Dilation and Curettage (D and C)

A D&C may be performed in a doctor’s office, on an outpatient
basis, or as part of your stay in a hospital. Procedures may vary
depending on your condition and your doctor’s practices.

The type of anesthesia will depend on the specific procedure being
performed. Some D&C procedures may be performed while you are
asleep under general anesthesia, or while you are awake under spinal or
epidural anesthesia. If spinal or epidural anesthesia is used, you will
have no feeling from your waist down. The anesthesiologist will
continuously monitor your heart rate, blood pressure, breathing, and
blood oxygen level during the surgery.

Generally, a D&C follows this process:

1. You will be asked to remove clothing and be given a gown to
   wear.

2. You will be instructed to empty your bladder.

3. You will be positioned on an operating or examination table,
   with your feet and legs supported as for a pelvic examination.

4. An intravenous (IV) line may be started in your arm or hand.

5. A urinary catheter may be inserted.

6. Your doctor will insert an instrument called a speculum into
   your vagina to spread the walls of the vagina apart to expose
   the cervix.

7. Your cervix may be cleansed with an antiseptic solution.

8. For local anesthesia, the doctor may numb the area using a
   small needle to inject medication.

9. If general or regional anesthesia is used, the anesthesiologist
   will continuously monitor your heart rate, blood pressure,
   breathing, and blood oxygen level during surgery.

10. A type of forceps, called a tenaculum, may be used to hold the
    cervix steady for the procedure.

11. The inside of the cervical canal may be scraped with a small
    curette if the cervical tissue needs to be examined.

12. A thin, rod-like instrument, called a uterine sound, may be
    inserted through the cervical opening to determine the length
    of the uterus. If you have local anesthesia, this may cause
    some cramping. The sound will then be removed.

13. The cervix will be dilated by inserting a series of thin rods.
    Each rod will be larger in diameter than the previous one. This
    process will gradually enlarge the opening of the cervix so
    that the curette (spoon-shaped instrument) can be inserted.

14. The curette will be inserted through the cervical opening into
    the uterus and the sharp spoon-shaped edges will be passed
    across the lining of the uterus to scrape away the tissues. In
    some cases, suction may be used to remove tissues. If you have
    local anesthesia, this may cause cramping.

15. The instruments will be removed.

16. Any tissues collected with the procedure will be sent to the
    lab for examination. Pregnancy tissues (called products of
    conception) may be sent to the lab for culture or testing for
    genetic or chromosomal abnormalities.

After the procedure

The recovery process will vary depending on the type of procedure
performed and type of anesthesia that was administered.

If you received regional or general anesthesia, you will be taken to
the recovery room for observation. Once your blood pressure, pulse, and
breathing are stable and you are alert, you will be taken to your
hospital room or discharged to your home. If this procedure was
performed on an outpatient basis, you should plan to have another
person drive you home.

After a D&C using local anesthesia, you may rest for about two
hours before going home.

You may want to wear a sanitary pad for bleeding. It is normal to have
some spotting or light vaginal bleeding for a few days after the
procedure.

You may experience cramping for the first few days after a D&C.

You may be instructed not to douche, use tampons, or have intercourse
for two to three days after a D&C, or for a period of time
recommended by your doctor.

You may also have other restrictions on your activity, including no
strenuous activity or heavy lifting.

Because a D&C removes the lining of the uterus, the lining must
build back up. Your next menstrual period may begin earlier or later
than usual.

You may resume your normal diet unless your doctor advises you
differently.

Take a pain reliever for cramping or soreness as recommended by your
doctor. Aspirin or certain other pain medications may increase the
chance of bleeding. Be sure to take only recommended medications.

Your doctor will advise you on when to return for further treatment or
care.

Notify your doctor if you have any of the following:

Your doctor may give you additional or alternate instructions after the
procedure, depending on your particular situation.

Online resources

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not designed to diagnose or treat a health problem or disease, or
replace the professional medical advice you receive from your doctor.
Please consult your health care provider with any questions or concerns
you may have regarding your condition.

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American Cancer Society

American College of Obstetricians and Gynecologists

American Society for Reproductive Medicine

National Cancer Institute (NCI)

National Institutes of Health (NIH)

National Library of Medicine

National Women’s Health Information Center

Endometrial curettage in abnormal uterine bleeding and efficacy of progestins for control in cases of hyperplasia

Background:

Abnormal uterine bleeding (AUB) is the most important symptom of endometrial hyperplasia and endometrial curettage (EC) is the gold standard diagnostic procedure. We present the results of patients who underwent EC for AUB and the efficacy of progestin administration in those with endometrial hyperplasia.

Materials and methods:

A total of 415 female patients who presented to Duzce Public Hospital in 2011-2012 for AUB and who underwent EC were included. We determined the reasons for AUB, and females with hyperplasia were treated with 10 mg/day medroxyprogesterone acetate for 14 days/month or 160 mg/day megestrol acetate continuously for 3 months. We evaluated the efficacy of progestins for periods of three and/or six cycles by repeating EC. A statistical analysis of specific endometrial causes according to age of presentation was conducted using the chi-square test.

Results:

Among the 415 females (average age, 53. 5 years) followed for 6 months, 186 had physiological changes (44.8%), 89 had simple hyperplasia (21.44%), 1 had atypical hyperplasia (0.2%), 6 had (1.44%) complex hyperplasia, 3 had (0.72%) atypical complex hyperplasia, and 5 had adenocarcinoma (1.2%). Regression rates were 72.7-100%, and the optimum results were observed after 6 months of hormonal therapy.

Conclusions:

The main cause of AUB was physiological change. Progestin therapy resulted in significant regression even in females with atypical hyperplasia.

Diagnostic accuracy of endometrial curettage in endometrial pathology

Background:

Abnormal uterine bleeding is one of the most frequent problems in life of an adult female. Uterine curettage or biopsy remains a preferred sampling procedure for diagnosis of the endometrial pathology. The objective of this study was to compare the sensitivity, specificity, positive and negative predictive value of endometrial curettage.

Patients and methods:

This validation study was carried out at the Department of Histopathology, Army Medical College Rawalpindi in collaboration with Military Hospital, Rawalpindi from January to December 2010. The study included 50 curettage and subsequent hysterectomy specimen of the same patients. Non-probability sampling technique was used to divide patients into two groups with 50 patients in each group. One group was of endometrial curettage having endometrial pathology (group A). Second group was of subsequent hysterectomy specimen of the same patients (group B).

Results:

Endometrial curettage was found most accurate in diagnosing endometrial carcinoma. Sensitivity of endometrial curettage was found to be 33% whereas specificity and positive predictive value was found to be 100% each. Negative predictive value was found to be 93.1%.

Conclusion:

Endometrial biopsy is a sensitive and a specific test in and is accurate in diagnosing endometrial pathology. It is found most accurate in diagnosing endometrial carcinoma.

Dilation and Curettage (D&C) | Gynecology Obstetrics Women’s Health

Who is a candidate for dilation and curettage (D&C)?

A dilation and curettage is used to diagnose and treat uterine conditions.

Your Mercy Health doctor may recommend a type of D&C called endometrial sampling for the following symptoms:

• Abnormal uterine bleeding
• Bleeding after menopause
• Presence of abnormal endometrial cells

A D&C may be used to diagnostic the following conditions:

• Uterine cancer
• Uterine polyps
• Endometrial hyperplasia – if the uterine lining becomes too thick, this can indicate a precancerous condition
• Infertility

A D&C may also be used to treat uterine conditions such as:

• Miscarriage
  Your doctor may need to clear out any abnormal tissues in the uterus after a miscarriage to prevent infection.
• Abortion
  Your doctor may need to clear out left over tissue in the uterus after an abortion to prevent heavy bleeding or infection.
• Molar pregnancy
  During a molar pregnancy, a tumor forms instead of an embryo. Your doctor may need to perform a D&C to remove the tumor from the uterine wall.
• Excessive bleeding
  If you experience excessive bleeding after delivering a baby, your doctor may need to clear out the remaining placenta with a D&C.
• Cervical and uterine polyps
  Your doctor may need to perform a D&C to remove non-cancerous cervical or uterine polyps.

In some cases, your doctor may perform a hysteroscopy in combination with a D&C. During a hysteroscopy, any abnormal uterine growths such as polyps or fibroids can be removed.

What are the risks of a dilation and curettage (D&C)?

Although a D&C is generally safe, complications can occur. Complications associated with a D&C include:

• Heavy bleeding
• Infection
• Hole in the bowel or uterine wall if a surgical instrument accidentally pokes through the walls
• Scar tissue can develop in the uterus – this could cause abnormal or painful menstrual cycles leading to miscarriages and infertility
• Damage to the cervix which can lead to heavy bleeding

What to expect during a dilation and curettage (D&C)?

A D&C can be performed in an outpatient setting such as your doctor’s office or in a Mercy Health hospital.

In preparation for a D&C, your doctor will start dilating your cervix. This could occur a few hours before the procedure or as long as a day before the procedure. Some types of procedures may need a greater opening, so this allows the cervix to open gradually.

Your doctor will either give you a general anesthesia, to put you asleep, or a local or regional anesthesia to numb a specific area. This varies based on why you need the D&C and your medical history.

You will be instructed to lie on an exam table with your feet in stirrups. When in position, your doctor will insert a speculum into your vagina to keep the walls open. The doctor will then insert medical instruments to completely dilate the cervix. Once the cervix is sufficiently opened, your doctor will take out the medical instruments and insert a curette with a sharp edge or suction device into the uterus to remove the endometrial tissue. You may experience cramping if you have a local anesthesia during this process. Let your doctor know right away if the pain is intense.

Your doctor will send the sample of tissue to the laboratory for evaluation. If the D&C was performed to remove tissue from a miscarriage, the tissue may be evaluated for chromosomal abnormalities.

Recovery from a dilation and curettage (D&C)

Recovery from a D&C will vary depending on why you had the procedure, what type of procedure was performed as well as if you needed general or local anesthesia.

Women who were given general anesthesia will be monitored in a recovery room until the anesthesia wears off. Some patients may be moved to a hospital room for recovery, while others may be able to go home. If you had the procedure performed as an outpatient, you will need to have someone drive you home after.

If you were given a local anesthesia, you will rest for a few hours before being discharged to go home.

Patients should expect the following after a D&C:

• You will likely experience spotting or bleeding for up to a week after the procedure and will need to wear a sanitary pad to collect the blood.
• Do not insert anything into the vagina for three days after the procedure. This includes tampons or douches.
• Do not have vaginal sexual intercourse for at least three days after the procedure.
• You could feel abdominal discomfort or cramping in the days after a D&C.
• Do not perform any strenuous activity or lift anything heavy until you have your doctor’s clearance.
• Your next menstrual period may not be on schedule – you may get it sooner or later than expected.
• Your doctor will give you a list of over-the-counter pain medications you can safely take to relieve pain. Do not take aspirin products.

Call your doctor right away if you experience any of the following side effects after a D&C:

• Fever
• Severe vaginal bleeding that causes you to change your pad or tampon every hour
• Cramping that persists more than 48 hours
• Pain that is intensifying
• Vaginal discharge that is yellowish or smells bad that indicates infection

Schedule a follow-up appointment with your doctor in the time frame he or she recommends.

Dilation and Curettage (D&C): Treatment, Risks, Recovery

Overview

Female Pelvic Anatomy

What is dilation and curettage (D&C?)

A D&C is a minor surgical procedure to remove tissue from the uterus (womb). A gynecologist or obstetrician performs this surgery in their office or a surgery center. It’s usually an outpatient procedure, so you go home the same day.

A D&C gets its name from:

• Dilation of the cervix: The provider dilates, or opens, the cervix. The cervix is the opening of the uterus, where it meets the top of the vagina. Usually, the cervix only dilates during childbirth.
• Curette: The provider uses this thin instrument to scrape the uterine wall and remove tissue.

Who needs a dilation and curettage (D&C?)

You might need a D&C if you have or had:

Sometimes, you have a D&C and hysteroscopy. During this procedure, your provider inserts a device into the cervix to see the inside of the uterus. You may have a hysteroscopy with a D&C if your provider is trying to diagnose a problem.

Procedure Details

What happens before a dilation and curettage (D&C)?

Occasionally, before beginning the D&C, your provider may begin to dilate your cervix using a laminaria stick. They insert this thin rod into the cervix and leave it there for several hours. You can get up and walk around while the laminaria stick is inside. The laminaria stick absorbs fluid from the cervix. When that happens, the cervix opens and gives access to the uterus.

What happens during a dilation and curettage (D&C)?

Before the procedure, your provider will give you medicine to make you comfortable. You may have general anesthesia, where you’re asleep for the procedure. Or your provider may give you medication to relax and sedate you, but you remain awake for the procedure. Your provider will recommend the best anesthesia option for you.

During the procedure, you lie on a table with your feet in stirrups, like during a gynecologic exam. Your provider will:

1. Insert a speculum into your vagina. This smooth device, shaped like a duck’s bill, helps open the cervix.
2. Use a clamp to hold the cervix in place.
3. Make sure your cervix is sufficiently dilated, using a series of rods to open it slowly.
4. Use a curette, a type of suction or scraping device, to clean out tissue from the uterus.
5. Send a sample of the tissue to a laboratory for analysis.

How long does a dilation and curettage (D&C) take?

The procedure itself takes about five to 10 minutes. But the process may be longer. And you’ll need to wait in the recovery room for a few hours after the procedure before you go home.

Does a dilation and curettage (D&C) hurt?

You may feel cramps similar to menstrual cramps. Pain medication can relieve the cramps.

Risks / Benefits

What are the advantages of a dilation and curettage (D&C)?

A D&C can help your provider figure out why you have abnormal bleeding. It can also help detect abnormal endometrial cells, which may be a sign of uterine cancer. After a D&C, your provider sends the sample of cells to a laboratory where pathologists can identify if you have normal or abnormal tissue, polyps or cancer.

A D&C is also important for your health after a miscarriage or abortion. It removes any leftover tissue to prevent heavy bleeding and infection.

What are the risks of a dilation and curettage (D&C)?

A D&C is a safe, routine procedure. But like any surgery, it has some risks. D&C risks include:

• Uterine perforation (a small tear in the uterus), which may happen if the tip of the curette passes through the uterine wall.
• Uterine infection.
• Uterine bleeding.

In rare cases, if you had a D&C after a miscarriage, you may develop Asherman’s syndrome. This condition occurs when adhesions, or bands of scar tissue, form in the uterus. In Asherman’s syndrome, scar tissue builds up between the uterine walls. The walls then stick together. This condition can cause infertility and change your menstrual flow. But providers can usually treat the adhesions with surgery.

###

Recovery and Outlook

What’s the follow-up care for a dilation and curettage (D&C)?

You’ll need someone to drive you home from the procedure. You can usually go home a few hours after a D&C. You might have mild pain or light bleeding for a few days. Use pads, not tampons, for the bleeding. Within a week, you should be able to get back to your regular activities. You usually return to your provider about a week or two after the procedure.

Will a dilation and curettage (D&C) affect my menstrual cycle?

After having a D&C, your next period may be early or late. You’ll need to avoid using tampons or having sex for a while after the procedure. Until your cervix returns to its normal, closed state, you’re at higher risk of bacteria entering your vagina and causing an infection. Your provider will tell you when you can resume having sex and using tampons.

When to Call the Doctor

When should I call my healthcare provider about a dilation and curettage (D&C)?

Complications from a D&C are treatable when they’re diagnosed early. If you notice symptoms after a D&C, call your provider so they can diagnose and treat the problem. Symptoms may include:

Additional Details

If I had a miscarriage, do I need a dilation and curettage (D&C)?

About half of women who miscarry don’t need a D&C procedure. If the miscarriage occurs before 10 weeks of pregnancy, it will most likely happen on its own and not cause any problems. After the 10th week of pregnancy, there’s a higher risk of having an incomplete miscarriage. In that case, you need a D&C procedure to make sure the uterus is clean.

You may be able to decide if you want to miscarry naturally or have a D&C procedure. Talk to your provider to decide what’s right for you.

A note from Cleveland Clinic

A D&C, or dilation and curettage, is a procedure to remove tissue from your uterus. You may need a D&C procedure if you had a miscarriage or abortion. Your healthcare provider can use a D&C and hysteroscopy to diagnose unexplained bleeding. A D&C is an outpatient procedure. You may have some mild cramping and bleeding for a few days after a D&C. If you had a miscarriage or have bleeding between your periods, talk to your healthcare provider to see if you need a D&C.

Uterine Cancer: Diagnosis | Cancer.

Net

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. Use the menu to see other pages.

Doctors use many tests to find, or diagnose, cancer. They do tests to learn whether cancer has spread to a different part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests such as CT scans (see below) can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know if an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This section describes options for diagnosing uterine cancer. Not all tests listed will be used for every woman. Your doctor may consider these factors when choosing a diagnostic test:

• The type of cancer suspected

• Your signs and symptoms

• Your age and general health

• The results of previous medical tests

In addition to a physical examination, the following tests may be used to diagnose uterine cancer:

• Pelvic examination. The doctor feels the uterus, vagina, ovaries, and rectum to check for any unusual findings. A Pap test, often done with a pelvic examination, is primarily used to check for cervical cancer. Sometimes a Pap test may find abnormal glandular cells, which are caused by uterine cancer.

• Endometrial biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist analyzes the sample(s). A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells and tissue samples to diagnose disease.

  For an endometrial biopsy, the doctor removes a small sample of tissue with a very thin tube. The tube is inserted into the uterus through the cervix, and the tissue is removed with suction. This process takes a few minutes. Afterward, the woman may have cramps and vaginal bleeding. These symptoms should go away soon and can be reduced by taking a nonsteroidal anti-inflammatory drug (NSAID) as directed by the doctor. Endometrial biopsy is often a very accurate way to diagnose uterine cancer. People who have abnormal vaginal bleeding before the test may still need a dilation and curettage (D&C; see below), even if no abnormal cells are found during the biopsy.

• Dilation and curettage (D&C). A D&C is a procedure to remove tissue samples from the uterus. A woman is given anesthesia during the procedure to block the awareness of pain. A D&C is often done in combination with a hysteroscopy so the doctor can view the lining of the uterus during the procedure. During a hysteroscopy, the doctor inserts a thin, flexible tube with a light on it through the cervix into the vagina and uterus. After endometrial tissue has been removed, during a biopsy or D&C, the sample is checked by a pathologist for cancer cells, endometrial hyperplasia, and other conditions.

• Transvaginal ultrasound. An ultrasound uses sound waves to create a picture of internal organs. In a transvaginal ultrasound, an ultrasound wand is inserted into the vagina and aimed at the uterus to take pictures. If the endometrium looks too thick, the doctor may decide to perform a biopsy (see above).

• Computed tomography (CT or CAT) scan. A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumors. A CT scan can be used to measure the tumor’s size. Sometimes, a special dye called a contrast medium is given before the scan to provide better detail on the image. This dye can be injected into a patient’s vein or given as a pill or liquid to swallow.

• Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can be used to measure the tumor’s size. Like with a CT scan, a special dye called a contrast medium can be given intravenously or orally before the scan to create a clearer picture. MRI is very useful for getting detailed images if the treatment plan will include hormone management (see Types of Treatment). MRI is often used in women with low-grade uterine cancer (see Stages and Grades) to see how far the cancer has grown into the wall of the uterus. Knowing this can help determine whether a woman’s fertility can be preserved.

• Molecular testing of the tumor. Your doctor may recommend running laboratory tests on a tumor sample to identify specific genes, proteins, and other factors unique to the tumor. Results of these tests can help determine your treatment options.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, additional testing will be performed to discover how far the disease has grown. This helps to categorize the disease by stage and grade and directs the type of treatment that will be needed.

The next section in this guide is Stages and Grades. It explains the system doctors use to describe the extent of the disease. Use the menu to choose a different section to read in this guide.

Endometrial Biopsy of the Uterus: Procedure, Recovery, Pain, Effects

An endometrial biopsy is a way for your doctor to check for problems in your uterus. That’s the pear-shaped organ in your lower belly that holds a baby during pregnancy.

The procedure takes just a few minutes and is often done in your doctor’s office. It’s very safe.

Who Gets This Test?

Your doctor may do this type of biopsy if your Pap test shows that you have “precancerous” cells in your uterus. They could also suggest one if you have any of these symptoms:

An endometrial biopsy can’t fix or stop any of these symptoms. But it can help your doctor learn what may be wrong.

What Happens

Most of the time, you can get this test done in your doctor’s office. You won’t need anesthesia, but your doctor may suggest you take an over-the-counter pain reliever 30 minutes before your visit.

Continued

The procedure usually takes 10 to 15 minutes.

You’ll lay on an exam table with your feet resting in stirrups, just like you would for a Pap smear. Your doctor will insert a device called a speculum into your vagina. This holds it open during the procedure.

After your cervix is cleaned, your doctor will insert a very thin, flexible tool to gently suction out a tissue sample from the lining (endometrium) of your uterus. This will then be sent to a lab so it can be looked at under a microscope and tested for abnormal cells like cancer.

Risks

While an endometrial biopsy is safe, there is a chance of bleeding and infection. The wall of your uterus could also get nicked by the tools used during the biopsy, but this is very rare.

If you think you may be pregnant, make sure to tell your doctor ahead of time. The biopsy could cause you to miscarry.

After the Procedure

It’s common to have some light spotting after this type of biopsy. You may also have some cramping. If so, ask your doctor which over-the-counter pain relievers are safe for you to take. Some, like aspirin, could make you bleed more.

You can return to your normal routine as soon as you feel able, but skip sex until all your bleeding has stopped.

What the Results Mean

You should get the lab results back in about a week. The possible causes of your abnormal bleeding could be:

Your doctor will go over the results with you. Based on what they reveal, they’ll also explain if any treatment is needed.

There’s also a chance that your results will come back inconclusive. This means that it’s unclear whether or not you have cancer cells in your uterus. If so, you may need to have a more involved medical procedure called a dilation and curettage (D&C). During a D&C, your doctor will scrape a bigger sample of tissue from the lining of your uterus for testing at a lab.

Endometrial biopsies aren’t perfect. Because they take a random tissue sample, they can sometimes miss precancerous or cancerous growths. If your symptoms don’t go away, tell your doctor. You may need to have another type of test to get more information.

Curettage of the walls of the uterine cavity

Curettage in gynecology is a type of surgical intervention aimed at removing the layer of the endometrium (tissues of the uterine cavity) for therapeutic or diagnostic purposes. As a rule, the procedure is performed under general anesthesia. In modern medicine, hysteroscopes are increasingly used for curettage.

Readings

The procedure for scraping the walls of the endometrium is performed for a number of indications. As a therapeutic technique, it is performed at:

• the appearance of polyps and other neoplasms on the uterine mucosa
• endometrial hyperplasia (that is, its excessive thickening)
• uterine bleeding
• endometritis

90,009 incomplete abortions (to remove the remnants of the placenta and other tissues)

• synechia (fusion of the walls of the endometrium)

Also, curettage is a popular method of screening (obtaining material for histological studies) and monitoring the state of the female reproductive system, for example, assessing the success of hormone therapy.A diagnostic procedure can be assigned:

• to clarify information obtained during ultrasound
• for menstrual irregularities (heavy menstruation, etc.)
• before planned “female” operations

Scraping specificity

To minimize the risk of complications, as well as to speed up the recovery process, curettage of the walls of the uterine cavity in the Viva clinic is most often performed using a hysteroscope – special equipment that provides visual control of the procedure on a monitor.

Before surgery, the patient undergoes a traditional examination:

• visits a gynecologist
• donates smears and analyzes of blood, urine
• undergoes ultrasound scan

Paracervical anesthesia or intravenous anesthesia is used as anesthesia during the procedure. The scraping itself requires a minimum of time. In most cases, the intervention refers to operations of one day, that is, the patient can go home on the same day and lead a normal life.

Recovery after surgery

The first time after the procedure, minor painful sensations in the lower abdomen and spotting are possible.

The doctors of the Viva Clinic give recommendations for the recovery of patients on an individual basis. The general set of rules includes abstinence for 2-4 weeks after curettage from:

• sex contacts
• swimming in pools and open reservoirs

90,009 visits to saunas or baths

• active physical activity

Additionally, medication can be prescribed to exclude inflammatory processes.

Gynecologists

Subdivisions where the procedure is carried out

Still have questions?

Treatment of uterine fibroids in Chelyabinsk

A benign formation emanating from the cells of the myometrium (the muscular membrane of the uterine wall). Uterine fibroids occur in 35-50% of women after 35 years, after 45 years, the incidence of the disease reaches 60-70%.

Uterine fibroids – a benign formation emanating from the cells of the myometrium (the muscular membrane of the uterine wall).

The term “tumor” is often confusing because fibroids are benign and therefore do not belong to the group of cancers. They grow very slowly in the wall of the uterus and are composed of connective tissue and smooth muscle cells.

The disease occurs in 35-50% of women after 35 years, after 45 years, the incidence reaches 60-70%.

Causes of fibroids

• hereditary predisposition.
• inflammatory diseases of the genitals.
• various intrauterine interventions (abortion, cesarean section, etc.).
• diabetes mellitus, arterial hypertension, obesity.

Symptoms of uterine fibroids

1. Heavy and prolonged menstrual bleeding. Menstruation is often accompanied by a clotted discharge.The intensity of bleeding gradually increases, anemia develops.
2. Pain syndrome. Pain may be completely absent, it is observed only with a complicated course of the disease. The asymptomatic course leads to the fact that time for conservative treatment is lost and only the path of surgical intervention remains.
3. Feeling of pressure on the bladder and intestines – frequent urination, constipation.
4. Infertility.
5. Complicated pregnancy.
   • threat of termination of pregnancy;
   • fetal growth retardation;
   • Premature placental abruption accompanied by bleeding;
   • violation of the blood supply to the nodes or their rapid growth, which often leads to termination of pregnancy.

Diagnosis of uterine fibroids

Asymptomatic fibroids are often detected incidentally, for example, during a gynecological examination.If a woman seeks advice from a gynecologist with symptoms, diagnostic procedures usually include the following steps:

• collecting anamnesis
• gynecological examination
• ultrasound examination
• diagnostic hysteroscopy or laporoscopy
• if necessary, CT or MRI study

Types of uterine fibroids

Intramural fibroids are located in the wall of the uterus and are the most common type.

Subserous fibroids are located under the outer wall of the uterus. In some cases, they can connect to the uterus through a thin vascular stem or leg. In this case, they are called subserous myomas on the pedicle. This type can rotate around the leg, causing severe pain.

Submucous myomas , or submucosal, are located under the inner layer of the uterus and protrude into the uterine cavity. This can lead to a change in the shape and size of the uterine cavity.

In very rare cases, they can develop at the level of the cervix ( cervical fibroids ) or in the ligaments that hold the uterus in place ( intra-ligamentous fibroids ).

Treatment of uterine fibroids

The correct choice of treatment method for a particular patient depends on various factors:

• the age of the patient and her plans for childbearing.
• size, number and localization of myomatous nodes.
• growth rate
• type, severity and frequency of symptoms.

Treatment can be conservative, surgical, or combined (both).

Surgical treatment

The indications for surgical treatment are as follows:

• fibroid sizes over 12 weeks of gestation;
• submucous arrangement of nodes, interstitial myoma with centripetal growth;
• rapid tumor growth;
• combination of fibroids with ovarian tumors;
• meno- and metrorrhagia, which lead to anemia;
• for miscarriage and infertility.

Depending on the age of the patient, on the location of the myomatous nodes, a choice is made in favor of one or another surgical intervention.

The goal of conservative treatment is to stop tumor growth, reduce its size and prevent complications.

Conservative treatment is carried out for all women who have:

• fibroid sizes less than 12 weeks of gestation;
• fibroids with subserous and interstitial nodes;
• there is no pronounced clinical picture with meno- and metrorrhagias and if there is no pain syndrome;
• if there are contraindications to surgical treatment (extragenital diseases).

The advantage of drug therapy is the ability to preserve the uterus and fertility.The choice of medication depends on the severity of the symptoms and the purpose of the therapy.

The specialists of “EVIMED” recommend: Preventive examination for a woman who does not complain about the state of her female health should be performed 1 time in 10-12 months. This examination includes a conversation with a gynecologist, examination on a gynecological chair with an examination of the cervix, colposcopy, cytology and urogenital smear, taking an analysis for HPV of a highly oncogenic type.After that, you should undergo an examination of the mammary glands and an ultrasound scan.

In the medical center “EVIMED” Lyudmila Nikolaevna Gladkova is engaged in the treatment of fibroids – an operating obstetrician-gynecologist with the highest category and many years of experience. You can get a consultation and the necessary examinations with the determination of the tactics of further treatment by making an appointment with her in advance.

Biopsy in Chelyabinsk | Prices

Aspiration biopsy is performed to obtain endometrial specimens for histological examination.Currently, it is one of the most common diagnostic procedures in gynecological practice.

Endometrial aspiration biopsy (pipel diagnostics) is currently one of the most common diagnostic procedures in gynecological practice. An aspiration biopsy is performed to obtain endometrial specimens for histological examination. The essence of the method lies in the fact that through a special tip “Paypel”, introduced into the uterine cavity, with the help of a syringe, pieces of the endometrium are sucked in.

The technical simplicity, safety, the possibility of performing it on an outpatient basis and the significant reliability of the results allowed the aspiration biopsy of the endometrium to take its rightful place in the methods of diagnosing pathologies of the female body.

Indications for endometrial aspiration biopsy

• monitoring the state of the endometrium during hormone therapy;
• diagnostics of hyperplastic processes and endometrial cancer;
• obtaining a sample of endometrium for bacteriological examination.

Contraindications and possible complications during endometrial aspiration biopsy

Pregnancy is a contraindication to performing.

Pipel biopsy gives a very small percentage of complications (less than 0.5%) in comparison with traditional material sampling (diagnostic curettage of the uterine mucosa). The occurrence of complications (damage to the uterine wall, bleeding, purulent-septic complications) is usually associated with a violation of the technique for performing the procedure or ignoring existing contraindications.A competent specialist always takes into account their likelihood and informs the woman in a timely manner.

Preparation for the procedure

Depending on the goals of the diagnosis, the study is carried out in different phases of the menstrual cycle. Most often, an aspiration biopsy is prescribed for 21-23 days.

Before performing an aspiration biopsy, a preliminary examination is necessary:

• consultation of a gynecologist.
• examination by a gynecologist.
• bacterioscopy of vaginal contents
• blood tests (RV, HIV, hepatitis B, C).
• Ultrasound of the pelvic organs.

How a biopsy is performed

In pipel biopsy, a special instrument is used – a flexible plastic tube with a diameter of 3 mm with a side hole at the end. Inside the tube, like a syringe, there is a plunger. Pipeline (name of the instrument) is inserted into the uterine cavity, the pipe piston is pulled out halfway, which creates negative pressure in the cylinder.Due to this, the endometrium is sucked into the cylinder from various parts of the uterine cavity. After this procedure, the pipe is removed from the uterus, and the material obtained by it is sent for histological examination to the laboratory. The operation lasts no more than half a minute, and the results of the study become known in a maximum of 7-10 days.

This procedure is practically painless. If necessary, patients who have a reduced pain threshold are given local anesthesia, due to which there is practically no pain during and after manipulation.

Pipel biopsy is preferred over classic biopsy for a number of reasons:

• Firstly , due to the small diameter of the instrument, it is not necessary to carry out a painful procedure for dilating the cervix.
• Secondly , the instrument can be used only once, is in a sterile package, which eliminates the risk of accidental infection.
• Thirdly , the pipel biopsy procedure is significantly easier in technique and cheaper.

Recovery from endometrial aspiration biopsy

After performing the manipulation, the patient fully maintains good health and working capacity, and can immediately leave the clinic. The doctor receives the results of the histological examination in 7-10 days, after which it is possible to determine the tactics of further management of the patient.

Diagnostic curettage of the cervix in gynecology of the Litfond polyclinic

Before the separate diagnostic curettage , after the expansion of the cervical canal of the cervix, a hysteroscope (a thin tube with a camera at the end) is inserted into the uterine cavity.The walls of the uterine cavity and cervical canal are examined. After that, curettage of the mucous membrane of the uterine cavity and cervical canal is performed. If the woman has had polyps, they are removed during the scraping process. After the end of curettage, the hysteroscope is re-inserted and a control hysteroscopy is performed to achieve a positive result.

Separate curettage means that curettage of the cervical canal of the cervix is ​​performed first, then the uterine cavity. Curettage can be diagnostic, when the removed mucous membrane is subjected to histological examination, and therapeutic, when the pathologically altered mucous membrane of the uterus or the remains of the ovum lingering in its spongy layer are removed for therapeutic purposes.

The scraping is collected in a sterile container and, after being processed, is sent to the laboratory for histological examination, indicating the date of the operation, the name of the patient, her age, the day of the menstrual cycle, the clinical diagnosis and the place where the tissue was taken.

After the operation, the patient stays in the ward for 1-3 hours, depending on the type of anesthesia and the patient’s well-being.

Contraindications for the procedure are:

• general infectious diseases
• diseases of the heart, liver, kidneys in the stage of decompensation
• genital diseases

Before curettage, the patient should undergo the following tests:

• Complete blood count
• Biochemical blood test
• Blood group and Rh factor
• Coagulogram (assessment of the blood coagulation system)
• ECG
• Tests for hepatitis B and C, RW (syphilis) and HIV
• Vaginal swab (there should be no signs of inflammation)
• Smear for oncocytology from the uterine cheek

Make an appointment with a gynecologist by phone +7 (495) 150-60-01

Appointment

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90,000 curettage of the uterine cavity for diagnostic and therapeutic purposes

Depending on the disease and the goals of the study, WFD can be performed both in the first and in the second phase of the menstrual cycle.As a rule, the procedure is combined with hysteroscopy, that is, it is performed using special endoscopic equipment.

For anesthesia, sedation can be used – immersion of the patient into sleep with the help of intravenous administration of special drugs. The operation is performed in a gynecological chair using sterile disposable instruments.

The cervix is ​​exposed in the mirrors, treated with an antiseptic solution and captured with special gynecological forceps.After that, the doctor uses a small curette to carefully scrape off the mucous membrane of the cervical canal, placing the obtained material in a separate test tube filled with a fixing solution.

Then the doctor inserts a thin probe into the uterus and measures the length of its cavity in order not to damage the organ during the operation. Having previously expanded the cervical canal with special dilators, he proceeds to curettage of the uterine cavity.

A larger curette is used to scrap the uterine cavity.The doctor consistently gently scrapes the endometrium from the anterior, posterior walls of the uterus and from the corners of its cavity. The resulting material is placed in a second container and marked.

Both containers, with material from the cervix and from the uterine cavity, accompanied by the appropriate documentation, are sent to the histological laboratory, where they are thoroughly examined.

The total duration of separate diagnostic curettage is 15-20 minutes.High-quality sampling of material ensures high diagnostic efficiency. Immediately after WFD, the patient is sent to the postoperative ward, where, under the supervision of a doctor, she spends 2-3 hours and then, in the absence of complications, is discharged home.

Medical and diagnostic curettage (LDV) – Medical Center “Paracelsus”

Medical and diagnostic curettage of the uterine cavity and cervical canal. (LDV) – minimally invasive therapeutic and diagnostic manipulation to remove the pathology of the endometrium (inner lining of the uterus), followed by histological examination of the removed material.LDV does not provide for the use of any incisions or scarring.

Medical and diagnostic curettage of the uterine cavity is the removal of its contents along with the functional layer of the mucous membrane (endometrium). To carry out the manipulation, a metal curette instrument is used. It is a curved spoon of various diameters, hollow inside and slightly sharpened at the end, which allows collecting and removing accumulated blood, particles of the contents of the uterine cavity.

!!! The disadvantage of this procedure is the lack of visual control over the state of the uterine cavity and mechanical damage to the uterine wall. Currently, the main method for the treatment of endometrial pathology is manual vacuum aspiration of the endometrium, followed by control with a hysteroscope.

Diagnostic curettage of the cervical canal is mandatory for patients with cervical pathology, and at the age of more than 40 years, to exclude oncological diseases of the cervix.

This manipulation is performed with a small metal instrument (curette), with which the gynecological surgeon scrapes the inner layer of the cervical canal. Indications for Therapeutic and diagnostic curettage of the uterine cavity and cervical canal:

• uterine bleeding
• polyp of the cervical canal
• endometrial hyperplasia
• the presence of enometrial hyperplasia with concomitant therapy of other diseases, for example, when using hormone therapy for breast cancer.
• Regressive pregnancy.
• Condition after incomplete spontaneous miscarriage.
• Remains of fetal tissue after abortion.

Contraindications:

• Acute infection of the genitourinary system.
• Acute infectious and inflammatory processes of any organs and systems.
• Desired pregnancy.
• Uterine cancer

Anesthesia: In order to be painless and to reduce discomfort, the procedure is performed under general intravenous anesthesia. You can undergo all the necessary examinations at the Multidisciplinary Clinic “Paracelsus” in one day and on the day of your visit! Surgery examination and validity of examination results:

• colposcopy-12 months
• Ultrasound of the pelvic organs – 1 month
• Ultrasound of the veins of the lower extremities – 3 months
• Swab for flora-10 days
• oncocytology from the cervix – 6 months
• General urine analysis-10 days,
• Complete blood count and reticulocytes -10 days,
• Electrocardiogram with decoding -14 days,
• Blood for HIV, Hepatitis B, Hepatitis C, Syphilis 3 months.
• Biochemical blood test: general, direct, indirect Bilirubin, Total protein, albumin, urea, glucose, creatinine, uric acid, AST, ALT, blood sodium and potassium, cholesterol -10dn
• Coagulogram – 10days
• Blood group and Rh factor
• Fluorography – 6 months.
• Mammography -24 months (after 36 years), 12 months (after 50 years)
• Ultrasound of mammary glands -12 months (up to 36 years)
• Consultation of a therapist, anesthesiologist and other specialists according to indications.

Other examinations can be added according to indications.

Before carrying out this surgical intervention, the patient must go to the reception of a gynecologist. At the reception, the doctor will explain in detail the essence of the procedure, alternative methods of treatment and answer all the patient’s questions.

This procedure requires hospitalization in a hospital for several hours. If necessary, a sick leave is issued. After receiving the results of a histological examination in our Paracelsus MC, you can continue observation and treatment by the gynecologist who performed the operation on you.For a more accurate diagnosis and safe treatment, Hysteroscopy is the best method. In the Multidisciplinary Clinic “Paracelsus” equipment of the company Karl Storz is used for hysteroscopy (the No. 1 manufacturer in the world of endoscopy).

Expansion and curettage procedure | Memorial Sloan Kettering Cancer Center

This information will help you prepare for your dilation and curettage (D&C) procedure.It tells you what to expect before, during and after your procedure.

D&C is a procedure in which the cervix dilates (slowly opens) and tissue is removed from the uterus. The tissue is removed with a thin instrument called a curette.

You may have a hysteroscopy at the same time as your D&C procedure. This is a procedure in which a thin endoscope with a flashlight and a camera at the end is inserted into the uterus through the vagina. This gives your doctor the opportunity to examine the lining of the uterus for any abnormalities.

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Objective D&C

Typically, a D&C procedure is performed to identify the cause of abnormal uterine bleeding (discharge of blood from the uterus). Examples of abnormal uterine bleeding:

• bleeding between periods;
• bleeding after vaginal intercourse, including small blood spots;
• profuse, irregular or prolonged menses;
• Sudden vaginal bleeding after a year or longer without menstruation.

The cause of this bleeding may be:

• Endometrial cancer. Endometrial cancer is cancer of the lining of the uterus. The D&C procedure helps diagnose cancer early.
• Fibroids. Fibroids are growths on the uterus, consisting of connective tissue and muscle fibers. In most cases, they are benign (not cancerous).
• Polyps. Polyps are growths that form on the inner wall of the uterus and protrude into the uterine cavity (the space inside the uterus).They are usually benign, but some of them may be cancerous or precancerous (leading to the development of cancer). Polyps can be removed during the D&C procedure.
• Hyperplasia.
  Hyperplasia is a pathological proliferation of the inner lining of the uterus. Hyperplasia may be precancerous.

The D&C procedure can also be used to diagnose or treat other diseases of the uterus.
In addition, it is used to clean the inner lining of the uterus after a miscarriage or induced abortion.

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Before the procedure

Ask questions about your medicines

You may need to stop taking some of your medicines before your procedure. Talk to your doctor about which medications you can stop taking. Below are some common examples.

• If you are taking a coagulant (blood thinner), ask your doctor when you should stop taking it.These drugs include warfarin (Coumadin ^® ), dalteparin (Fragmin ^® ), heparin, tinzaparin (Innohep ^® ), enoxaparin (Lovenox ^® ), clopidogrel (Plavix ^® ) (clopidogrel (Plavix ^® ) and ® ).
• If you are taking insulin or other diabetes medications, ask the doctor who prescribed the medication what to do on the morning of your procedure. You may need to change your dose.

Arrange someone to take you home

You must arrange with someone at least 18 years of age to be taken home after your procedure.If you don’t have one, call one of the agencies listed below. You will be provided with an escort who will take you home. These services are usually chargeable and you will need to provide transportation.

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The day before the procedure

Record the time at which the procedure is scheduled

The Admitting Office will call you after 2:00 pm the day before your procedure.If your procedure is scheduled for a Monday, you will be called on the Friday before.

The staff member will tell you what time you must arrive at the hospital for your procedure. He will also tell you where to go. If no one contacts you by 19:00, please call 212-639-5014.

Instructions for eating and drinking before the procedure

• Do not eat after midnight the day before your procedure.This also applies to candy and chewing gum.

• Between midnight and two hours before your scheduled hospital arrival time, you may only drink 12 ounces (350 ml) of water (see illustration).

• Avoid eating or drinking two hours before your scheduled hospital arrival time. This also applies to water.

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Day of the procedure

Points to remember

Take only the medicines your doctor has prescribed for the morning of your procedure.Wash them down with a few small sips of water.

What to expect

You will be shown to the dressing room and asked to remove all clothing, jewelry, dentures and contact lenses. One of the staff will give you a hospital gown.

After changing into a hospital gown, you will meet with a nurse. The nurse will take you to the treatment room and assist you on the operating table. If you feel cold, ask the nurse for a blanket.

If you feel cold, ask the nurse for a blanket. First, you will be given an intravenous fluid, and then anesthesia (a drug that will make you fall asleep) will be given anesthesia through the same dropper. You will also be hooked up to equipment to monitor your heart rate, breathing, and blood pressure.

You will be given anesthesia (medication that makes you fall asleep) through an IV catheter. When you fall asleep, your doctor will begin your procedure.

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After procedure

Hospital

• You will be transferred to the Post Anesthesia Care Unit (PACU).There, a nurse will monitor your body temperature, heart rate, breathing, and blood pressure. You may receive oxygen through a thin tube under your nose. You will be in the recovery room until you fully recover.
• When you are fully awake, you will be transferred to the recovery area. You can have tea or juice, have a light snack and see your visitors.
• You may experience aching, cramping pains in your lower abdomen (belly).Ask your nurse for pain relief medication. Your doctor or nurse may also give you a prescription for pain medication to take at home.
• The nurse will give you instructions on how to take care of yourself at home. When you are allowed to leave the recovery area (discharged), you must have a companion who is at least 18 years old.

Houses

• You may feel sleepy while still under anesthesia.It is important that you have someone near you for the first 24 hours after your procedure.
• For 2 weeks after the procedure or as indicated by your doctor, refrain from:
  • douching;
  • use of tampons;
  • vaginal intercourse.
• It is allowed to take a shower. Ask your doctor when you can take a bath.
• You may have cramps and vaginal bleeding, like during menstruation.This can continue for several days after the procedure. Use sanitary pads for vaginal bleeding.
• Call your doctor to make an appointment for your follow-up.

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Call your doctor or nurse if you have:

• Temperature 101 ° F (38.3 ° C) or higher
• Vaginal bleeding more profuse than normal menstrual bleeding;
• pain that does not go away after taking a medication recommended by your doctor;
• swelling in the abdominal cavity;
• Unpleasant odor of vaginal discharge.