Every woman tries to take care of her health. After all, many gynecological diseases, if not treated in time, can lead to infertility or even threaten life. One of the popular ways to eliminate pathologies associated with reproductive system, is curettage of the cervical canal and uterine cavity. But many girls, having heard about the method there, refuse it. Everything, because not everyone knows what it is and why curettage is needed.
Endocervical curettage specimens obtained at colposcopy can detect cervical cancers and precursors that would otherwise be missed by biopsy alone; but the procedure may be painful and reduce compliance with necessary follow-ups.
Utilization was greatest among women aged 46 years selected after complete cytology. Key words: cervical intraepithelial neoplasia, colposcopy, curettage, diagnosis, endocervical sampling. The colposcopic specialist will take biopsies of visualized lesions and possibly probe the endocervical canal using a curette to rule out the presence of occult cervical intraepithelial neoplasia. This last procedure, endocervical curettage, involves scraping the endocervical canal circumferentially.
Curettage of the uterine cavity is a gynecological operation, the purpose of which is to scrape the upper functional layer of the mucous cavity (endometrium). In gynecology, separate diagnostic curettage(RDV), separate because cleaning is performed in stages, first the cervical canal is scraped, and only then the uterine cavity.
Another option is to try the endocervix using an endocervical brush instead of curettage. The Calgary Health Region and the Alberta Cervical Cancer Screening Program in Alberta, Canada, have an extensive data collection system that records histopathology, cytopathology, and colposcopy and patient characteristics for all colposcopy examinations performed.
The Calgary Health Region provides services to a population of approximately 2 million people. Colposcopy, cytopathology and histopathology are regionalized services with uniform practical recommendations and standards. Using the patient number, records from the pathology database were linked to the colposcopic examination database to abstract the colposcopic impression and whether the examination was satisfactory when available. In addition, personal characteristics of women were obtained, including density, parity, contraceptive use, and date of last menstrual cycle.
The cervical canal is the space connecting the uterine cavity and vagina. It is through this passage that active sperm move to fertilize a mature egg. For example, inflammation can occur not only in the cavity, but also in the cervical canal itself. Sexually transmitted infections are diagnosed quite often.
The peer review review received approval for research in the field. human objects from the Collaborative Health Research Ethics Review of the University of Calgary and the Calgary Health Region and was considered excluded from the review by the National Cancer Institute, National Institutes of Health.
If more than one specimen was taken for an exam and analyzed, we considered the worst histopathology as the final diagnosis for that specimen type. If a sample was read more than once, we considered the final reading as the final diagnosis for that sample.
During the examination, the gynecologist can only see the presence of incomprehensible mucus, then a smear is taken and sent for analysis. If the true cause cannot be determined, curettage of the cervical canal is prescribed.
Many are interested in why it is diagnostic, but everything is simple: after collecting highly informative material, it is sent for histology to accurately establish the diagnosis or confirm it.
Each woman contributed an average of 2 exams to the data set, and women who contributed one exam did not differ from those who contributed more than one with respect to age, parity, or oral contraceptive use. Cytopathology records for specimens processed at Calgary Laboratory Services two years prior to the date of histopathology specimen reading were obtained. A colposcopy visit was considered a referral visit if the cytopathology result was within 270 days of the examination and the result was unsatisfactory or abnormal.
During the cleaning process, only the top layer of the endometrial mucosa is collected, so the lining of the uterine cavity is easily restored.
The main goal of separate diagnostic curettage is to make sure that the collected material does not degenerate into cancer cells.
An important stage of this procedure is the examination of the endometrial mucosa, since the results can reveal the following abnormalities:
Findings were stratified by woman's age at examination, parity, contraceptive method, reference cytology, and colposcopy when available. Because satisfactory visualization of the transformation zone is closely related to menopausal status, we impute this variable depending on their age and date of last menstrual period. Logistic regression and contingency analysis using chi-square statistics were used to assess the influence of potential factors.
Based on the results obtained and if indicated, the gynecologist develops an individual course of treatment for the patient. Separate curettage is not only diagnostic procedure, but also therapeutic, during which the immediate focus of inflammation in the uterine cavity is removed.
Proof of financial support: Dr. The authors thank Calgary Laboratory Services for making data extraction possible from their information. As a service to our clients, we are providing this early version of the manuscript. The manuscript will undergo copying, typesetting, and review of the resulting evidence prior to publication in its final form. Please note that errors may be discovered during the production process that may affect the content and all legal disclaimers that apply to the magazine.
Of course, a procedure such as curettage has its own indications and contraindications. Also, before the procedure, the gynecologist must prescribe a number of laboratory and medical tests to make sure that there are no contraindications, for example, infections, inflammations and concomitant gynecological diseases.
Endocervical curettage during colposcopic evaluation of the cervix. Endocervical curettage has no place in the routine treatment of women with cervical intraepithelial neoplasia: a debate. Clinical significance endocervical curettage as part of a colposcopic evaluation.
Endocervical curettage in the evaluation of abnormal cervical cytology. Endocervical curettage: a method in search of guidance?: debate. There are two superficially similar operations: evacuation of an incomplete or septic abortion, which usually does not require cervical dilatation and which is described in section A, dilatation and curettage of the uterus, which are described here. Ideally, all curettes should be sent for histology. Unfortunately, this is unlikely to be possible, so you will probably only have to send the most urgent ones.
Separate curettage is indicated for the following deviations:
Contraindications include acute inflammatory and infectious diseases of women reproductive organs. Such contraindications are considered absolute.
If the patient is under 40, sending her curettes for histology is less relevant unless they appear abnormal macroscopically or you suspect choriocarcinoma. The main risks are: Perforation of the uterus, possibly subsequent bleeding or sepsis. Damage to the descending cervix. Most of the complications we list are very rare. Uterine perforation is less likely if you use your finger as a guide and is more resilient to it. After Bonnie's Gynecological Surgery.
Use dilatation followed by curettage: investigate abnormal bleeding. It may reveal: endometrial carcinoma, endocervical adenocarcinoma, choriocarcinoma, "chronic endometritis", tuberculous endometritis, chronic anovulation or submucosal fibroids. So always do this during the premenstrual stage. Submit curettes for histology and make sure you tell the pathologist that this is what you want to know, or he may simply report them as “normal.” He will usually make a diagnosis of tuberculosis histologically, but consider sending a separate specimen in a sterile bottle for tuberculosis culture if you think this is the cause and are working in an area of high incidence.
In fact, whether there will be complications or not depends on the experience and accuracy of the operation by the surgeon. Therefore, if the specialist is experienced and did everything correctly, complications should not arise.
Complications after RDV:
It is imperative to prepare for diagnostic curettage. The first thing you need to do is pass all the prescribed medical and laboratory tests.
If your pathology services are under pressure, you won't be able to do this very often. The infection will immobilize her uterus, moving it with dilators could cause her to vomit, spread pus, and cause fatal peritonitis. You can do it like outpatient treatment using only a paracervical block. catheter, catheter, Auward's sims and vaginal specula, uterine sound, 2 ulchellas, a pair of narrow egg forceps, sharp curettes of different sizes and a set of uterine dilators from Hegar.
Arrange them in size order on the cart. Empty your bladder if necessary. As you dilate your cervix, you will need a mental picture of the shape, length, and direction of your uterine cavity. Get this picture: Examine her binarily to get a feel for the size, position and mobility of her uterus. Pay attention, especially if her uterus has been inverted, because this increases the likelihood of perforating it with a misdirected dilator. Measure the depth of her uterus with sound unless you suspect an abortion.
Preparatory activities:
To minimize the risk during manipulation, curettage is carried out before menstruation, a couple of days. For such diagnostic operation Anesthesia is used because the process of dilation of the cervix is quite unpleasant and painful.
Start with her buttocks at the edge of the table. Grab the front lip of your cervix with one or even two valshells and pull it down. This will result in a sharply pointed or inverted uterus in an axial position and will reduce the risk of perforation. If it is soft, as after childbirth or abortion, use sponge tweezers. With the image of her uterine cavity in your mind, dilate her cervix, starting with the smallest dilator. As you do this, place your finger next to it to act as a "brake" if you suddenly enter her cervix.
During the operation, the patient sleeps deeply. Curettage is performed on a gynecological chair using a medical instrument - a curette. With its help, the operating surgeon carefully removes the top layer from the mucous membrane of the cervical canal and uterus. The sampling information material is collected in a test tube and sent for histology. The procedure lasts about 40 minutes, after which the patient is placed in a room where she is under control medical personnel several hours.
Insert the expander in the direction that minimizes its resistance as much as possible. for at least half a minute, insert the next size without delay and without waiting for her cervix to contract again. Thin a large uterus more than a small one. If your goal is only to take a biopsy, use a thin curette and don. Expanding beyond the Hagar size, a size 8 can ruin the cervix. All this makes it soft, doughy and easily perforated. If you suspect cancer, make sure you dilate her cervix enough so that you can adequately examine her uterus.
A week before the proposed operation, it is necessary to abstain from intimacy and douching. On the day of surgery you should not eat or drink. Immediately before the operation, the woman performs toileting of the genitals.
How does the Russian Far East go:
Only the upper mucous layer of the endometrium is taken, the basal layer is not affected and does not suffer.
Do not allow the retractor or probe to fall into the false passage. Never use a shower. Perform full or partial curettage according to these indications. If all you need is some endometrium to tell if she's ovulated, do a partial curettage. Examine her uterus with long, careful strokes to obtain long, thin strips of endometrium for histology. If you are treating for an incomplete abortion or to diagnose intermenstrual bleeding or other forms of abnormal bleeding, and trying not to miss body carcinoma, do a complete curettage.
Content
Curettage (curettage, cleaning) of the cervical canal is a fairly widely practiced gynecological operation. The procedure is carried out if necessary differential diagnosis or confirming the diagnosis in the presence of certain symptoms.
Start scraping her bottom and scrape towards all the front, back and sides of her uterine cavity. Continue until you feel a scratch. When it is on the axis of her fallopian canal, it will likely pass. If bimanual examination shows that it is fixed, consider foregoing surgery. If you rupture the adhesions holding her uterus together, it may bleed into her pouch of Douglas or into her peritoneum. You may then need to open up her abdomen and secure the bleeding vessels.
If the stretcher is tight when you remove it, insert it and leave it in a little longer before inserting the next larger size. Zero and senile hearing aids often tough. You can usually do adequate curettage with a small, sharp curette as her cervical canal dilates to Hegar 6. If you don't know what you're doing, you may only be healing her cervical canal, not the body of her uterus. Go back to smaller expanders and start again. You've likely ruptured her cervix and increased the risk of bleeding and sepsis.
The cervical canal (Cervix) is the isthmus that connects the uterine cavity and the vagina. It is thanks to this organ that the cavity reproductive organ protected from infections, and through it male reproductive cells penetrate into the uterus.
Since the cervical canal opens directly into the vagina, the infection initially develops in the latter. And only then does it rise higher. A gynecologist may suspect infection during an examination. As a rule, the reason for prescribing curettage is the presence of mucus of uncharacteristic consistency or color in the cervical canal. A woman notes uncharacteristic discharge from the genital tract.
Smear cytology in some cases cannot provide a complete clinical picture. The curettage procedure helps to obtain the most useful information about the current state of the cervical canal.
The technique makes it possible to identify the disease at the very beginning of its formation, which greatly simplifies the treatment of the detected pathology.
During curettage, only the upper layer of the mucous membrane of the cervical canal is removed, which is then completely restored.
In gynecology, three types of cervical canal curettage are used.
All three types of curettage can be practiced not only for diagnostic, but also for therapeutic purposes. They are carried out only in a hospital setting.
Curettage of the cervical canal is performed in the following cases.
For diagnostic purposes, the technique is practiced in the following cases:
Carrying out diagnostic curettage of the cervical canal requires special preparation. The woman is prescribed the following tests:
To eliminate the risk of developing uterine bleeding, curettage is performed two to three days before the start of menstruation.
Such timing of the procedure is as close as possible to the natural process of mucosal rejection.
The procedure for curettage of the cervical canal is quite painful and therefore requires anesthesia. Typically, the patient receives intravenous anesthesia and sleeps throughout the procedure.
Curettage of the cervical canal is carried out on a gynecological chair using a curette. All collected material placed in formaldehyde and submitted for histological examination. Total duration cleaning - 20-40 minutes. Then the woman is woken up and transferred to the ward.
Scraping stages:
During curettage, only the top layer of the cervical canal mucosa is removed.
Preparation also includes the following points:
Doctors call the main complications after curettage of the cervical canal:
The development of complications depends on the experience of the gynecologist performing the procedure.
The woman will bleed quite heavily for several hours after the cleansing. This is normal, since in this way the uterus is freed from the remnants of the damaged endometrium. Then the discharge becomes more scanty and continues for 7 to 14 days.
If after curettage of the cervical canal no blood discharge is observed, then this sign indicates a hematometra.
This must be reported to the gynecologist immediately. Otherwise, there is a high risk of developing more serious complications.
In the next two weeks it is necessary to avoid certain situations and procedures:
A woman needs urgent medical attention if the following symptoms appear:
In the absence of pathological symptoms indicating the development of complications, a visit to the gynecologist is scheduled for 10-14 days after curettage. A woman may be recommended to undergo a transvaginal ultrasound to assess the current condition of the uterus.
Treatment is prescribed after receiving histology results.
A woman's body is enough fine system. And the main specialist who should take care of women's health is a gynecologist. It is no secret that for a woman, consulting a good gynecologist at least twice a year is not the whim of a capricious doctor, but the law of preserving health.
However, during a routine examination by a gynecologist, many women are faced with the need to prescribe a procedure such as separate diagnostic curettage of the cervical canal. In other words, women must go through a “purging.” Often, doctors, perhaps due to their busyness, do not consider it necessary to tell the woman in detail about the procedure itself and the need for it, hence the unreasonable worries and fears for the condition of their women's health. In our article we will try to be as detailed and as possible in simple words explain the essence of this method.
As you know, in the female body the uterine cavity and the cervical canal are lined with a special mucous tissue - the endometrium. During the menstrual cycle, the mucous membrane undergoes some changes. During the release of a mature egg from the ovary, the endometrium softens, which should facilitate the attachment of a fertilized egg. In this way, the onset of pregnancy can be roughly described. If the egg does not attach to the wall of the uterus, the endometrium is rejected, and the growth process is repeated every month. The curettage procedure is a surgical intervention to remove only the superficial layer of the endometrium, which itself is regularly rejected if pregnancy does not occur. After the procedure, the process of growth of the surface layer of the endometrium resumes. This applies to the uterine cavity, but the cervical canal can also be subjected to curettage for diagnostic purposes.
What is the cervical canal? The cervical canal is a certain part of the uterus that connects the uterine cavity and the vagina. Typically, the width of the cervical canal is 8–9 millimeters and the length is 1–2 centimeters. Moreover, the cervical canal on one side connects to the vagina, and on the other side it opens the uterine cavity. During sexual intercourse, it is through the cervical canal that sperm enter the uterus.
To prepare for carrying out the Russian Far East, the patient walks a series laboratory research. She takes a blood test for venereal diseases(syphilis), HIV, hepatitis. Preparation for the RDV involves a study of the heart, the results of which are shown by a cardiogram, a smear test for flora and a transvaginal ultrasound.
RDV is carried out two or three days before the start of the menstrual cycle, curettage is also carried out during bleeding. Bleeding is accompanied by natural rejection of the mucous membrane; this natural process allows you to avoid prolonged bleeding during the recovery period after surgery.
Before starting the RDV procedure, the patient’s vulva and cervix are treated. The area in which the operation will be performed is pre-treated with a solution of iodine or alcohol.
Separate diagnostic curettage of the cervical canal may be necessary in the following cases:
If there are neoplasms of a malignant or benign nature in the cervix;If it is necessary to undergo surgery to remove a tumor on the uterus;
If available pathological changes cervix;
If there is a problem with conception;
If there is an inflammatory process of the mucous membrane of the canal.
By the way, inflammation of the mucous membrane of the cervical canal is called endocervitis.
Inflammatory processes in the cervix can be caused for various reasons. The most common are: 1. Inflammations of infectious origin. These include:
Streptococcal infection;Gonococcal infection;
Chlamydia;
Trichomoniasis;
Candidiasis;
Escherichia coli;
Staphylococcal infection;
Ureaplasmosis;
Papillomas;
Herpes.
2. Inflammation of non-infectious origin. Among them:
Cervical injury;Radiation exposure;
Cervical erosions;
Neoplasms on the mucous membrane of the cervix;
Prolapse of the cervix.
It should be noted here that for the most part, the cause of inflammatory processes in the cervical canal is inflammatory processes in the vagina, which then spread to the cervical canal.
Separate diagnostic curettage of the cervical canal is a special type of biopsy. It is widely used to find out the true cause of the disease, to identify accurate diagnosis for diseases of unknown etymology, in the presence of obvious gynecological pathologies. The procedure is carried out under hysteroscopy control. This allows you to increase the accuracy of diagnosis significantly. This sharply reduces the possibility of various postoperative complications. When performing separate diagnostic curettage of the cervical canal, the mucous membrane is exposed to instrumental influences. At the same time there is real opportunity discover:
Polyps of the cervical canal;Endometriosis;
Adenomyosis;
Endometrial hyperplasia;
Dysplasia of the cervical canal;
Cervical cancer.
Separate diagnostic curettage of the cervical canal is performed under general or local anesthesia, since it should be noted that the procedure is far from pleasant. With the help special tool– curettes, scrape the cervical canal and tissue samples, in mandatory sent for histological analysis. A few hours after the operation, the woman calmly goes home. Just remember that in a week you need to visit a gynecologist, conduct another examination and get the results of histology tests. In conclusion, I would like to say, dear women, take care of yourselves!
Surgical manipulation, the essence of which is curettage (or scraping) of the functional layer of the uterine mucosa.
Curettage of the uterine cavity is a surgical procedure, the essence of which is to scrape off (or scrape off) the functional layer of the uterine mucosa. The term is also used RDV (“separate diagnostic curettage”)- it is called separate because it is carried out in stages - first, the cervical canal is scraped, and then (a separate manipulation) - the uterus itself; It is called diagnostic because the resulting scraping will be sent for histological examination to establish an accurate diagnosis.
During the curettage process, only the top layer of the endometrium is removed, so the uterine mucosa is subsequently restored.
The scraped material is sent for histological examination. This eliminates the possibility that the disease is malignant. This is the main purpose of curettage performed for diagnostic purposes.
Absolute contraindications to scraping are sharp infectious diseases and inflammatory processes of the genital organs.
With careful and the right approach specialist for this manipulation, complications can be avoided. However, you need to know about possible complications curettage:
In 2 weeks Before curettage: stop taking any medications and food additives(including additives for plant based), the reception of which was not agreed in advance with the doctor who will perform the curettage. Some medications can change blood clotting and increase the risk of bleeding. If you are taking medications for a serious illness (for example, hypertension, arrhythmia, epilepsy), do not stop treatment, but be sure to tell your doctor about the medications you are taking.
In 2-3 days before scraping:
Diagnostic curettage is performed before menstruation, a few days before its onset.
The operation takes place under intravenous anesthesia- This is a type of general anesthesia. Its duration is on average 15-25 minutes.
Curettage of the uterine cavity and cervical canal in our clinic is carried out in our own operating room, equipped in strict accordance with current sanitary and hygienic standards. During the operation, anesthetic equipment with constant monitoring of the patient's condition, disposable materials, surgical equipment and instruments from leading manufacturers of medical equipment are used.
The patient is placed in a gynecological chair and the anesthesiologist performs intravenous anesthesia.
The doctor inserts a speculum into the vagina to expose the cervix. Using special forceps (“bullet pins” there is a tooth at the ends of this instrument) it catches the cervix and fixes it. Using a special probe (iron rod), the doctor enters the cervical canal and penetrates the uterine cavity, measuring the length of the cavity.
Curettage is performed with the smallest curette. A curette is an instrument similar to a spoon with a long handle, one edge of which is sharpened. A sharp edge is used to scrape. The scraping obtained from the cervical canal is placed in a separate jar. If curettage is accompanied by hysteroscopy, then after dilation of the cervical canal, a hysteroscope (a thin tube with a camera at the end) is inserted into the uterine cavity. The uterine cavity and all walls are examined. After this, the lining of the uterus is scraped. If a woman had polyps, they are removed with a curette during curettage. After the curettage is completed, the hysteroscope is reinserted and the result is checked. If something remains, reinsert the curette and scrape it out until the result is achieved.
At the end of the diagnostic curettage procedure, the patient is transferred to a comfortable day hospital ward, where she remains under the supervision of an anesthesiologist and nursing staff until she fully awakens from anesthesia. After the anesthesia wears off, the patient can be discharged from the clinic.
Within a few hours after curettage, heavy bleeding and bloody clots from the vagina may appear. This is normal.
After a few hours, the discharge becomes less abundant. Scanty bloody, spotting, brown or yellowish discharge after curettage they can persist for another 10 days. The rapid disappearance of discharge after curettage may be a sign of cervical spasm and accumulation of blood clots in the uterus. In this case, you must immediately consult a doctor.
Within 2 weeks after curettage it is forbidden:
After visiting a gynecologist, many patients are prescribed an operation to curettage the uterine cavity. Some women also call this operation a cleansing. Worry about similar operation It’s not worth it, because it’s not as scary as it seems, and now you’ll see for yourself.
Let's figure out what curettage of the walls of the uterus is and why it is used in gynecology?
The uterus is a muscular organ; doctors call it the pyriform body, since the shape of the uterus is very similar to a pear. Inside the piriform body there is a mucous membrane, the so-called endometrium. It is in this environment that the child grows and develops during pregnancy.
Throughout the entire menstrual cycle, the membrane of the piriform body grows, accompanied by various physical changes. When the cycle comes to an end and pregnancy does not occur, all the mucous membranes leave the body in the form of menstruation.
When performing a curettage operation, doctors remove exactly that layer of mucous membrane that has grown during the menstrual cycle, that is, only the surface layer. The uterine cavity, as well as its walls, are scraped out using instruments along with the pathology. This procedure is needed as in medicinal purposes, and for the purpose of diagnosing such pathologies. Curettage of the walls is carried out under the supervision of hysteroscopy. After the operation, the scraped layer will grow again in one menstrual cycle. In fact, this entire operation is reminiscent of menstruation, performed under the supervision of a doctor and with the help of surgical instruments. During the operation, the cervix is also scraped out. Treated samples from the cervix are sent for analysis separately from scrapings from the piriform body cavity.
Simple curettage of the uterine mucosa is carried out blindly. When using a hysteroscope, the attending physician examines the cavity of the piriform body using a special device, which he inserts through the cervix before starting the operation. This method safer and better quality. It allows you to identify pathologies in the uterine cavity and carry out curettage without any risks to the woman’s health. After the operation is completed, you can check your work using a hysteroscope. The hysteroscope allows you to evaluate the quality of the operation and the absence or presence of any pathologies.
Carrying out this type of operation has several goals. The first goal is to diagnose the uterine mucosa, the second is to treat pathologies inside the uterus.
During diagnostic curettage, the doctor obtains a scraping of the uterine cavity mucosa for further study and identification of pathology. Therapeutic curettage of the uterine cavity is used for polyps (growths of the uterine mucosa), since there are no other methods of treating this pathology. Also, curettage can be used as post-abortion therapy, as well as for abnormal thickening of the uterine cavity mucosa. Curettage is also used for uterine bleeding, when the nature of the bleeding cannot be determined, and curettage can stop it.
With planned curettage, the operation is performed before the onset of menstruation. Before the operation begins, the patient must undergo some tests. First of all, this is a general blood test, cardiogram, test for the presence/absence of HIV infection, test for various types hepatitis, as well as a blood clotting test. The patient must undergo complete depilation of pubic hair and also purchase sanitary pads. It is recommended not to eat before surgery. You should also bring a clean T-shirt, hospital gown, warm socks and slippers.
Typically, the operation of curettage of the uterine cavity is not very complicated and is carried out within 20 – 25 minutes. There should be no complications after the operation. In the postoperative period, the attending physician may prescribe a short course of antibiotics. This course should be taken to avoid any complications.
Histology results will be ready within 10 days. If you experience abdominal pain during the postoperative period, you should contact your doctor.
I would like to note that the operation of curettage of the uterine cavity is the safest and most painless operation in the field of gynecology.
Many women are prescribed separate diagnostic curettage of the uterine cavity and cervical canal at least once in their lives. This is one of the most traumatic, but indispensable procedures for diagnosing dangerous, including oncological diseases, as well as a method of non-surgical treatment - removal of polyps, hyperplastic endometrium, .
Good specialist, especially those who have secured a hysteroscope, will carry out all manipulations as carefully as possible, without consequences for health. And he will calculate on which day of the cycle it is better to carry out the RDV. Typically, elective surgeries are scheduled as close as possible to the expected day of the start of a new menstrual cycle. That is, with a 28-day cycle, on day 26-27. So as not to break the cycle.
Diagnostic dilatation (widening of the cervical canal) and curettage (cleaning of the uterus) were originally intended to identify intrauterine pathology of the endometrium and help with abnormal uterine bleeding. Now new methods have emerged for assessing the uterine cavity and diagnosing endometrial pathologies. For example, pipel or aspiration biopsy. But dilatation and curettage still play an important role in medical centers where advanced technology and equipment are not available, or when others diagnostic methods do not give results.
Traditionally, cervical dilatation and curettage of the walls of the uterine cavity are performed blindly. Diagnosis can be done under ultrasound guidance or in combination with hysteroscope imaging.
Gynecological intervention is performed in a hospital setting to ensure complete sterility, in the operating room. Woman empties bladder. Afterwards, in his room he undresses, takes off his underwear (usually they are allowed to leave only a nightgown). Upon entering the operating room, a non-woven cap is put on her head, a non-woven shirt on her body, and non-woven shoe covers on her feet.
He lies down on something like a gynecological chair, but improved. An IV is placed on one arm through which drugs will be administered to provide anesthesia. And on the other - a sensor for measuring blood pressure and pulse. The latter is optional.
By right hand the anesthesiologist gets up and usually begins to “talk her teeth.” This is done in order to relieve anxiety. At this time, the gynecologist who will do the curettage carries out gynecological examination to clarify the size of the uterus and its location (inclination relative to the cervix). This is the most unpleasant moment, but not painful.
There is no need to be afraid, the insertion of gynecological instruments into the vagina, dilation of the cervix, which is really very painful, and so on will be carried out after the woman “falls asleep”.
After everyone is gathered in the operating room and ready, the drug is delivered through an IV into the patient’s vein. And within a few seconds she falls asleep. This is usually preceded by a feeling of warmth in the throat.
Afterwards, the doctor installs a gynecological speculum (dilator) in the vagina, uses a probe to measure the length of the uterus and begins to dilate the cervix. Alternately, he inserts Hegar dilators into it, each time with a larger diameter. In this way, the process is gradual. The cervical canal is scraped out with a curette, and the material is taken for histological examination.
Further, if this is not a simple curettage, but a hysteroscopy, liquid is injected into the uterus so that its walls can be examined. Then the hysteroscope is inserted. The doctor can use it to notice foci of adenomyosis ( internal endometriosis), by the way, a very common cause of infertility is polyps, fibroids growing into the uterine cavity (submucosal) and cancerous tumors.
Many tumors can be removed immediately. This is called hysteroresectoscopy. And all without an incision, through vaginal access! Even 4-centimeter fibroids can be removed with a hysteroresectoscope.
Thus, RDV turns into LDV, that is, the procedure is not just diagnostic, but therapeutic and diagnostic.
If not hysteroscopy is performed, but exclusively RDV, fluid and the hysteroscope are not introduced into the uterus. And its walls are immediately scraped out with a curette. The scraping is sent for histological examination. It usually takes 7-10 days.
The entire procedure usually takes no more than 20 minutes. Afterwards, the IV is removed, and the patient immediately or almost immediately begins to wake up. Next, she is usually left for a short time on a gurney near the intensive care unit, and then transported to the ward.
Place absorbent diapers under her, as there will be bleeding.
Within 3-4 hours after anesthesia, dizziness, abdominal pain (you can ask the nurse to inject a painkiller), and nausea are felt.
When all this stops, you are allowed to get up.
A mini-operation, also called abrasion of the uterine cavity, is performed to evaluate the endometrium and take material for histological examination. A separate diagnostic curettage also includes evaluating the endocervix (the lining of the cervix) and taking a biopsy material from the ectocervix (the lower part of the cervix that protrudes into the vagina) and (the place where the cancer is usually located).
Indications for fractional curettage in gynecology are as follows.
RDV is often performed simultaneously with other gynecological procedures (for example, hysteroscopy, laparoscopy).
Assessment of the uterine cavity during dilatation and curettage, if the doctor uses a hysteroscope, is much more accurate than with ultrasound. Often ultrasound examination doesn't give full picture endometrial conditions due to shading from leiomyoma, pelvis, intestinal loops.
Dilation and curettage can also be a treatment procedure. Therapeutic and diagnostic curettage of the uterus is performed for:
Absolute contraindications to separate diagnostic curettage (including under the control of hysteroscopy and ultrasound) include:
Relative contraindications are as follows:
These contraindications can be overcome in some cases. For example, magnetic resonance imaging determines the anatomy of the cervix or its body with certain structural features, thereby ensuring a safe examination of the endocervix and endometrium.
Complications may arise during the work of doctors. Possible complications include the following:
Complications, in particular uterine perforation, are more common in patients after childbirth, with gestational trophoblastic disease, altered genital anatomy, cervical canal stenosis, or existing acute infection at the time of the operation.
Rupture mainly occurs during dilatation - widening of the neck. Doctors have tools in their arsenal that minimize this complication. In addition, the use of prostaglandin preparations or kelp as preparation for the opening of the uterus significantly improves the picture.
Perforation is one of the most common complications of dilation and curettage. The risks are especially great during pregnancy (abortion), after childbirth (removal placental polyp), with malformations of the uterus. Perforation of the uterus is rare during menopause.
If the perforation occurred with a blunt instrument, medical observation of the victim's condition is required for several hours, and that's all that is needed. If perforation is suspected with a sharp instrument, such as a curette, laparoscopic surgery is required. Possibly suturing the wound. In case of severe bleeding, a laparotomy (surgery with an incision) is performed.
Infections associated with diagnostic dilation and curettage are rare. Problems are possible when cervicitis (inflammation of the cervix) is present during the procedure. The study recorded a 5% frequency of bacteremia after curettage of the uterine cavity and isolated cases of sepsis - blood poisoning. before the Russian Far East is usually not carried out.
Curettage of the uterine cavity after childbirth or abortion can lead to injury to the endometrium and subsequent formation of intrauterine adhesions. This is called Asherman's syndrome.
Intrauterine synechia complicates future intrauterine interventions, including diagnostic curettage, and increases the risk of perforation.
Intrauterine synechiae is one of the causes of scanty and irregular menstruation and infertility.
To avoid complications, since most often curettage is performed under general anesthesia(intravenous sedation), patients are asked not to eat anything 8 hours before the procedure. And do not drink 2-4 hours before it. This is necessary, since after the administration of drugs vomiting may occur, and vomit if it enters the respiratory tract cause their blockage and even death from asphyxia.
In very rare cases, during anesthesia it happens anaphylactic shock- a deadly condition.
If large doses of drugs were administered, a few weeks after curettage, hair may fall out more severely and your head may hurt.
If there are indications for diagnostic or medical procedure, the doctor draws up an anamnesis based on your words, conducts a gynecological examination and writes out a referral. But before coming to the hospital, you must undergo the following examinations and tests:
On the appointed day, the woman appears at the gynecological department, emergency room (Russian realities are described) with a referral from the doctor, the results of all tests, an ultrasound scan, a passport and an insurance policy. Be sure to take with you absorbent diapers, sanitary pads, a mug, a spoon, a plate, a bottle of water (you can drink it after coming out of anesthesia if you feel well), a robe, a nightie, and slippers.
The gynecologist who will do the cleaning and the anesthesiologist talk with the woman. They find out what chronic, acute diseases she has, what medications she uses or has taken in the recent past, whether she is allergic to anything, whether she smokes, whether she often takes alcohol, drugs, whether she has had concussions, etc. All this necessary to decide which anesthesia to use (sometimes a decision is made local anesthesia) And possible contraindications to currently perform the procedure.
If you had unusual vaginal discharge 1-2 days before, you suspect, for example, thrush, then warn your doctor about it.
After the conversation, papers are signed regarding consent to the operation and anesthesia. In some cases, the patient is immediately called to the nurse to receive a prophylactic antibiotic injection.
Important!
Before going to the operating room, for your own convenience, put panties, a pair of pads, mobile phone(be sure to charge it in advance), since you will be lying down for the first 1-2 hours after anesthesia. Place an absorbent diaper on the bed.
You should immediately consult a doctor if:
Delayed menstruation also requires attention. If critical days no, 5 weeks after curettage, this may indicate complications- formation of intrauterine synechiae, hormonal imbalance or pregnancy. a woman can immediately after cleaning. More precisely, in 2 weeks, when she will ovulate and possibly conceive.
In the video, a gynecologist talks about the features of uterine curettage.
