm on the diameter. All D&C sets are supplied under ISO 13485:2016 with CE marking.
Hegar Dilator Quick Reference
| Indication | Hegar range | Curette | Notes |
|---|---|---|---|
| Diagnostic endometrial sampling | 5–9 mm | Sharp, size 3–4 | Office or day-case; minimal dilation |
| Incomplete miscarriage / RPOC | Up to 11–12 mm | Sharp or blunt, size 4–5 | Blunt preferred if perforation risk raised |
| Post-partum retained products | 10–13 mm | Blunt, size 5–6 | Soft post-partum uterus — blunt only |
| Retroverted uterus, posterior wall | Per indication | Thomas posterior-angled | Standard curettes miss the posterior fundus |
| Second-trimester / cervical incompetence | Full 1–20 mm set | As indicated | Requires full obstetric range |
Related reading: our guides to vaginal speculum types (Cusco, Graves and Sims) and curette types in surgery cover two components of this tray in more depth. Full ISO 13485 and CE documentation is available on request.
Frequently Asked Questions
What is the difference between a sharp and a blunt curette?
The working edge. A sharp curette has a serrated cutting rim that shears intact strips of endometrium, which is what the histopathologist needs for a diagnostic sample. A blunt curette has a smooth rounded rim that scoops tissue without cutting. Use blunt where the uterine wall is soft or thin — post-partum, atrophic endometrium, or a uterus with prior surgery — because a sharp curette in that setting perforates readily.
How far should the cervix be dilated?
To the smallest diameter that admits the chosen curette, and no further. Over-dilation is not harmless: it is associated with cervical trauma and, with repeated procedures, cervical incompetence. Sound the uterus first, select the curette, and dilate to match it — typically Hegar 9 for a diagnostic case and 11–12 for first-trimester evacuation.
Why sound the uterus before dilating?
To establish cavity depth and, more importantly, direction. An anteverted uterus and a retroverted one take a dilator on quite different axes, and the commonest perforation is a dilator driven along the assumed axis rather than the actual one. The graduated malleable sound tells you both, and it is the step most often skipped when a list is running late.
Can Hegar dilators be substituted with Hanks or Pratt dilators?
They are not interchangeable in feel or in sizing. Hegar dilators are blunt-ended and graduated in millimetres of diameter; Hanks and Pratt are tapered and graduated in French, and the taper distributes force differently through the canal. Many surgeons find the tapered designs require less force. Whichever your department stocks, standardise on one — mixing systems on the same tray invites a sizing error.
How do we know a dilator has drifted out of specification?
Measure it. A dilator under bending stress over hundreds of cycles develops dimensional drift and surface roughness, and the size stamped on the shaft stops being true. Gauge dilators against a calibrated standard periodically and withdraw any outside tolerance — ours are held to ±0.1 mm on diameter. A dilator that reads 10 mm and measures 11 is delivering an over-dilation the surgeon never chose.
Ordering
D&C sets are available in the three standard configurations above, or built to your instrument card. Used by gynecology departments and maternity clinics across Pakistan, Saudi Arabia, UAE, Egypt, and West Africa. Contact Fizza Surgical for pricing or to request a catalog.
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