Alternative names: English: Endocervical Curettage (ECC).
Diagnostic curettage cervical canal- method instrumental diagnostics in gynecology, which consists of mechanical removal of the mucous layer of the cervical canal, followed by studying the resulting biological material under a microscope.
This method is used in cases where there is suspicion of localization pathological process deep in the cervical canal, with difficult visualization.
The method is quite in demand in practical gynecology due to its ease of implementation and high information content. However, routine use of this method without specific indications is not recommended.
The most widely used diagnostic procedure is the separate curettage of the cervical canal and the uterine cavity. The procedures are performed during one doctor's visit sequentially. This allows you to more accurately determine the localization of the pathological process - in the cervix or in the cavity.
Before performing cervical canal curettage, the patient must undergo a general clinical examination, including obtaining the results general analysis blood, urine analysis, fluorography. IN mandatory the patient should be examined for sexually transmitted infections, AIDS, hepatitis B and C. It is also necessary to first undergo and take cervical smears.
Curettage is carried out no earlier than on the 5th day menstrual cycle and no later than 5 days before the start of new menstruation. 24 hours before the procedure, you should refrain from sexual intercourse or introducing medications into the vagina.
Curettage is performed in a gynecological chair. If the procedure is performed under anesthesia, the presence of an anesthesiologist performing anesthesia is mandatory.
A gynecologist creates access to the cervix using gynecological speculum. The neck is taken with special clamps - bullet forceps. After this, the doctor scrapes the canal with curette No. 2. The resulting biological material is collected and sent to the histology laboratory.
If further curettage of the uterine cavity is necessary, the canal is expanded using Hegar dilators and the uterine cavity is curetted with a curette No. 2 or 4.
At the end of the procedure, the cervix is treated with an antiseptic.
In some cases, curettage is also a therapeutic procedure, as it is indicated for cervical polyps.
An absolute contraindication can only be a severe somatic illness that poses a threat to life. Relative contraindications include inflammation in the uterus and vagina. If a cytogram of a smear of purity class 3-5 is detected, it is recommended to postpone the procedure and carry it out after sanitization of the vagina.
If curettage is performed correctly, there are no complications.
A histologist examines the obtained material. In his conclusion, he reflects the nature of the epithelium of the cervical canal. Normally it is cylindrical single layer epithelium. For precancerous and cancer diseases Atypical cells may be encountered.
After the manipulation, a woman may experience spotting- this is an acceptable phenomenon. Curettage of the cervical canal is part of a complex of diagnostic procedures aimed at early diagnosis oncological pathology of the cervix, therefore it is recommended for all women at risk.
Diagnostic curettage of the uterine cavity can be carried out using several methods. This procedure is prescribed by a doctor in accordance with a strict list of symptoms.
In some cases, curettage is necessary to diagnose the condition of the uterine tissue. In this case, it is carried out in combination with hysteroscopy, that is, examination of the walls of the uterus with a special device. There is also separate curettage, which touches the cervix.
Diagnostic curettage of the uterine cavity is the release of the internal cavity of the organ from the mucous membrane. It requires cleaning the cervical canal and dilating the cervix.
This procedure is performed in medical institution and is equivalent to surgery. Often the patient is given anesthesia because the operation is very painful. But in some cases, for example, after childbirth, it can be done without anesthesia.
There are many various indications for such an operation. Recommendations for this procedure are usually prescribed by the treating gynecologist. The most common indications for surgery are the following:
The duration of the operation is usually 30 – 45 minutes. This duration is due to the following actions: cleaning the cervical canal, inserting a probe into the uterine cavity, as well as the need to carefully carry out all procedures so as not to damage the walls of the vagina, the cervix and its walls.
The operation is carried out by removing the mucous layer using a special surgical instrument - curettes. It resembles the shape of a spoon with a long handle, which should pass freely along the walls of the vagina and cervical canal.
There is a separate type of such treatment - separate curettage. It has a wider coverage area. In this case, the cervical canal is scraped. This procedure can also be prescribed after a miscarriage, childbirth, fibroids and other neoplasms.
Separate and conventional curettage require the same preparation, which should begin several days before surgery. The exception is emergency procedures, which are necessary in some cases after childbirth or miscarriage.
The following tests are required before the procedure:
Equally important is examination of the cardiovascular system. It is necessary to do an electrocardiogram and measure blood pressure to make sure there are no pathologies.
Usually, after the procedure is prescribed, at least 2 weeks pass before it is carried out. During this time, it is advisable not to take any medications.
Any drug can affect blood clotting, and therefore increase the risk of dangerous complications.
You need to stop having sexual intercourse for 4-5 days. It is prohibited to douche or use any vaginal suppositories, which can change the composition of the mucus of the cervical canal.
If the operation is performed after childbirth or miscarriage, it is aimed at removing the unnecessary mucous layer of the uterine epithelium so that sepsis does not subsequently develop and the woman recovers quickly. After childbirth, this procedure also helps remove any remaining placenta. In this case, the operation is therapeutic in nature.
Typically, therapeutic and diagnostic curettage of the uterine cavity involves not only cleaning the upper layer of the internal cavity of the uterus, but also histological analysis collected material, as well as tissue examination using a special device - a hysteroscope. It is equipped with a small camera that allows you to obtain an image displayed on the monitor.
Such diagnostics can identify a number of dangerous diseases of the uterus, appendages and cervical canal at the very beginning of their development. If curettage is not carried out in time, the consequences of such diseases can be extremely severe for the body.
Sometimes initial treatment can be done on site, such as removing polyps, which are often diagnosed after a miscarriage. Polyps in some cases can degenerate into malignant neoplasms.
For a successful pregnancy and easy childbirth, a woman must be healthy. Often any violations cause miscarriage and other severe consequences. That is why it is extremely important to undergo timely examinations by a qualified doctor. Therapeutic and diagnostic curettage helps with this. In addition, the procedure helps solve the problem of irregular, painful or heavy periods, thereby increasing the woman’s quality of life.
It can be summarized that there are two types of curettage - therapeutic and diagnostic. This procedure is prescribed in many situations, for example, it is common to eliminate the consequences after a miscarriage or childbirth. It is important to know that it is equivalent to surgical intervention, and therefore is carried out under shallow anesthesia.
All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.
A huge number of women of reproductive age and menopause experience uterine curettage. The intervention is quite traumatic, but it happens that you cannot do without it, because gynecological pathology is very common, and in many medical institutions more gentle diagnostic methods are simply not available.
Nowadays, curettage has ceased to be the main method of diagnosis and treatment. They are trying to replace it with more modern and safe manipulations, which provide no less information for the further management of the patient. In developed countries, curettage has long given way to diagnostics, and curettage is performed very rarely and more often for therapeutic purposes.
At the same time, it is not possible to completely abandon the method: not all clinics have the necessary endoscopic equipment, not everywhere there are trained specialists, and some endometrial diseases require urgent treatment, and then scraping is the fastest and reliable way eliminate pathology.
Curettage of the endometrium and cervical canal is one of the most radical methods of treatment in gynecology. In addition, it makes it possible to obtain a large volume of material for histological analysis. However, the traumatic nature of the operation causes many risks and dangerous complications, so curettage, or curettage, is usually prescribed for really good reasons.
curettage of the uterus
Curettage of the uterus is carried out only in an operating room - this is one of the main and mandatory conditions of the operation, the reason for which is that during the procedure serious complications may arise, for the rapid elimination of which there are no conditions in any antenatal clinic. In addition, general anesthesia required for curettage should also be performed exclusively in a hospital and by a competent anesthesiologist.
Typically, a woman who is scheduled for curettage experiences a well-founded fear of the procedure itself and its consequences, especially if there are plans for childbearing in the future, so a qualified gynecologist must explain to the patient the advisability of intervention in her case and take all measures to prevent dangerous consequences.
Separate curettage of the uterine cavity and cervical canal is most often indicated for tissue collection for histological analysis, which is why it is called diagnostic. The therapeutic goal of the intervention is to remove the changed tissue and stop bleeding. The reasons for curettage of the uterine cavity are:
Uterine bleeding, perhaps, remains the most common cause of curettage. In this case, the operation has, first of all, a therapeutic purpose - to stop the bleeding. The resulting endometrium is sent for histological examination, which makes it possible to clarify the cause of the pathology.
curettage for endometrial polyp
Curettage for polyp and endometrial hyperplasia, diagnosed by ultrasound, eliminates the pathological process, and histology clarifies or confirms the existing diagnosis. If possible, polypectomy is performed through hysteroscopy, which is less traumatic but just as effective as curettage.
Curettage is not uncommon after medical abortion and childbirth, when continued bleeding may indicate retention of fragments of placental tissue, embryo, and formation in the uterine cavity. placental polyp. Postpartum acute inflammation inner lining of the uterus (endometritis) is also treated by removing inflamed tissue and is supplemented by subsequent conservative treatment antibiotics.
Curettage can be performed as a medical abortion. Thus, curettage of a frozen pregnancy diagnosed at a short term is one of the main methods of removing pathology, widely practiced in most countries of the post-Soviet space. In addition, a pregnancy that is developing favorably is terminated in this way if it is not possible or the deadline for vacuum aspiration is missed.
A woman who decides to undergo curettage during a normally developing pregnancy is always informed by the doctor about the possible consequences of the procedure, including the main one - infertility in the future. There are also certain risks when curettage of a frozen pregnancy, so a competent specialist will try to avoid this operation altogether or suggest a vacuum abortion.
Adhesions (synechias) in the uterine cavity can be eliminated with a curette, but this pathology is increasingly becoming an indication for curettage due to the introduction of hysteroscopic techniques. After instrumental dissection of synechiae, there is a risk of them re-education and inflammatory complications, so gynecologists are trying to avoid such radical effects.
hysteroscopy
If there is absolute readings to curettage, it is advisable to supplement it with hysteroscopy, because acting blindly, the doctor cannot exclude that the operation is not radical enough, and the hysteroscope makes it possible to examine the surface of the uterus from the inside and make the treatment as effective as possible.
Diagnostic curettage uterus can be carried out as planned when, during examination and ultrasound examination, the gynecologist suspects hyperplasia or tumor growth. The purpose of such an operation is not so much treatment as obtaining fragments of the mucous membrane for pathohistological analysis, which makes it possible to accurately say what exactly is happening to the endometrium.
In the vast majority of cases, during curettage, the gynecologist sets the task of obtaining not only the endometrium, but also the lining of the cervical canal, which will somehow be passed through by the instrument, so curettage of the cervical canal is usually a stage of one large operation.
The mucous membrane of the cervical canal has a different structure from the endometrium, but polyp formation and tumor growth also occur in it. It happens that it is difficult to determine where exactly the process comes from, but the pathology can also be combined, when one thing happens in the endometrium, and something completely different happens in the cervical canal.
Separate curettage of the cervical canal and uterine cavity necessary to obtain tissue from both parts of the organ, and to prevent it from mixing, the gynecologist first takes samples from one part, placing them in a separate container, and then from the other. This approach allows the most accurate assessment of the changes occurring in each area of the uterus through histological analysis of the tissue obtained.
When prescribing curettage, the doctor must take into account the presence contraindications, which are considered inflammatory changes in the genital tract, acute general infectious diseases, suspicion of perforation of the uterine wall, severe concomitant decompensated diseases. It is worth clarifying, however, that when curettage is performed for health reasons (massive uterine bleeding), in case acute endometritis after childbirth or abortion, the doctor may neglect some obstacles, since the benefits of the operation are disproportionate to the possible risks.
In preparation for separate curettage, a woman will have to undergo a series of studies if the procedure is scheduled. In case of urgent surgery, you will have to limit yourself to a minimum of general clinical tests. When preparing for treatment, you should not only take with you the results of examinations, clean linen and a gown, but also do not forget about disposable hygiene products, because after the operation there will be bloody discharge from the genital tract for some time.
Preoperative preparation includes:
Upon admission to the clinic, the attending physician talks with the patient, who ascertains the obstetric and gynecological history, clarifies the presence of allergies to any drugs, and necessarily records what medications the woman takes constantly.
Aspirin-based medications and anticoagulants are discontinued before surgery due to the risk of bleeding. On the eve of curettage, the last meal and water are allowed 12 hours in advance if general anesthesia is planned. Otherwise, eating and drinking is allowed, but you shouldn’t get carried away, because the load on gastrointestinal tract may affect the flow postoperative period.
In the evening before the operation, you should take a shower, thoroughly hygienically wash the genitals, and shave your hair. Douching and the use of vaginal medications are completely excluded at this point. According to indications, a cleansing enema or mild laxatives will be prescribed. If you are nervous on the eve of surgery, you can take mild sedatives (valerian, motherwort).
Curettage of the uterine cavity is the excision of the upper, regularly renewed, layer of the mucous membrane using sharp surgical instruments - curettes. The basal layer should remain intact.
The introduction of instruments into the uterus through the cervical canal implies its expansion, and this is an extremely painful stage, so anesthesia is necessary and prerequisite operations. Depending on the woman’s condition and the characteristics of the pathology, it can be used local anesthesia(paracervical injection with anesthetic), but most women still experience severe pain. General intravenous anesthesia can be considered more preferable, especially in patients with labile psyche and low pain threshold.
Curettage of the uterus is carried out in several steps:
Before the intervention begins, he empties bladder the woman alone or a special catheter is inserted into it for the entire duration of the manipulation. The patient lies in a gynecological chair with her legs apart, and the surgeon performs a manual examination, during which he clarifies the size and location of the uterus relative to the longitudinal axis. Before inserting the instruments, the genital tract and vagina are treated with an antiseptic, and then special surgical mirrors are inserted, which are held by an assistant throughout the procedure.
uterine cavity curettage technique
Nude in mirrors cervix grabbed with forceps. The length and direction of the organ cavity are determined by probing. In most women, the uterus is slightly tilted towards the symphysis pubis, so the instruments face the concave surface anteriorly. If the gynecologist has determined that the uterus is deviated backwards, then the instruments are inserted in the opposite direction to avoid injury to the organ.
To access the inside of the uterus, you need to widen the narrow cervical canal. This is the most painful stage of the manipulation. Expansion occurs using metal Hegar dilators, starting with the smallest and ending with the one that will ensure subsequent insertion of the curette (up to No. 10-11).
Tools must be carried out as carefully as possible, using only the brush, but not pushing them inside with the force of the whole hand. The dilator is inserted until it passes the internal uterine os, then it is held motionless for several seconds, and then changed to the next one of larger diameter. If the next dilator does not pass or is very difficult to advance, then the previous smaller size is reintroduced.
Curette- this is a sharp metal instrument that resembles a loop moving along the wall of the uterus, as if cutting off and pushing the endometrial layer towards the exit. The surgeon carefully brings it to the bottom of the organ and moves it to the exit with a faster movement, lightly pressing on the wall of the uterus and excising areas of the mucous membrane.
Scraping is carried out in a clear sequence: front wall, back, side surfaces, pipe corners. As mucosal fragments are removed, the curettes are changed to a smaller diameter. Curettage is carried out until the surgeon feels the smoothness of the inner layer of the uterus.
Supplementing the operation with hysteroscopic control has a number of advantages over “blind” curettage, Therefore, if you have the necessary equipment, it is unacceptable to neglect it. This approach not only provides a more accurate diagnosis, but also helps minimize some of the consequences. With hysteroscopy, the doctor has the opportunity to specifically take material for histology, which is important if cancer is suspected, as well as examine the wall of the organ after cutting off pathologically altered tissues.
When curettage, only the functional layer of the endometrium is removed, which undergoes cyclic changes, “growing” towards the end of the menstrual cycle and sloughing off during the menstrual phase. Careless manipulation may damage the basal layer, due to which regeneration occurs. This is fraught with infertility and menstrual dysfunction in the future.
Particular care should be taken in the presence of uterine fibroids, which with their nodes makes the lining tuberous. Careless actions by a doctor can cause injury to myomatous nodes, bleeding and tumor necrosis.
Curettage for endometrial hyperplasia gives abundant scraping of the mucous membrane, but even with a tumor, a large volume of tissue can be obtained. If the cancer grows into the wall of the uterus, it can be damaged by the curette, which the surgeon must remember. During an abortion, curettage should not be carried out until there is a “crunch”, since such a deep impact contributes to traumatization of the neuromuscular structures of the organ. An important point when removing a frozen pregnancy, a subsequent histological examination is considered, which can help determine the cause of the embryo development disorder.
At the end of curettage, the doctor removes the forceps from the cervix, performs a final treatment of the genitals with a disinfectant, and removes the speculum. The material obtained during the intervention is placed in a bottle with formaldehyde and sent for histology. If carcinoma is suspected, separate curettage is always performed - the first step is to scrape the cervical canal, then the uterine cavity with tissue taken for histology in different bottles. Mucous different departments reproductive system must be marked when sent for analysis.
In the postoperative period, the patient is prescribed a gentle regimen. For the first 2 hours, it is forbidden to stand up; an ice pack is placed on the lower abdomen. By the evening of the same day you can get up, walk, eat and shower without any significant restrictions. If the postoperative period is favorable, you will be allowed to go home for 2-3 days. for observation by an obstetrician-gynecologist at the place of residence.
At pain syndrome Analgesics can be prescribed, and antibiotic therapy can be prescribed to prevent infectious complications. To facilitate the outflow of bloody masses, antispasmodics (no-spa) are prescribed for the first 2-3 days.
Bloody discharge is usually not profuse and can persist for up to 10-14 days, which is not considered a pathology, but with the development of bleeding, a change in the nature of the discharge ( bad smell, color with a yellowish or green tint, increase in intensity) should be reported to your doctor immediately.
In order to avoid infection, the gynecologist will prohibit the woman from any douching, as well as the use of hygienic tampons during the period postoperative discharge. For these purposes, it is safer to use regular pads, controlling the volume and type of discharge.
For successful recovery, hygiene procedures are important - you need to wash yourself at least twice a day, but it is better not to use any cosmetics, even soap, limited to only warm water. You will have to give up baths, saunas and swimming pools for up to a month.
Sex after curettage is possible no earlier than a month later, and physical activity and it is better to postpone visiting the gym for a couple of weeks due to the risk of bleeding.
The first menstruation after curettage usually occurs after about a month, but a delay is possible, associated with ongoing mucosal regeneration. This is not considered a violation, but it would not be a bad idea for a doctor to see it.
During the first 2 weeks you should monitor your well-being very carefully. Of particular concern are:
With such symptoms, the development of acute endometritis or hematometra cannot be ruled out, which requires urgent treatment by reoperation. Other complications are less common, among them are possible:
The possibility and timing of planning a pregnancy after curettage worries many patients, especially young, as well as those who underwent surgery for a missed abortion. In general, subject to correct technique surgery, there should be no difficulties with pregnancy, and it is better to plan it no earlier than six months later.
On the other hand, infertility is one of the possible complications, which may be associated with infection, secondary inflammation, and the development of synechiae in the uterus. An unqualified surgeon can affect the basal layer of the endometrium, and then significant difficulties may arise with the restoration of the mucosa and implantation of the embryo.
To avoid complications, it is advisable to choose in advance a clinic and a gynecologist whom you can trust with your health, and after the intervention carefully follow all his appointments and recommendations.
Uterine curettage is performed free of charge in all public hospitals, and it's paid. The cost of curettage of the uterine cavity averages 5-7 thousand rubles; separate curettage of the cervical canal and the uterine cavity with subsequent histology will cost more - 10-15 thousand. The price for the service in Moscow clinics is slightly higher and starts on average from 10 thousand rubles. Hysteroscopic control significantly increases the cost of the operation - up to 20 thousand rubles or more.
Women who are indicated for curettage are interested in reviews of patients who have already undergone such treatment. Unfortunately, it cannot be said that the impressions of the procedure were entirely good, and reviews are often negative. This is due to the pain that one has to experience during local anesthesia, as well as the very fact of intervention in such a delicate and important organ female body.
However, there is no need to panic in advance. A qualified doctor who is confident in the absolute necessity of the procedure as the only possible method diagnosis and treatment will not cause irreparable harm, and curettage will allow you to detect the disease in time and get rid of it most radically.
The external genitalia and cervix are treated both before and after the procedure.
Carrying out curettage in combination with hysteroscopy has several advantages:
The results of diagnostic curettage are based on data from histological analysis, which involves studying the structure of tissues and cells using microscopy of sections of biological material. The results of the study are usually released within two weeks after the operation.
Before curettage of the uterus, a number of studies are required to assess the condition of the female genital organs, as well as to assess general condition woman's body. Preoperative preparation is usually carried out on an outpatient basis. Studies that precede uterine curettage are:
The day before the procedure, you must refrain from eating and also do not drink water for several hours before the examination. Also on the eve of the study, a cleansing enema is performed. Compliance with these requirements allows for cleansing of the gastrointestinal tract ( gastrointestinal tract). At general anesthesia this is necessary to prevent food masses into the respiratory tract.
It is recommended not to use before scraping by special means for intimate hygiene and medications for topical use ( vaginal suppositories, tablets). Immediately before surgery, the bladder must be emptied.
After curettage, the biological material is sent to the laboratory for histological examination. In the laboratory, thin sections of the resulting tissues are made and stained special solutions, and then examined under a microscope. A pathologist performs a detailed macroscopic examination ( visible to the naked eye) and a microscopic description of the preparation followed by writing a conclusion. It is the histological examination of materials obtained during diagnostic curettage that makes it possible to establish a diagnosis and prescribe appropriate treatment. In order to understand what pathological changes can be detected using diagnostic curettage, you need to know what the uterine mucosa should be like normally.
Depending on the phase of the menstrual cycle, characteristic patterns are observed in the uterine mucosa physiological changes associated with the effects of sex hormones on the endometrium. If physiological changes characteristic of one phase of the cycle occur in another phase, then this is considered pathological condition.
The characteristics of the endometrium in different phases of the menstrual cycle are:
Signs of uterine diseases identified after diagnostic curettage are:
Diagnostic curettage is an intervention that can be used to detect a number of pathological conditions of the mucous membrane of the body and cervix. Pathological conditions that can be identified using curettage are:
Polyps small sizes may not manifest clinically. Symptoms usually appear as their size increases.
The basis of the structure of polyps is the stromal ( connective tissue) and glandular components, which, depending on the type of polyp, can be in different proportions. At the bases of polyps, dilated blood vessels with sclerotic changes in the wall are often found.
Endometrial polyps can be of the following types:
From a histological point of view, polyps are formed from prismatic epithelium. They are more often glandular or glandular-fibrous. Other types of cervical polyps are much less common.
Characteristic signs of adenomatous endometrial hyperplasia are:
It is extremely rare for this precancerous condition to reverse. In approximately 10% of cases, it degenerates into adenocarcinoma ( malignant formation of glandular epithelium).
Macroscopic characteristics show thickening of the mucous membrane, and polypoid growths are noted in some areas.
Microscopic characteristics of glandular endometrial hyperplasia include the following signs:
When examining endometrial scrapings, endometrial cancer is most often represented by adenocarcinoma. Also to malignant diseases endometrium include squamous cell carcinoma (an aggressive form of cancer characterized by the rapid appearance of metastases), undifferentiated cancer ( a tumor in which cancer cells significantly different from normal cells ), however such forms are much less common. Typically, such a tumor is characterized by exophytic growth ( into the lumen of the organ). The tumor can be highly differentiated, moderately differentiated and poorly differentiated. Prognosis upon detection of such a pathological condition ( especially poorly differentiated tumor) is usually unfavorable, but timely detection allows for effective treatment. The higher the degree of differentiation of the tumor, the more similar elements it has to normal endometrium and the better it responds to hormonal treatment.
Most often, endometrial cancer develops against the background of precancerous conditions - atypical endometrial hyperplasia, endometrial polyposis.
The histological picture of cervical cancer can be different depending on the location of the malignant process ( vaginal part of the cervix, cervical canal).
Histological characteristics of cervical cancer
Curettage allows you to identify endometriosis localized in the body of the uterus ( adenomyosis), isthmus, various departments cervix.
Signs of cervical endometriosis are also detected during colposcopy, but the final diagnosis can only be established on the basis of curettage of the mucous membrane of the cervical canal followed by histological examination.
Histological examination reveals an epithelium atypical for the cervix, similar to the structure of the endometrium. Endometrioid tissue ( tissue affected by endometriosis) is also subject to cyclic changes, however, the intensity of these changes is much less compared to the normal endometrium, since it responds relatively weakly to various hormonal influences.
Acute endometritis is most often a complication of childbirth or termination of pregnancy. Chronic form endometritis is more common. The disease is caused by pathogenic microorganisms. Endometritis is characterized by signs of inflammation on the mucous membrane and purulent plaque.
Characteristic histological signs of endometritis are:
Myomatous nodes are round-shaped formations that consist of chaotically intertwined muscle fibers.
Diagnostic curettage in the case of uterine fibroids can be carried out only for differential diagnosis with other diseases of the uterus. To detect fibroids this method is not informative, since the material for examination during diagnostic curettage is the mucous membrane, and myomatous nodes, as a rule, are located under the mucous membrane. Carrying out diagnostic curettage without indications is fraught with the development of serious complications. In this regard, to diagnose this pathological condition, other research methods are recommended, which are more informative - aspiration biopsy (a research method in which a section of tissue is excised for subsequent examination), hysteroscopy.
Curettage makes it possible to obtain biological material from the epithelium of the cervical canal, which is then subject to histological examination. If the pathological process is located in the vaginal part of the cervix, material for research is obtained during colposcopy. A Pap test is performed to confirm the diagnosis.
Histological examination of scrapings reveals lesions with atypical cell structure and intercellular connections.
There are three degrees of cervical dysplasia:
Signs of pregnancy pathology identified by histological examination are:
When performing a histological examination of biological material if pregnancy pathology is suspected, it is important to know when the patient had her last menstruation. This is necessary for a full analysis of the results obtained.
Histological examination allows us to confirm the fact of termination of pregnancy, to detect possible reasons such a phenomenon. For more full assessment clinical picture, and also to prevent a recurrence of the problematic course of pregnancy in the future, it is recommended to undergo a series of laboratory and instrumental studies. List necessary research determined by the doctor individually for each patient.
After surgery, patients remain in the hospital for at least several hours. Usually the doctor discharges patients on the same day, but if there is an increased risk of complications, hospitalization is recommended. The doctor should warn patients what symptoms may appear after curettage and which of them are normal. When pathological symptoms You should consult a doctor immediately, as these may be signs of complications. It is not recommended to use gynecological tampons or douche after scraping ( washing the vagina with solutions in hygienic and medicinal purposes ). As for intimate hygiene, it is recommended to use only warm water for these purposes.
Physical activity on the body ( for example, sports) must be stopped for a while, as it may cause post-operative bleeding. You can engage in sports at least one to two weeks after the procedure, but this must be discussed with your doctor.
After curettage, after some time, patients should come to the doctor for control. The doctor talks with the patient, analyzing her complaints and assessing her condition, then a vaginal examination and colposcopy are performed, followed by examination of a vaginal smear. It may also be prescribed ultrasound examination pelvic organs to assess the condition of the endometrium.
If inflammatory complications develop, anti-inflammatory drugs for local or general use may be prescribed.
After the operation, the first sexual intercourse may be accompanied by pain, itching and discomfort, but this phenomenon quickly passes.
Curettage is a procedure that requires caution when performed. The consequences of such a procedure can be positive and negative. Positive consequences include the diagnosis and subsequent treatment of uterine pathologies. The negative consequences of curettage include complications, the occurrence of which can be associated both with poor-quality work of a specialist and with individual reaction body to this intervention. Complications can occur both during the operation or immediately after its completion, or after a long time ( long-term complications).Complications of uterine curettage may include:
Separate diagnostic curettage– instrumental removal of the mucous membrane of the cervical canal, and then the mucous membrane of the uterine body.
Indications for separate diagnostic curettage:
1) to determine the state of the mucosa in various benign and malignant processes (hyperplastic promalignant processes (hyperplastic processes, precancerous changes, cancer)
2) if there is a suspicion of the remains of a fertilized egg
3) if endometrial tuberculosis or polyposis of the mucous membrane is suspected
4) for menstrual disorders
Contraindication for diagnostic curettage: acute inflammatory processes in the genitals.
Technique of separate diagnostic curettage:
1. Separate diagnostic curettage is carried out in a hospital setting with strict adherence to the rules of asepsis and antisepsis.
2. Anesthesia: local paracervical anesthesia with a 0.25% solution of novocaine or mask anesthesia (nitric oxide, fluorotan).
3. After disinfection of the external genitalia and vagina, the cervix is exposed using mirrors, treated with alcohol and grabbed by the front lip with bullet forceps. If the uterus is in retroflexion, then it is better to grab the cervix by the back lip.
4. The uterine cavity is probed and the cervix is dilated with Hegar dilators up to No. 9-10. Expanders are introduced, starting with small numbers, only with the strength of the fingers, and not with the whole hand. The dilator is not brought to the fundus of the uterus; it is enough to pass it through the internal os. Each dilator should be left in the canal for a few seconds; if the subsequent dilator enters with great difficulty, then the previous dilator should be inserted again.
5. First, the mucous membrane of the cervical canal is scraped, without going beyond the internal os. The scraping is collected in a separate tube.
6. After scraping the mucous membrane of the cervical canal, they begin to scrape the walls of the uterine cavity, using sharp curettes of different sizes. The curette should be held freely, without resting on the handle. It is carefully inserted into the uterine cavity to the fundus of the uterus, then the curette handle is pressed so that the loop slides along the wall of the uterus, and it is brought out from top to bottom to the internal os. To scrape the posterior wall, without removing the curette from the uterine cavity, carefully turn it 1800. Curettage is performed in a certain order: first, the anterior wall is scraped, then the left lateral, posterior, right lateral and corners of the uterus. The scraping is collected into another tube, two tubes are signed, noting where the scraping came from, and sent for histological examination.
7. After curettage, the patient is taken to the ward on a gurney. Cold is prescribed to the lower abdomen. After 2 hours you are allowed to get up. Discharged under the supervision of a antenatal clinic on the 3rd day, if there are no complications.
