Dial Tat Ion And Curettage
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DIALTATION AND CURETTAGE DONE BY DR.P.UMA DEVI
Definition.. Dilatation and curettage (D & C) is a gynecological procedure in which the lining of the uterus (endometrium) is scraped away.
Purpose.. D & C is commonly used to obtain tissue for microscopic evaluation to rule out cancer. D & C may also be used to diagnose and treat heavy menstrual bleeding, and to diagnose endometrial polyps and uterine fibroids. A D & C can be used as a treatment as well, to remove pregnancy tissue after a miscarriage, incomplete abortion, or childbirth. D & C can also be used as an early abortion technique up to 16 weeks. Removal of the uterine lining causes no side effects, and may be beneficial if the lining has thickened so much that it causes heavy periods.
Procedure Prerequisites.. Provide emotional support and encouragement and give pethidine IM or IV before the procedure. If necessary, use a paracervical block. Administer oxytocin 10 units IM or ergometrine 0.2 mg IM before the procedure to make the myometrium firmer and reduce the risk of perforation. Perform a bimanual pelvic examination to assess the size and position of the uterus and the condition of the fornices. Apply antiseptic solution to the vagina and cervix (especially the os).
Procedure.. Check the cervix for tears or protruding products of conception. If products of conception are present in the vagina or cervix, remove them using ring (or sponge) forceps. Gently grasp the anterior lip of the cervix with a vulsellum or single-toothed tenaculum. Note: With incomplete abortion, a ring (sponge) forceps is preferable as it is less likely than the tenaculum to tear the cervix with traction and does not require the use of lignocaine for placement.
:
If using a tenaculum to grasp the cervix, first inject 1 mL of 0.5% lignocaine solution into the anterior or posterior lip of the cervix which has been exposed by the speculum (the 10 o’clock or 12 o’clock position is usually used).
In case of pregnancy,dilatation is needed only in cases of missed abortion or when some retained products of conception have remained in the uterus for several days: - Gently introduce the widest gauge cannula or curette; - Use graduated dilators only if the cannula or curette will not pass. Begin with the smallest dilator and end with the largest dilator that ensures adequate dilatation (usually 10–12 mm) - Take care not to tear the cervix or to create a false opening.
Gently pass a uterine sound through the cervix to assess the length and direction of the uterus. The uterus is very soft in pregnancy and can be easily injured during this procedure. Evacuate the contents of the uterus with ring forceps or a large curette. Gently curette the walls of the uterus until a grating sensation is felt.
Inserting a retractor and holding the anterior lip of the cervix
Dilating the cervix and curetting the uterus..
Perform a bimanual pelvic examination to check the size and firmness of the uterus. Examine the evacuated material. Send material for histopathological examination, if required.
Post procedure care.. Give paracetamol 500 mg by mouth as needed. Encourage the woman to eat, drink and walk about as she wishes. Offer other health services, if possible, including tetanus prophylaxis, counselling or a family planning method. Discharge uncomplicated cases in 1–2 hours.
Advise the woman to watch for symptoms and signs requiring immediate attention: - prolonged cramping (more than a few days); - prolonged bleeding (more than 2 weeks); - bleeding more than normal menstrual bleeding; - severe or increased pain; - fever, chills or malaise; - fainting.
Risks.. The primary risk after the procedure is infection. Signs of infection include: fever heavy bleeding severe cramps foul-smelling vaginal discharge
A woman should report any of these symptoms to her doctor, who can treat the infection with antibiotics before it becomes serious. D & C is a surgical operation, which carries certain risks associated with general anesthesia. Rare complications include puncture of the uterus (which usually heals on its own) or puncture of the bowel or bladder (which require further surgery to repair).
References.. Shaw’s Textbook of gynaecology Dutta Textbook of gynaecology www.google.com –search notes on D&C
Definition.. Dilatation and curettage (D & C) is a gynecological procedure in which the lining of the uterus (endometrium) is scraped away.
Purpose.. D & C is commonly used to obtain tissue for microscopic evaluation to rule out cancer. D & C may also be used to diagnose and treat heavy menstrual bleeding, and to diagnose endometrial polyps and uterine fibroids. A D & C can be used as a treatment as well, to remove pregnancy tissue after a miscarriage, incomplete abortion, or childbirth. D & C can also be used as an early abortion technique up to 16 weeks. Removal of the uterine lining causes no side effects, and may be beneficial if the lining has thickened so much that it causes heavy periods.
Procedure Prerequisites.. Provide emotional support and encouragement and give pethidine IM or IV before the procedure. If necessary, use a paracervical block. Administer oxytocin 10 units IM or ergometrine 0.2 mg IM before the procedure to make the myometrium firmer and reduce the risk of perforation. Perform a bimanual pelvic examination to assess the size and position of the uterus and the condition of the fornices. Apply antiseptic solution to the vagina and cervix (especially the os).
Procedure.. Check the cervix for tears or protruding products of conception. If products of conception are present in the vagina or cervix, remove them using ring (or sponge) forceps. Gently grasp the anterior lip of the cervix with a vulsellum or single-toothed tenaculum. Note: With incomplete abortion, a ring (sponge) forceps is preferable as it is less likely than the tenaculum to tear the cervix with traction and does not require the use of lignocaine for placement.
:
If using a tenaculum to grasp the cervix, first inject 1 mL of 0.5% lignocaine solution into the anterior or posterior lip of the cervix which has been exposed by the speculum (the 10 o’clock or 12 o’clock position is usually used).
In case of pregnancy,dilatation is needed only in cases of missed abortion or when some retained products of conception have remained in the uterus for several days: - Gently introduce the widest gauge cannula or curette; - Use graduated dilators only if the cannula or curette will not pass. Begin with the smallest dilator and end with the largest dilator that ensures adequate dilatation (usually 10–12 mm) - Take care not to tear the cervix or to create a false opening.
Gently pass a uterine sound through the cervix to assess the length and direction of the uterus. The uterus is very soft in pregnancy and can be easily injured during this procedure. Evacuate the contents of the uterus with ring forceps or a large curette. Gently curette the walls of the uterus until a grating sensation is felt.
Inserting a retractor and holding the anterior lip of the cervix
Dilating the cervix and curetting the uterus..
Perform a bimanual pelvic examination to check the size and firmness of the uterus. Examine the evacuated material. Send material for histopathological examination, if required.
Post procedure care.. Give paracetamol 500 mg by mouth as needed. Encourage the woman to eat, drink and walk about as she wishes. Offer other health services, if possible, including tetanus prophylaxis, counselling or a family planning method. Discharge uncomplicated cases in 1–2 hours.
Advise the woman to watch for symptoms and signs requiring immediate attention: - prolonged cramping (more than a few days); - prolonged bleeding (more than 2 weeks); - bleeding more than normal menstrual bleeding; - severe or increased pain; - fever, chills or malaise; - fainting.
Risks.. The primary risk after the procedure is infection. Signs of infection include: fever heavy bleeding severe cramps foul-smelling vaginal discharge
A woman should report any of these symptoms to her doctor, who can treat the infection with antibiotics before it becomes serious. D & C is a surgical operation, which carries certain risks associated with general anesthesia. Rare complications include puncture of the uterus (which usually heals on its own) or puncture of the bowel or bladder (which require further surgery to repair).
References.. Shaw’s Textbook of gynaecology Dutta Textbook of gynaecology www.google.com –search notes on D&C
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