Uterine cavity curettage is the operation most often performed in gynecology. This procedure is also called curettage. With the help of a curette (a special surgical instrument), the mucous layer of the uterus is removed. In this case, only the superficial (functional) layer of the mucosa is removed.
Definition
Uterine cavity curettage is a gynecological procedure in which the doctor removes the top layer of the uterine lining using a vacuum system or a special instrument.
Most often, the procedure requires dilatation of the cervix, which is performed using instruments or drugs.
Today, the procedure is common and is most often performed for the treatment of gynecological diseases or as a diagnosis.
Often, curettage of the uterine cavity is combined with hysteroscopy, which makes it possible to "examine" the inside of the uterus aftercleansing process and, if necessary, perform additional manipulation on unaffected areas.
Types of procedure
There are several basic techniques for performing this cleaning:
- Regular - this procedure consists in removing only the inside of the mucosal cavity. Most often done in medical cases, for example, after an abortion, difficult childbirth or other gynecological ailments. A significant disadvantage is that the procedure is performed blindly and after it some complications are possible, for example, damage to the uterus.
- Separate curettage of the uterine cavity is an important diagnostic and therapeutic procedure that is performed to obtain the necessary samples for histological examination or for treatment. The process is called "separate", since the scraping of the cervix and cervical canal is done in several stages. To perform the procedure, general internal anesthesia is used, due to which the patient must be in the hospital. At the time of the operation, a parting is introduced into the cervical canal and into the cervix separately, which is used for scraping from the mucous membrane to obtain diagnostic material. The purpose of the procedure is to obtain the necessary materials for subsequent research by the laboratory. Separate curettage of the uterine cavity and cervical canal is performed a few days before the onset of the menstrual cycle or during the period of bleeding. During therapeutic implantation, the remnants of the fetal egg or altered areas of the mucosa are removed from the uterine cavityshell.
- There is another type of procedure - this is curettage with simultaneous reduction of hysteroscopy. Using a special optical device (hysteroscope), it is possible to illuminate the uterus from the inside, and the image from its surface is greatly enlarged. This contributes to the fact that the doctor does not act blindly. Thanks to the presented curettage of the uterine cavity, the risk of endometrial particles remaining there is significantly reduced, as well as various complications after the procedure.
Why curettage is performed
Correctage is carried out as a therapeutic and diagnostic procedure, and obstetric curettage can also be placed in a separate category.
These are the circumstances under which therapeutic insertion occurs:
- Uterine bleeding - they can be different in etiology and nature. In this case, the true reason for their appearance may not be completely clear. The procedure is done to stop bleeding.
- Endometritis is a severe inflammation of the lining of the uterus. For a full-fledged therapeutic course of treatment, it is necessary to first perform curettage of the endometrium of the uterine cavity.
- Synechia are uterine cavities spliced together. The presented procedure is carried out to dissect existing adhesions. It is done only using a hysteroscope and other operating instruments.
- Uterine cavity curettage for endometrial hyperplasia is performed in case of excessivethickening of the mucosa. Such a procedure is the only way to both treat and diagnose such a pathological condition. After all the manipulations have been carried out, the patient is prescribed medications that help to consolidate the result.
- Polyps on the mucous membrane. Since it is impossible to overcome such a problem with the help of drugs, curettage is performed.
Diagnostic curettage of the uterine cavity is performed when:
- suspicion of changes in the cervix and uterine mucosa;
- heavy and prolonged periods with clots;
- infertility;
- intermenstrual bleeding of unknown etiology;
- preparing for intervention for uterine fibroids.
Obstetric curettage is done in the following cases:
- for abortion (artificial termination of pregnancy, performed for a period of no more than 12 weeks);
- after a miscarriage, when there is a need to remove the placenta and the remains of the fetal egg;
- with heavy bleeding in the postpartum period, indicating incomplete removal of the placenta;
- during a missed pregnancy, when it is necessary to completely eliminate the dead fetus and clean out the uterus to prevent inflammation.
Contraindications
Therapeutic and diagnostic curettage of the uterine cavity is prohibited in the following cases:
- acute and subacute pathologies of the genitourinary system;
- problems with the kidneys, liver and heart in the acute stage;
- infectious diseases;
- the presence of suspicions of a change in the integrity of the walls of the uterus.
If there are extremely difficult cases, then all these contraindications can be ignored, for example, with very heavy postpartum bleeding.
Preparation
In order to conduct a therapeutic or separate diagnostic curettage of the uterine cavity, it is necessary to perform certain preparations:
- Refuse to eat the night before and on the day of the procedure.
- Take a shower.
- Perform cleansing enema.
- Completely remove the hair layer from the external genitalia.
- At a consultation with an anesthesiologist.
- Perform a general speculum examination at the OB/GYN.
Tests
In order to avoid complications after curettage of the uterine cavity, it is required to pass all tests indicating the state of human he alth:
- Analysis for HIV (human immunodeficiency virus).
- Indicators for hepatitis B and C.
- Tests for RW (syphilis is a chronic venereal disease of an infectious type, which is accompanied by damage to the skin, mucous membranes, internal organs, bones and nervous system).
- Vaginal swab to rule out inflammation.
- Blood test with decoding.
- Coagulogram - to determine the indicator of blood coagulation.
Procedure steps
To perform separate curettage of the uterine cavity and other types of procedures, you must go through the following steps:
- bladder emptying;
- treatment of the vagina and external genitalia;
- detection (using a mirror) of the cervix;
- fastening with bullet forceps (a surgical instrument that looks like a ceramic clip with hooks) of the cervix;
- dilation of the cervical canal;
- curette scraping of the mucous membrane;
- treatment of the uterus with tincture of iodine;
- deleting instruments.
How surgery is performed
After the bladder is completely empty, the patient is placed on the gynecological chair for a two-handed examination of the vagina. It is necessary to establish the size and location of the uterus. Next, the vagina and external genital organs are treated with alcohol and iodine tincture. Then the doctor is engaged in the detection of the cervix using spoon-shaped mirrors. The uterine probe (a thin, smoothly bent metal instrument) helps to determine the length and orientation of the uterine cavity. Often the uterus is in the anteflexio-versio position, that is, in a position that is anatomical norm. In this case, all instruments are introduced into the organ with a concavity forward. When the uterus is in a state of retroflexio uteri, namely when its body in the region of the internal os is bent backwards, then the instruments move concavely backwards, thanks to which it is possible to avoidinjuries.
Sometimes doctors cannot do without metal Heger dilators (metal rods), thanks to which it is possible to enlarge the cervical canal to the size required for the largest curette. The dilators are introduced quite slowly without effort, and only the smallest dilator is inserted initially.
After the cervical canal has been sufficiently enlarged, the surgeon is armed with a curette. It is necessary to introduce such an operating tool very carefully. Each time it should reach the bottom of the uterus. As for the return movements, they should be more vigorous, with the application of force, to capture the mucous membrane.
This process must be done sequentially. Initially, the front is scraped, and then the back and side walls. In conclusion, it is required to carry out procedures in the corners of the uterus. Manipulation is performed until the uterine walls become completely smooth to the touch. Most often, curettage of the uterine cavity during bleeding and other pathologies takes from 15–25 minutes. The specifics of the operation are determined by the nature of the ailments. For example, with submucosal myoma of the uterine cavity there is a bumpy surface, it is for this reason that all procedures are performed carefully enough so as not to damage the capsule of the myomatous node.
During pregnancy, such manipulations are carried out with extreme caution so as not to destroy the neuromuscular apparatus.
At the end of the procedure, the bullet forceps are removed, then the cervix is again treated with iodine and the mirrors are completely removed. The scraping is collected in a prepared container with a 10% solution of farmazalin, and after that the material is sent by the doctors for histological examination. In case of suspicion of the presence of a malignant neoplasm, a scraping is taken from the mucous membrane of the uterine cavity and cervical canal. Each of the analyzes is placed in a separate container.
Recovery
If the planned intervention is successfully completed, the rehabilitation process takes 4-5 weeks. Recommended for the first 14-15 days:
- refuse to use vaginal tampons, suppositories, douching, and other manipulations inside the vagina;
- refrain from sexual intercourse;
- limit work and physical activity in an inclined position of the body;
- avoid temperature extremes (saunas, baths, hypothermia);
- refuse to swim in pools, ponds and baths.
In the first days of discharge after curettage of the uterine cavity in the form of blood clots are quite normal and may not stop for several days. Minimal bleeding can last up to 10 days. In order to prevent the formation of hematomas (accumulation of blood in the uterine cavity) and spasms of the cervix, it is required to use antispasmodic drugs, which are prescribed individually by the doctor.
Monthly after procedure
The first menstruation after such implantation most often comes with a slight delay, after about 4-5 weeks, sometimes much later. Such a delay should not cause concern. Only in the case whenit lasts more than three months, you need to see a doctor.
Safety of procedure
Many women are interested in the possible risks of such a procedure. Often, modern gynecologists try to use a device such as a gyroscope for additional control in their work. Thanks to him, it is possible to monitor the condition of the uterus, as well as to see those areas that have avoided exposure. Such control is incredibly important with a non-standard shape of the uterus. A hygroscope is often used when the uterus has not had time to completely shrink after childbirth.
It should be noted that most patients prefer to undergo the procedure at the gynecologist observing them or at the specialist they know. But this is not always correct, and if the doctor refers to a certain professional, then it is better to listen to his opinion. Consulting specialists are not always able to perform the required manipulations well from a technical point of view. A professional is the best guarantee of safety.
Complications after surgery
These include:
- Development of inflammatory pathologies. Such a problem arises when the procedure is carried out against the background of an inflammatory process or when doctors do not follow all the rules of disinfection. Antibiotics are mandatory for treatment.
- Violation of the integrity of the uterus (perforation) with any surgical instrument. The main causes of the violation are poor expansion and strong friability of the tissues of the cervix. Therapy is notappointed, as everything heals on its own.
- If, after curettage of the uterine cavity, the discharge does not end for three months, then this indicates the presence of an infection. Antibacterial drugs are used for therapy.
- Injuries to the mucous membrane. Occur due to excessive curettage, due to which the growth layer of the endometrium is touched. In this case, the mucosa is not restored. All therapies are ineffective.
- Asherman's syndrome, in this condition, the menstrual cycle and reproductive function are disturbed. Quite often it causes the formation of synechia. For treatment, hormonal and antibacterial drugs, as well as physiotherapy procedures are used.
- Hematometra is an accumulation of blood in the uterine cavity. For therapy, drugs that relieve spasm are used.
Further pregnancy
Curettage, which passed without complications, usually does not affect the course of childbirth and pregnancy. The possibility of conception most often returns to women a few weeks after the procedure. However, doctors do not recommend planning for it before the end of three months.
Reviews
Uterine cavity curettage, according to experts, is the so-called cleaning. And in fact, the meaning of the procedure is to cleanse the uterus by removing the upper layer of the mucosa. According to surgeons, if performed correctly, the procedure is absolutely safe and does not entail the formation ofcomplications.
According to the reviews of patients, at the first mention of the need for curettage, they experience panic and fear. To this, the doctors reply that the procedure is used for serious medical reasons, but it must be remembered that it is performed to preserve women's he alth.
