If need d&c will you end up with major issues such as uterine perforation?

Rarely: Non pregnant uterus is difficult to perforate. Most gynecologist perform a hysteroscopy so the curettage (scraping) is not done blindly. In the case of a miscarriage or abortion, the uterus is soft and easier to perforate. An experienced gynecologist will adjust the technique appropriately to prevent this complication.

Observation: Most uterine perforations will happen through the fundus or thicker muscular top of the womb. This area tends to heal well with minimal bleeding. Observation is appropriate as long as the patient's blood count is normal and no signs of infection are present.