Fever after d and c: Dilation and curettage (D&C) – Mayo Clinic
Dilation and Curettage (D&C): Treatment, Risks, Recovery
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.
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:
- Insert a speculum into your vagina. This smooth device, shaped like a duck’s bill, helps open the cervix.
- Use a clamp to hold the cervix in place.
- Make sure your cervix is sufficiently dilated, using a series of rods to open it slowly.
- Use a curette, a type of suction or scraping device, to clean out tissue from the uterus.
- 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:
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.
Treating miscarriage | The Royal Women’s Hospital
If a miscarriage has begun, there is nothing that can be done to stop it. Any treatment you have will be aimed at avoiding heavy bleeding and infection.
A discussion with the doctor or nurse will help you to work out which treatment options are best and safest for you.
On this page:
No treatment (expectant management)
You can choose to wait and see what will happen. This is called ‘expectant management’. If nothing is done, sooner or later the pregnancy tissue will pass naturally. If it is an incomplete miscarriage (where some but not all pregnancy tissue has passed) it will often happen within days, but for a missed miscarriage (where the fetus or embryo has stopped growing but no tissue has passed) it might take as long as three to four weeks.
While you are waiting you may have some spotting or bleeding, much like a period. When the pregnancy tissue passes, you are likely to have heavier bleeding with crampy, period-like pains. You can use sanitary pads and take pain relieving tablets, such as paracetamol.
If your miscarriage is incomplete, with just a small amount of pregnancy tissue remaining, it’s probably best to take a wait and see approach. But if there is heavy bleeding or signs of infection you will need treatment.
If the tissue does not pass naturally or you have signs of infection, the doctor will recommend a dilatation and curettage (D&C). You and the doctor can discuss and decide the preferred option for you.
Things to know
- There are many reasons why some women prefer to wait and see. It may feel more natural, it may help with the grieving process or it may give you more of a sense of control.
- Some women become worried or frightened when the bleeding gets heavier, especially if blood clots, tissue or even a recognisable embryo is passed.
- Usually, the wait and see approach takes longer than any other approaches such as surgery or medication. Sometimes bleeding can last for up to four weeks.
- Although excessive bleeding and blood transfusion are very rare, they are slightly more common with expectant management than with surgery.
- A few women still need to have surgery – sometimes urgently – if they develop infection, bleed heavily or if the tissue does not pass naturally.
- The waiting time can be emotionally draining for some women.
Treatment with medicine
Medicine is available that can speed up the process of passing the pregnancy tissue. For an incomplete miscarriage, the medicine will usually encourage the pregnancy tissue to pass within a few hours. At most it will happen within a day or two. For a missed miscarriage, it may happen quickly, but it can take up to two weeks and, occasionally, longer.
- Medication is not suitable if there is very heavy bleeding or signs of infection. It is usually not recommended for pregnancies that are older than about nine weeks.
- If the tissue does not pass naturally, eventually your doctor will recommend a dilatation and curettage (D&C).
Things to know
- The pregnancy tissue will pass between four to six hours after taking the medicine, during which time you may be in hospital. After a few hours, if the pregnancy hasn’t passed, you may be sent home to wait. This will depend on where you are and which hospital you are in.
- The medicine has side effects which usually pass in a few hours but can be unpleasant, such as nausea, vomiting, diarrhoea, fever and chills. The tablets can be swallowed or dissolved under the tongue, or inserted in the vagina.
- After receiving the medication there may be some spotting or bleeding like a period. When the pregnancy tissue passes, you are likely to notice heavier bleeding and clots with strong cramping, period-like pains. You can use sanitary pads and take pain relieving tablets such as paracetamol.
- Some women may need stronger pain killers or a pain relieving injection.
- A few women still need to have surgery, sometimes urgently, if they develop infection, bleed heavily or if the tissue does not pass.
Surgical treatment (curette)
A D&C (or ‘curette’) is a minor operation. The full name is dilatation and curettage. It is done in an operating theatre, usually under general anaesthetic. There is no cutting involved because the surgery happens through the vagina. The cervix (neck of the uterus) is gently opened and the remaining pregnancy tissue is removed so that the uterus is empty. Usually the doctor is not able to see a recognisable embryo.
The actual procedure usually only takes five to ten minutes, but you will usually need to be in the hospital for around four to five hours. Most of this time will be spent waiting and recovering.
You may have to wait a day or two to have a curette and sometimes, while you are waiting, the pregnancy tissue will pass on its own. If this happens and all of the tissue is passed you may not need to have a curette.
A curette is done in the following circumstances:
- You have heavy or persistent bleeding and/or pain.
- The medical staff advise that this is a better option for you; this may be because of the amount of tissue present, especially with a missed miscarriage.
- This is an option you prefer.
Things to know
The risks of a D&C are very low, but include:
- some pregnancy tissue remains in uterus. This can cause prolonged or heavy bleeding and the operation may need to be repeated
- infection needing antibiotics
- damage to the cervix or uterus. This is very rare (around 1 in 1000) and, when it does happen, it is usually a small hole or tear which will heal itself
- excessive bleeding (very rare)
- anaesthetic risks. These are very low for healthy women, but no anaesthetic or operation is without risk.
Waiting for treatment
If you have heavy bleeding with clots and crampy pain, it is likely that you are passing the pregnancy tissue. The bleeding, clots and pain will usually settle when most of the pregnancy tissue has been passed. Sometimes the bleeding will continue to be heavy and you may need further treatment.
You should go to your nearest emergency department if you have:
- increased bleeding, for instance soaking two pads per hour and/or passing golf ball sized clots
- severe abdominal pain or shoulder pain
- fever or chills
- dizziness or fainting
- vaginal discharge that smells unpleasant
- diarrhoea or pain when you open your bowels.
What to do while you are waiting
- You can try to rest and relax at home.
- Usual activity that is not too strenuous will not be harmful. You can go to work if you feel up to it.
- If you have pain you can take paracetamol.
- If there is bleeding, use sanitary pads rather than tampons.
After a miscarriage
- It is usual to have pain and bleeding after a miscarriage. It will feel similar to a period and will usually stop within two weeks. You can take ordinary painkillers for the pain. Your next period will usually come in four to six weeks after a miscarriage.
- See a doctor or attend a hospital emergency department if you have strong pain and bleeding (stronger than period pain), abnormal discharge, (especially if it is smelly), or fever. These symptoms may mean that you have an infection or that tissue has been left behind.
- Try and avoid vaginal sex until the bleeding stops and you feel comfortable.
- Use sanitary pads until the bleeding stops (do not use tampons).
- All contraceptive methods are safe after a miscarriage
- See a GP (local doctor) in four to six weeks for a check-up.
Anti-D injection after a miscarriage
It is important to have your blood group checked. If you’re RhD negative and the fetus is RhD positive this can cause problems for future pregnancies. This is because the fetus’s blood cells have RhD antigen attached to them, whereas yours do not. If small amounts of the fetus’s blood mixes with your blood, your immune system may perceive this difference in blood cells as a threat and produce antibodies to fight against the fetus’s blood. Once your body has made these antibodies they can’t be removed. This is unlikely to have caused your miscarriage and is more likely to affect future pregnancies. Women with a negative blood type usually need an Anti-D injection, which will stop the antibodies forming.
Future pregnancies after a miscarriage
One of the most common concerns following a miscarriage is that it might happen again. However, if you have had one miscarriage the next pregnancy will usually be normal.
If you do try for another pregnancy, try and avoid smoking, alcohol and excess caffeine as they increase the risk of miscarriage. It is recommended that all women take folic acid while trying to conceive, and continue until three months of pregnancy. In your next pregnancy you are encouraged to see your GP and have an ultrasound at about seven weeks. If ultrasound is done too early in pregnancy the findings are often uncertain and cause unnecessary worry.
Feelings and reactions
There is no ‘right’ way to feel following a miscarriage. Some degree of grief is very common, even if the pregnancy wasn’t planned. Partners may react quite differently, just as people can respond differently to a continuing pregnancy. Feelings of loss may persist for some time and you may have mixed feelings about becoming pregnant again. Some friends and family may not understand the depth of emotion that can be attached to a pregnancy and may unreasonably expect for you to move on before you are ready.
Some couples decide that they want to try for a pregnancy straight away, while others need time to adjust to their loss. If you feel anxious about a possible loss in future pregnancies, you may find it helpful to talk to someone about this. If it’s difficult to speak with your friends and family about these issues, your doctor, community support group and counsellors can provide information and assistance.
The Women’s does not accept any liability to any person for the information or advice (or use of such information or advice) which is provided on the Website or incorporated into it by reference. The Women’s provide this information on the understanding that all persons accessing it take responsibility for assessing its relevance and accuracy. Women are encouraged to discuss their health needs with a health practitioner. If you have concerns about your health, you should seek advice from your health care provider or if you require urgent care you should go to the nearest Emergency Dept.
Recovering from a miscarriage – HSE.ie
While your body is recovering from a miscarriage, you are likely to have:
When to get urgent medical help
Contact your GP or maternity hospital after a miscarriage if you have:
These symptoms could mean that some of the pregnancy tissue is still in your womb.
They could also be signs of an infection, especially if you also:
- feel feverish – a temperatures above 38°C (100.4°F)
- have flu-like symptoms like a sore throat, fever and muscle ache
You should go to the hospital if you are feeling unwell or feverish in the days after your miscarriage
Infection happens in about 2% of women who have had a miscarriage (2 in every 100 women). Infection can be treated with antibiotics.
If your infection is not treated, sometimes serious complications like sepsis can occur. Sepsis is a very severe infection. It is caused by germs (usually bacteria) getting into your bloodstream.
Sepsis can cause organ damage and even death. It is very important to get medical help urgently if you think you may have an infection.
Do not use tampons
Do not use tampons or moon cups, as these could cause infection. It is safe to use sanitary towels or pads.
Your next period
Your next period will usually be 4 to 6 weeks after a miscarriage.
Emotions after a miscarriage
A miscarriage can be devastating for you and for your partner. The amount of emotional pain you feel is unique to you, and you may find it changes from time to time.
Sometimes, you may feel you are doing fine, but a sudden memory could trigger emotions. Feelings such as guilt, shock and anger are common. There is no right or wrong way to feel after a miscarriage.
Try to be open about your feelings and to communicate with your partner, family or friends.
Talk to your GP if you feel you are not coping. Remember your partner may have different ways of coping with the miscarriage.
Coping with difficult situations
The loss of a pregnancy through miscarriage affects people in different ways. It can be a very distressing and emotional experience. You may need lots of support afterwards from your partner, family or friends.
Your GP can give you support during your physical and emotional recovery.
Your maternity hospital may offer support such as:
- chaplaincy or pastoral care
- clinical midwife specialist in bereavement and loss
The Pregnancy and Infant Loss in Ireland website has information and advice for parents.
Returning to work after a miscarriage
Your return to work depends on how you feel physically and emotionally.
If you can, rest for a few days before returning to work. Discuss this with your doctor in the hospital or with your GP.
You can get full maternity leave if you have a stillbirth or miscarriage after week 24 of your pregnancy.
Find out what benefits and entitlements you can get after a miscarriage or stillbirth.
Sex after a miscarriage
You can have sex again as soon as you feel ready. Make sure to wait until you feel well and until the pain and bleeding has reduced.
Remember you could get pregnant in the first month after a miscarriage. This can happen before your period returns. If this is not what you want, talk to your GP about contraception.
You can try for another baby as soon as you and your partner feel physically and emotionally ready.
Chances of another miscarriage
Most women will have a successful pregnancy after miscarriage. Having one or two miscarriages does not mean you are at higher risk for miscarriage in the future.
If you have 3 miscarriages, there might be a medical reason. Some medical conditions make it more likely to miscarry. Speak with your GP about treatment options.
Miscarriage – What happens – NHS
If there’s no pregnancy tissue left in your womb, no treatment is required.
However, if there’s still some pregnancy tissue in your womb, your options are:
- expectant management – wait for the tissue to pass out of your womb naturally
- medical management – take medicine that causes the tissue to pass out of your womb
- surgical management – have the tissue surgically removed
The risk of complications is very small for all these options. It’s important to discuss them all with the doctor in charge of your care.
If you have a miscarriage in your first trimester, you may choose to wait 7 to 14 days after a miscarriage for the tissue to pass out naturally. This is called expectant management.
If the pain and bleeding have lessened or stopped completely during this time, this usually means the miscarriage has finished. You should be advised to take a home pregnancy test after 3 weeks.
If the test shows you’re still pregnant, you may need to have further tests.
If the pain and bleeding have not started within 7 to 14 days or are continuing or getting worse, this could mean the miscarriage has not begun or has not finished. In this case, you should be offered another scan.
After this scan, you may decide to either continue waiting for the miscarriage to occur naturally, or have drug treatment or surgery. If you choose to continue to wait, your healthcare professional should check your condition again up to 14 days later.
Contact your hospital immediately if the bleeding becomes particularly heavy, you develop a high temperature (fever) or you experience severe pain.
You may choose to have medicine to remove the tissue if you do not want to wait, or if it does not pass out naturally within 2 weeks. This involves taking tablets that cause the cervix to open, allowing the tissue to pass out.
In most cases, you’ll be offered tablets called pessaries that are inserted directly into your vagina, where they dissolve.
The tablets usually begin to work within a few hours. You’ll experience symptoms similar to a heavy period, such as cramping and heavy vaginal bleeding. You may also experience vaginal bleeding for up to 3 weeks.
In most units, you’ll be sent home for the miscarriage to complete. This is safe, but ring your hospital if the bleeding becomes very heavy.
You should be advised to take a home pregnancy test 3 weeks after taking this medicine. If the pregnancy test shows you’re still pregnant, you may need to have further tests.
You may be advised to contact your healthcare professional to discuss your options if bleeding has not started within 24 hours of taking the medicine.
In some cases, surgery is used to remove any remaining pregnancy tissue. You may be advised to have immediate surgery if:
- you experience continuous heavy bleeding
- there’s evidence the pregnancy tissue has become infected
- medicine or waiting for the tissue to pass out naturally has been unsuccessful
Surgery involves removing any remaining tissue in your womb with a suction device. You should be offered a choice of general anaesthetic or local anaesthetic if both are suitable.
After a miscarriage
A miscarriage can be very upsetting, and you and your partner may need counselling or support. You may also have questions about trying for another baby and what happens to the miscarried foetus.
For more information, read what happens after a miscarriage.
Page last reviewed: 01 June 2018
Next review due: 01 June 2021
What to Expect After an Endometrial Ablation
Women with extremely heavy periods (who soak through a pad every two hours) have been turning to endometrial ablation to combat their most intense symptoms. During your period, your body sheds endometrium, or the lining of the uterus, and this procedure destroys (or ablates) that endometrium. While this surgery is not for everyone, such as people who have been recently pregnant or hope to get pregnant, the women who get this procedure experience relief from their severe period symptoms.
If you have usually heavy periods across many days and are looking into this as a possible solution, you may be asking yourself, “What can I expect after an endometrial ablation?” This FAQ can help point out the different symptoms and experiences of women who have this common procedure.
Is bleeding after endometrial ablation normal?
Yes, vaginal bleeding for a few days is a normal part of endometrial ablation recovery. You will likely want to wear pads; do not use tampons, douche or have sex in the first few days to the first week. Persistent bleeding, though, may be a concern and may require a pelvic exam as well as a conversation with your doctor about next steps, which may lead to a future hysterectomy.
Will periods go away forever after the surgery?
Most women (9 out of 10) will either have no periods or lighter periods after endometrial ablation. It is possible that your period will come back heavier after a few years.
Is it normal to experience discharge after ablation?
It’s normal to experience a thin, watery discharge after ablation. The discharge may also be bloody or mixed with blood. It will likely be heavy for the first few days after your surgery. Any endometrial ablation discharge should stop after, at the latest, a few months. If your discharge changes in color or smell, call your doctor right away.
Can you have kids after endometrial ablation?
Pregnancy after an endometrial ablation is unlikely, but possible, which is potentially dangerous. If pregnancy does happen after ablation, serious and sometimes deadly complications can occur. This type of surgery is not an alternative to a hysterectomy or sterilization surgery, so talk to your doctor if that is one of your needs. Women should still use forms of birth control after uterine ablation, as pregnancy remains possible until after menopause.
Is back pain after endometrial ablation normal?
Largely, back pain is not normal, though some abdominal cramping immediately following the surgery is to be expected. In rare cases, some women develop cyclic pelvic pain (CPP) after the procedure, which can last for months or even years. This may be a potential indication of late-onset endometrial ablation failure. If you experience back pain after the surgery, call your doctor.
Which symptoms are a cause for concern?
These are warning signs of infections or complications after your endometrial ablation:
- A fever
- Increased pain and swelling after a few days
- Trouble passing gas and/or stool
- Being sick to your stomach
- Trouble drinking fluids
- Trouble urinating
- A change in the vaginal discharge in color or smell
- An increase in bleeding for longer than two days after the procedure
- Large clots in the vaginal discharge
- Signs of a blood clot in your leg (such as pain or swelling in the leg)
- Persistent abdominal pain after the normal cramping
If you are experiencing any other unusual symptoms, please contact your doctor.
What are some other long-term side effects of having an endometrial ablation?
Immediately after surgery, women should expect cramps, some vaginal discharge and frequent urination. In the follow-up after endometrial ablation, excessive bleeding, holes in the uterus, impacts on other organs and discharge should be watched carefully. Long-term risk factors often depend on the type of surgery you’re having (whether it’s electrosurgery, microwaves, a heated balloon or other method removing the lining), but some of the less common risk factors include hematometra, which is the retention of blood in the uterine cavity caused by obstructed menstrual flow, post-ablation tubal sterilization syndrome and delays in finding and diagnosing endometrial cancer. Talk to your doctor about the details of your specific procedure for endometrial ablation. Sexually active individuals should keep in mind that pregnancy is possible but unsafe after an ablation.
If you want to know if you’re right for this surgery or more about the potential long-term symptoms, call us at (678) 253-2179 or schedule with us online.
Postoperative FAQ’s – Samuel A. Taylor, MD
What are some warning signs of infection?
- If you have a measured temperature greater than 101.5°F, recurrent chills, yellow or foul smelling drainage, or increasing redness around the incisions you should call the office.
What if I have a low-grade fever after surgery?
- A have a low-grade fever (less than 101.5°F) during the first week after your surgery is common. This is a normal response by your body to the stress of surgery. Drinking plenty of fluids and taking deep breaths is helpful.
Is the swelling normal?
- Yes, some swelling is normal. For lower extremity surgery, it will be worse when the leg is down and better when the leg is elevated. Elevation and ice can be very helpful. If the swelling does not go down or you start to develop calf pain please notify the office. For upper extremity surgery, movement of the wrist/hand/fingers, particularly repetitive squeezing an object such as silly putty can help reduce swelling
Why is there bruising that tracks down the operative limb?
- This is normal after surgery. Blood from the surgical site is pulled down by gravity and causes bruising in locations away from the area that was operated on. Some people get bruising into the foot after knee surgery or the fingers after shoulder surgery. You should not be alarmed it will resolve over 3-5 weeks. The amount of such bruising varies by person.
Is pain normal?
- Yes, surgery is painful. The most pain will occur within the first 72 hours after surgery. There is no purpose in “being a hero” during this time. During the early postoperative period, pain is like fire, if you wait too long to put it out it gets out of control. Take your pain medicines when scheduled for the first few days and then you can begin to space them out. Remember, it takes 30-45 minutes for a pain pill to begin working, so do not wait for the pain to become unbearable before taking the next dose. Also, ice is one of the most important parts of pain relief.
How often should I ice?
- Ice and elevation are your best friends! You should ice around the clock (30 minutes on, 30 minutes off) for the first 3-5 days. Then ice at least 3 times per day thereafter. Be sure to place a thin towel between the ice and your skin.
Should fluid draining from the incisions alarm me?
- If you had arthroscopic surgery, some draining fluid onto the dressing is normal during the first 24-48 hours because we use large amount of water during the surgery and it is therefore only natural for some of this fluid to leak out while your body absorbs the rest. If the bulky bandage becomes wet and red, do not be alarmed; just reinforce it with another bandage. If you have persistent drainage 4 days after surgery, please contact the office.
How do I take off the bandage?
- You may remove the dressing 72 hours after surgery. For knee surgery, remove the ACE wrap and gauze underneath throw it away. For shoulder surgery, carefully peal back the tape and remove the gauze underneath. If there are pieces of yellow gauze you may remove them. Do NOT remove any steri-strips if present. The incisions can stay open to air at this point. You may cover them if you wish with a clean ACE wrap, Band-Aids, or loose gauze dressing so it does not rub/catch on your clothes. Do NOT apply any ointments, creams, or gels.
How do I elevate?
- For lower extremity surgery, prop the leg up (elevation) using several pillows or blankets underneath. Elevation is extremely important to limits swelling and pain after surgery. Proper elevation works by gravity. The foot should be higher than the knee, which should be higher than the hip allowing gravity to pull the fluid/swelling back towards the heart.
What activities can I do?
- It is very important for you to do as much activity as possible while still adhering to the limits imposed by Dr. Taylor. Simply getting up and walking around the house is important. This will decrease the possibilities of post-anesthesia problems such as pneumonia and blood clots. Generally, if you have a job with little physical activity, you may return to work 3-7 days after surgery. If your job requires excessive lifting or use of the arm, then discuss your return to work date with your doctor.
When can I drive?
- You cannot drive for at least 6 weeks following shoulder surgery or at least 4 weeks following knee surgery depending on the side and type of surgery. Prescription narcotic pain medications impair your motor skill, reaction time and judgment. It is against the law to drive while taking prescription pain medications (even if they were prescribed for you). It is also against the law to drive while you are (or should be) in a sling or brace.
What happens at my first post-operative visit?
- Your first postoperative visit typically occurs 10-14 days after surgery. Dr. Taylor will review your surgery and any arthroscopic photographs. He will outline your post-operative physical therapy protocol. If you have sutures that need to be removed, they will be. You will be provided a copy of your operative report and any arthroscopic pictures for your records.
What if I need a pain medicine refill?
- Only your doctor and his staff can call in pain medication. During the weekend, on call doctors will NOT call in prescriptions for you. Therefore, if you feel that you will need a prescription during the weekend, please call the office during regular business hours.
Postoperative Fever – an overview
Almost 1000 cases of halothane hepatitis were reported worldwide during the 1960s and 1970s,705,713–715 and what emerges is a fairly uniform clinical syndrome of postoperative fever, eosinophilia, jaundice and hepatic necrosis, with a high case-fatality rate, occurring a few days or weeks after anaesthesia, usually after repeat exposure to halothane. Rare cases of halothane-induced liver injury have occurred after workplace exposure among anaesthesiologists, surgeons, nurses and laboratory staff and after halothane sniffing for ‘recreational’ use. In this situation, antibodies can be demonstrated, indicating prior exposure.41,716,717
Two types of postoperative liver injury have been associated with halothane. A mild injury is seen in 10–30% of patients who develop mild asymptomatic elevations in serum ALT values between the first and tenth postoperative day, the risk being higher after a second (or more) exposure to halothane than with subsequent use of agents such as enflurane, isoflurane and desflurane.718,719 There is no evidence of immune activation in these patients.720 The severe form of halothane-induced hepatotoxicity is a rare, dose-independent, severe hepatic drug reaction with elements of immunoallergy and metabolic idiosyncrasy. After an initial exposure to halothane, the frequency is low, estimated to be about 1 : 10,000 exposed persons,721 but increases to about 1 : 1000 after two or more exposures, especially when the repeat anaesthesia occurred within a few weeks. 722,723 Classic halothane hepatitis presents as a hypersensitivity reaction with delayed postoperative fever (5–14 days after anaesthesia), accompanied by rash, eosinophilia and jaundice, which is usually preceded or accompanied by symptoms of hepatitis. Severe hepatocellular necrosis is accompanied by serum ALT levels typically exceeding 1000 U/L and sometimes much higher. The case-fatality rate ranged between 14% and 71% in severe cases.
The hepatic injury is cytotoxic, with both zonal necrosis and steatosis. Perivenular zonal necrosis, resembling that of CCl4 as described by Morgenstern et al.724 and Peters et al.,725 is the most characteristic lesion, particularly in patients whose prior exposure was recent (Fig. 12.44). In cases described as ‘massive necrosis’, there is often a remnant of residual tissue in the periportal zone, suggesting that the lesion is severe zonal rather than massive necrosis. In a study of 77 cases of halothane hepatitis reviewed by the U. S. Armed Forces Institute of Pathology (AFIP),726 massive or submassive necrosis involving zone 3 was present in all autopsy specimens, while biopsy material revealed a broader range of injury, from spotty necrosis in about one-third of cases and zone 3 necrosis in two-thirds. In mild or moderately severe injury, biopsies show diffuse spotty necrosis, apoptotic bodies and mononuclear infiltration, changes that may be indistinguishable from those of viral hepatitis. The sharp demarcation of the areas of necrosis in halothane injury is an infrequent feature of fatal cases of viral hepatitis. In general, inflammatory infiltration is less prominent in halothane-induced injury than in viral hepatitis, although the liver from some patients may show a prominent, eosinophilic inflammatory response. Granulomatous inflammation is also described.727,728
Halothane injury appears to occur by one or more of three potential mechanisms: (1) immunologically mediated, (2) production of hepatotoxic metabolites and (3) halothane-associated hypoxia, in decreasing order of importance. Evidence for the role of hypersensitivity is found in the increased susceptibility and shortened latency after repeat exposure, the hallmark symptoms and signs of drug allergy (fever, rash, eosinophilia, granuloma formation) and demonstration of neoantigens and antibodies.729 Halothane oxidation yields trifluoroacetylchloride, which acts on hepatocyte proteins to produce neoantigen formation responsible for the major form of injury. In contrast, reductive pathways produce free radicals that can act as reactive metabolites and may have a role in causing minor injury. The hepatotoxic potential of halothane depends on the susceptibility of the patient and factors that promote production of hepatotoxic or immunogenic metabolites.
Adverse prognostic factors include older age (>40 years), obesity, severe coagulopathy, bilirubin >20 mg/dL and a shorter interval to the onset of jaundice.713 As many as two-thirds of cases occurred in persons with a history of previous reactions to halothane, and the majority of cases were associated with repeated use of halothane within 28 days, especially in obese, middle-aged women. 713 Because halothane may leach out of the tubing of anaesthetic devices, prevention of recurrence in sensitized patients requires that the equipment used for anaesthesia should never have been exposed to halothane. Cross-sensitivity between halothane and other haloalkane anaesthetics is best documented for methoxyflurane, an agent that is no longer in use. Cross-reactivity also was reported with enflurane and possibly for isoflurane, as described later, but has not been reported for desflurane and sevoflurane.
90,000 Fever (fever): symptoms, causes, features
Causes of fever
Fever appears when pyrogens – lipids, proteins, toxins and other substances introduced with viruses, bacteria or allergens – enter the bloodstream. They interact with the cells of the immune system. Because of this, cytokines that affect thermoregulation begin to be produced, and the body temperature begins to rise.
There are many reasons for the appearance of a fever. They can be relatively harmless, for example:
- Recent vaccination.
- Teething in children.
- Overheating, if a person has been in the bath for a long time or in the sun in hot weather.
- Eating spicy or hot food.
- Physical activity.
The reasons can also be serious, requiring a visit to a doctor:
- Infectious diseases: influenza and parainfluenza, enterovirus, dysentery, meningitis, fungal, parasitic and other diseases.
- Diseases of the respiratory system: otitis media, pleurisy, pneumonia, bronchitis and others.
- Diseases of the digestive system in acute form: cholecystitis, pancreatitis, appendicitis and others.
- Kidney diseases: glomerulonephritis, pyelonephritis.
- Autoimmune diseases.
- Sepsis, abscess.
- Intoxication: poisoning with low-quality food, ethanol decomposition products (after drinking alcohol), heavy metals.
- Inflammation of the brain: encephalitis, meningitis, meningoencephalitis.
- Formation of malignant tumors.
- Complication of injuries: deep wounds or fractures, electrical injuries.
- A side effect or consequence of an overdose when taking certain medicines.
There are many possible causes of fever, and it is not always possible to accurately determine them. There is a fever of unknown etiology. With it, there are no other symptoms or changes in well-being, and the high temperature persists for up to 3 weeks.
Types of fever
A normal body temperature is 36.6 degrees Celsius, but in a healthy person it may be slightly lower or higher. Body temperature can also change during the day – for example, it may rise slightly after a hearty meal. This is not a fever. An elevated temperature is considered to be 37.1 ° C and above.
There are four degrees of temperature rise:
- subfebrile – 37.1-38 ° C;
- moderate – 38.1-39 ° C;
- high – 39.1-41 ° C;
- excessive – above 41.1 ° C.
Fever can be acute (persists no longer than two weeks, usually resolves in a few days) or subacute (can persist for up to six weeks).
There are six types of fever, which differ in the way the temperature changes:
- Constant. A high temperature with fluctuations in the range of 1 ° C lasts for several days. There is no chill or heavy sweating in the heat.
- Remitting. Daily temperature fluctuations can be 1-2 ° C, while it does not fall to normal values.Its decrease may be accompanied by sweating. Chills may begin periodically.
- Intermittent. Periods of normal and elevated temperatures alternate, and the change in thermometer values can be both sharp and gradual. When the temperature rises, a person feels chills, when he drops, he throws himself into a sweat.
- Perverted. Body temperature is higher in the morning than in the evening.
- Hectic. With such a fever, daily temperature drops are 3-4 ° C, it can fall below normal values.
- Wrong. There are no patterns in body temperature changes. The fever is accompanied by perspiration and chills.
Is fever dangerous?
Fever is normally tolerated by adults and children and is not dangerous. At the same time, it is important to control the values of body temperature and how it changes. Its sharp and rapid increase to values above 40 ° C can be dangerous.
Important! Fever is more difficult to tolerate and is more dangerous for people in old age, for those who have chronic heart or respiratory diseases, endocrine or neurological diseases.Individual intolerance to heat is also possible. In this case, convulsions may occur with the fever.
Most often, with fever, the temperature rises in the range of 38-40 ° C. Higher values are dangerous. If the temperature reaches 42 ° C, the destruction of proteins in cells begins, the release of inflammatory cytokines. Cell work is disrupted. Because of this, there is a failure of most of the internal organs. This condition leads to death.
In some diseases, fever can cause additional complications.It can worsen heart or respiratory failure in patients with chronic heart and respiratory disease. In mental illness, fever can worsen the condition. In children, high fever can cause febrile seizures.
Symptoms and Features
When the temperature rises, several characteristic symptoms appear:
- chills when the temperature rises and sweating when it falls;
- muscle aches;
- decreased appetite;
- pain, pain in the eyes in bright light.
Some additional symptoms may appear in children:
- The skin becomes pale or reddened (blush may appear on the cheeks).
- Decreased appetite or refusal to eat or drink.
- Difficulty swallowing food.
- The child may become irritable, lethargic, but sometimes the fever does not affect behavior and activity in any way.
Severe fever may present with more severe symptoms such as seizures, confusion, vomiting and diarrhea.
Diagnosis of a disease: how to measure temperature
Body temperature is measured to diagnose fever. This can be done in several ways.
To measure the temperature in the armpit, the thermometer is held by hand in the armpit for about 10 minutes. The skin should be dry and the tip of the thermometer should fit snugly against it.
When measuring the temperature in the rectum before the introduction, the tip of the thermometer is lubricated with petroleum jelly and injected to a depth of 2 cm through the anus for 1-2 minutes.The rectal measurement is considered to be the most accurate. It runs quickly and is recommended for young children.
To measure the temperature in the mouth, place the tip of the thermometer under the tongue for 3 minutes (or until the signal of the digital thermometer). They do not eat or drink anything 15 minutes before the thermometry. The method is suitable for adults and children over 4 years old.
An infrared ear thermometer with a specially shaped tip is used to measure the temperature in the ear. The thermometer is brought to the ear, directing it with the sensor towards the ear canal.The measurement is carried out before the sound signal. It is not necessary to insert the tip into the ear canal. The method can be used for children over 6 months old and for adults.
Important! Before and after each temperature measurement (especially if it is performed rectally or orally), the tip of the thermometer should be disinfected with a disinfectant. The same thermometer must not be used for rectal and oral measurements.
If there is no thermometer, you can roughly estimate the temperature by touching.To do this, first you need to touch your own skin, and then the skin of another person: this way you can feel whether it is hot. An indirect sign of fever may be dehydration. To test it, you need to gently pinch the skin on the back of your hand. If the skin does not flatten out instantly, the body may be dehydrated.
Types of thermometers
There are three main types of medical thermometers: mercury, electronic and infrared (Fig. 1). They differ in their principle of operation, accuracy and method of application.
Figure 1. Types of medical thermometers. Source: MedPortal
Mercury is poured into the flask of such a thermometer, the volume of which decreases or increases with a change in temperature. Mercury thermometers are very accurate, they have minimal error, they are suitable for measurements in the armpit, orally or rectally. On the other hand, they have a long measurement time. The mercury they contain is hazardous to health, and the thermometers themselves are fragile and break frequently.Since 2020, mercury thermometers have been banned under the Minamata Convention on Mercury. Russia signed it in 2014.
What to do if a mercury thermometer breaks?
If the mercury thermometer is broken:
- Move people and animals out of the room immediately.
- Put on a damp bandage or mask to protect the respiratory system.
- Turn off the heaters, open the window to lower the air temperature and slow down the evaporation of mercury.
- Close the door to avoid a draft.
- Protect your hands with gloves to avoid skin contact with mercury.
- Collect the mercury in a tightly closed container of water, such as a jar. For collection, you can use a medical syringe, paper, tape or plaster. Do not try to pick up the mercury with a vacuum cleaner or broom.
- A can of mercury can be temporarily placed on the balcony or taken out into the street, leaving it in a place where it will definitely not break.
- In the room, do wet cleaning, wash the floor with plenty of water, without using household chemicals.
- Hand over the collected mercury at the station of the Ministry of Emergency Situations or SES, to the reception point or demercurization center.
Temperature measurement with an electronic thermometer is performed by contact (the thermometer should touch the skin or mucous membrane). The temperature indicator is determined by measuring the electrical resistance of the conductor.Such thermometers can be used to measure the temperature on the skin, in the rectum, in the mouth. Their shape can be traditional, in the form of a strip that is glued to the forehead, in the form of a nipple (used for small children). The measurement is performed quickly. When finished, the thermometer beeps. Among the disadvantages are measurement errors and limited service life. When the warranty expires for an electronic thermometer, it should be checked periodically to ensure that it measures accurately.
They react to infrared radiation of human skin and convert it into temperature values. Measurement is taken in a few seconds. Can be ear (with a special tip). They do not need to be disinfected before or after use. Disadvantages – high price and measurement error up to 0.2 ° C.
Infrared thermometers measure temperature in a few seconds. Photo: https://ru.freepik.com
When and how should the temperature be brought down?
It is not always necessary to use drugs to bring down the temperature.As long as it stays within 38.9 ° C, adults do not need to use antipyretics if they feel normal. The exception is the elderly, as well as people with heart disease, respiratory system, neurological and other serious diseases.
Antipyretic or non-steroidal anti-inflammatory drugs are used to lower the temperature. According to the recommendations of the World Health Organization, drugs based on paracetamol and ibuprofen are considered safe (but they do not need to be used together).In case of fever, medications are taken only if the fever begins to build up (you do not need to drink them constantly). Between doses, the interval recommended by the attending physician or indicated in the drug’s instructions must be observed.
At high temperatures, it is important to use non-drug methods of treatment:
- Rest. It is important to stay at home, relax, and stay in bed.
- Drinking regime. Fever causes dehydration, so the person needs to drink more fluids.This will help remove toxins faster.
- Overheating protection. It is better if the clothes are light, not too warm. The air in the room should be cool. It can be ventilated periodically.
- Rubdown. Wiping down with cool water will help to bring down the heat and improve well-being. To do this, use a damp sponge or napkin, rubbing the skin on different parts of the body for several minutes.
At elevated temperatures, it is important to observe the drinking regime. Photo: https: // ru.freepik.com
Important! A cold bath or shower is not always effective at high temperatures. Cool water will cool the body, but it can also cause muscle tremors and chills, which will only increase the heat.
When a child has a fever, it is important that the temperature does not rise above 38.5 ° C. To do this, you can give the antipyretic drugs recommended by the doctor, make sure that the child does not overheat (you do not need to wrap him up). When the temperature rises, you can rub with cool water, but not with alcohol, vodka or vinegar.It is also necessary to exclude dehydration: everything is in order if the child drinks enough, urinates on average once every four hours, and his urine remains light. To adjust the fluid balance, the child can be given sugary drinks, juices, compotes, water. While the fever persists, you need to constantly monitor the child, monitor his condition and consult a doctor if it worsens (Fig. 2).
Figure 2. What to do at a high temperature in a child. Source: MedPortal
When should you see a doctor?
For fever in an adult, see a doctor if the body temperature rises above 40 ° C, and antipyretic drugs do not help bring it down.The help of a doctor is also needed if an elderly person has a fever, if there are diseases of the heart, respiratory organs, neurological diseases, or a weakened immune system.
For fever in a young child, see a doctor if the temperature rises above 38 ° C for under three months or above 39 ° C for over three years.
Urgent medical care for an adult is needed when the following symptoms appear with a fever:
- severe headache;
- breathing disorders and throat swelling;
- pain in the abdomen or when urinating;
- severe chest pain;
- confusion of consciousness;
- Rapid spread of skin rash throughout the body.
In case of fever in a child, call an ambulance under any of the following conditions:
- The temperature rises in an infant (up to 2 months of age).
- There are signs of severe dehydration (rare urination, dry mucous membranes and tongue, drowsiness or agitation, restlessness, no tears when crying).
- Convulsions appear.
- A rash spreads or bruises develop throughout the body.
- Breathing labored, slow or too fast, intermittent.
- Apathy, drowsiness appears, the child cannot be woken up.
- Severe headache.
As soon as possible, within a few hours, you need to see a doctor if antipyretic drugs do not help bring down the temperature, if the child is less than 6 months old, his condition worsens, or there is a risk of dehydration due to refusal to drink, diarrhea, vomiting.
Fever most often occurs due to infections.Usually he is not dangerous, he does not need to be knocked down. At the same time, it is important to constantly monitor the temperature, measure it, use antipyretics if it rises strongly. If this does not help, the condition worsens, or the person has severe underlying medical conditions, it is important to see a doctor as soon as possible.
- MedicalNewsToday. Fever: What you need to know. – 2020
- Healthline. Do You Have a Fever? How to Tell and What You Should Do Next.- 2020
TEMPERATURE AFTER TOOTH EXTRACTION – Dentistry Severnoye Butovo Delia only high-quality services
A tooth extraction procedure is a surgical intervention, which is often accompanied by an increase in body temperature in the postoperative period. What should patients do when their temperature rises and is it normal, the doctors of the Delia clinic told.
WHY DOES THE TEMPERATURE RISE AFTER TOOTH EXTRACTION?
An increase in body temperature after tooth extraction can be monitored for the following reasons:
- Restoration of gum tissue.Even with the most careful surgical intervention, damage to the soft tissues in the extraction zone is inevitable. As a result, the body reacts to the intervention and the body temperature rises. As a rule, it reaches a maximum of 38 degrees and disappears in a couple of days.
- Excitement. The level of the patient’s emotional state before the procedure is accompanied by a response from the body in the form of an increase in body temperature.
- Infection. Often, in addition to an increase in temperature, a lump or swelling appears in the gums.Infection can occur if an untreated instrument was used during the procedure, or the patient himself did not follow the dentist’s recommendations for home care. The inflammatory process can also appear due to the ingress of harmful bacteria into the hole from other teeth infected with caries.
- Foreign bodies. In rare cases, the cause of an increase in body temperature is foreign bodies in the socket, for example, a fragment of a tooth or part of a cotton swab.
WHAT TO DO IF THE TEMPERATURE RISES?
First of all, it is necessary to determine the reason for the temperature rise.If you do not notice other symptoms, and your condition is improving every day, it is enough just to take an antipyretic.
If additional symptoms are detected (swelling, discharge of pus, pain) or if the temperature persists for more than two to three days, you should seek medical help from a doctor.
The dentist will conduct a series of diagnostic tests to determine the root cause of the fever, if necessary, clean the hole, treat it with an antiseptic and apply a protective bandage.Sometimes the patient is prescribed antibiotics to prevent complications.
Do not delay visiting the dental clinic, because if complications have already begun, the treatment will be longer and more complicated.
90,000 Recommendations after vaccination on the website of the clinic CHILDHOOD Plus
Our tips will help you understand the procedure after vaccination:
In the first 30 minutes after vaccination
Do not forget and do not hesitate to ask your doctor your questions.The doctor will explain what reactions to the vaccine may occur and when, as well as in what cases to seek medical help.
Take your time to leave the clinic or medical center. Sit for 20-30 minutes near the office. Firstly, it will help you calm down, and secondly, it will allow you to quickly provide assistance in the event of unpredictable immediate allergic reactions to the vaccine.
If the baby is breastfed, breastfeeding will help him calm down.
If the child is old enough, please him with some pleasant surprise, reward him with something, praise him. Tell him everything is okay.
Upon returning home after vaccination
If the child’s temperature rises above 38.5 C (in the armpit), give him a dose (candle or syrup) of antipyretic. For this purpose, paracetamol (calpol, cefekon, efferalgan, panadol and others) or ibuprofen (nurofen, ibufen and others)
If the child does not have a fever, you can take a shower as usual.The presence of reactions at the injection site is not a contraindication to bathing, and even vice versa.
First night after vaccination
Most often, temperature reactions to inactivated vaccines occur in the first day or two after vaccination.
In case of temperature reactions, you can wipe the child with water at room temperature. Do not use alcohol and vinegar for rubbing – they irritate and dry baby skin.
Give the child antipyretic only according to indications – at a temperature above 38.5 C (in the armpit).Remember that the daily dosage of paracetamol or ibuprofen is not unlimited (!!!). In case of an overdose, severe complications are possible. Carefully read the instructions for the drug you are using.
Never use aspirin! Its use in young children is fraught with serious complications. Analgin is a drug that can be administered to children only by injection (not through the mouth or in a candle!), Under the supervision of a doctor or ambulance teams.
The first two days after vaccination (all vaccines)
Do not introduce new foods into your baby’s diet (and into your diet if the baby is breastfed). This can be done on the 3rd day after vaccination and later.
Take whatever medications your doctor has prescribed to prevent allergies.
Monitor your baby’s body temperature. Try so that it does not rise above 38.5 C (in the armpit).If the temperature remains elevated, continue to take antipyretic drugs as directed.
In some children, against the background of an increase in temperature, the appearance of so-called febrile seizures is possible. In this case, it is necessary for the child to be examined by a doctor.
You can walk with your child (if you feel), you can bathe him in the shower.
If the Mantoux test was carried out – when bathing, try to prevent water from getting into the place where the sample was taken.Remember that sweat is also liquid, so make sure that your child’s hand does not sweat (do not cover the sample area with anything).
In the event of strong reactions at the injection site (swelling, induration, redness), contrasting lotions can be used topically (alternating between a cloth soaked in room temperature water and a cloth soaked in warm water), and also use ointments recommended by a doctor.
After vaccination – does not always mean “due to vaccination”
If there is any adverse reaction after 48 hours after vaccination with an inactivated vaccine, then the vaccination is 99% likely to have nothing to do with it.The most common cause of temperature and some other reactions in young children is teething, in older children – colds.
In any case, a temperature reaction that persists for more than 3 days after vaccination requires a doctor’s examination of the child.
5-12 days after vaccination (live vaccines)
In the case of vaccination with live vaccines, adverse reactions usually occur 5-12 days after vaccination.
Measles vaccine sometimes causes a temperature reaction, a runny nose, sore throat, coughing, conjunctivitis, and sometimes a small measles-like rash. All these symptoms disappear in 2-3 days by themselves.
Rubella vaccine is often accompanied by a short-term rash similar to rubella itself. Such a rash does not require treatment, it is not dangerous and goes away on its own in 1-2 days, without a trace.
The mumps vaccine also occasionally produces fever reactions and a slight enlargement of the parotid glands.
In the case of vaccination with a live polio vaccine, there are practically no adverse reactions, but after vaccination it is necessary to follow the rules of personal hygiene (separate bed, pot, bedding, clothes and isolation of the vaccinated child in the family from immunodeficient patients).
If, after reading this article, you still have any questions about vaccinations, please contact your doctor.
We wish you and your children health!