Curettage of the cervical canal of the uterus temperature 37 3. Why is curettage of the cervical canal done. Why is cervical canal curettage performed? Preparing for surgery. Technique for uterine curettage

After visiting a gynecologist, many patients are prescribed an operation to curettage the uterine cavity. Some women also call this operation a cleansing. There is no need to worry about such an operation, since it is not as scary as it seems, and now you will see for yourself.

Let's figure out what curettage of the walls of the uterus is and why it is used in gynecology?

The uterus is a muscular organ; doctors call it the pyriform body, since the shape of the uterus is very similar to a pear. Inside the piriform body there is a mucous membrane, the so-called endometrium. It is in this environment that the child grows and develops during pregnancy.

Throughout the menstrual cycle, the membrane of the piriform body grows, accompanied by various physical changes. When the cycle comes to an end and pregnancy does not occur, all the mucous membranes leave the body in the form of menstruation.

When performing a curettage operation, doctors remove exactly that layer of mucous membrane that has grown during the menstrual cycle, that is, only the surface layer. The uterine cavity, as well as its walls, are scraped out using instruments along with the pathology. This procedure is needed both for therapeutic purposes and for the diagnosis of such pathologies. Curettage of the walls is carried out under the supervision of hysteroscopy. After the operation, the scraped layer will grow again in one menstrual cycle. In fact, this entire operation is reminiscent of menstruation, performed under the supervision of a doctor and with the help of surgical instruments. During the operation, the cervix is also scraped out. Treated samples from the cervix are sent for analysis separately from scrapings from the piriform body cavity.

Advantages of the technique under hysteroscopy control

Simple curettage of the uterine mucosa is carried out blindly. When using a hysteroscope, the attending physician examines the cavity of the piriform body using a special device, which he inserts through the cervix before starting the operation. This method is safe and of higher quality. It allows you to identify pathologies in the uterine cavity and carry out curettage without any risks to the woman’s health. After the operation is completed, you can check your work using a hysteroscope. The hysteroscope allows you to evaluate the quality of the operation and the absence or presence of any pathologies.

Indications for RDV

Carrying out this type of operation has several goals. The first goal is to diagnose the uterine mucosa, the second is to treat pathologies inside the uterus.

During diagnostic curettage, the doctor obtains a scraping of the lining of the uterine cavity for further study and identification of pathology. Therapeutic curettage of the uterine cavity is used for polyps (growths of the uterine mucosa), since there are no other methods of treating this pathology. Also, curettage can be used as post-abortion therapy, as well as for abnormal thickening of the uterine cavity mucosa. Curettage is also used for uterine bleeding, when the nature of the bleeding cannot be determined, and curettage can stop it.

Preparing a woman for the Russian Far East

With planned curettage, the operation is performed before the onset of menstruation. Before the operation begins, the patient must undergo some tests. First of all, this is a general blood test, cardiogram, test for the presence/absence of HIV infection, test for various types of hepatitis, as well as a test for blood clotting. The patient must undergo complete depilation of pubic hair and also purchase sanitary pads. It is recommended not to eat before surgery. You should also bring a clean T-shirt, hospital gown, warm socks and slippers.

Typically, the operation of curettage of the uterine cavity is not very complicated and is carried out within 20 – 25 minutes. There should be no complications after the operation. In the postoperative period, the attending physician may prescribe a short course of antibiotics. This course should be taken to avoid any complications.

Histology results will be ready within 10 days. If you experience abdominal pain during the postoperative period, you should contact your doctor.

I would like to note that the operation of curettage of the uterine cavity is the safest and most painless operation in the field of gynecology.

Separate diagnostic curettage– instrumental removal of the mucous membrane of the cervical canal, and then the mucous membrane of the uterine body.

Indications for separate diagnostic curettage:

1) to determine the state of the mucosa in various benign and malignant processes (hyperplastic promalignant processes (hyperplastic processes, precancerous changes, cancer)

2) if there is a suspicion of the remains of a fertilized egg

3) if endometrial tuberculosis or polyposis of the mucous membrane is suspected

4) for menstrual disorders

Contraindication for diagnostic curettage: acute inflammatory processes in the genital organs.

Technique of separate diagnostic curettage:

1. Separate diagnostic curettage is carried out in a hospital setting with strict adherence to the rules of asepsis and antisepsis.

2. Anesthesia: local paracervical anesthesia with a 0.25% solution of novocaine or mask anesthesia (nitric oxide, ftorotan).

3. After disinfection of the external genitalia and vagina, the cervix is exposed using mirrors, treated with alcohol and grabbed by the front lip with bullet forceps. If the uterus is in retroflexion, then it is better to grab the cervix by the back lip.

4. The uterine cavity is probed and the cervix is dilated with Hegar dilators up to No. 9-10. Expanders are introduced, starting with small numbers, only with the strength of the fingers, and not with the whole hand. The dilator is not brought to the fundus of the uterus; it is enough to pass it through the internal os. Each dilator should be left in the canal for a few seconds; if the subsequent dilator enters with great difficulty, then the previous dilator should be inserted again.

5. First, the mucous membrane of the cervical canal is scraped, without going beyond the internal os. The scraping is collected in a separate tube.

6. After scraping the mucous membrane of the cervical canal, they begin to scrape the walls of the uterine cavity, using sharp curettes of different sizes. The curette should be held freely, without resting on the handle. It is carefully inserted into the uterine cavity to the fundus of the uterus, then the curette handle is pressed so that the loop slides along the wall of the uterus, and it is brought out from top to bottom to the internal os. To scrape the posterior wall, without removing the curette from the uterine cavity, carefully turn it 1800. Curettage is performed in a certain order: first, the anterior wall is scraped, then the left lateral, posterior, right lateral and corners of the uterus. The scraping is collected into another tube, two tubes are signed, noting where the scraping came from, and sent for histological examination.

7. After curettage, the patient is taken to the ward on a gurney. Cold is prescribed to the lower abdomen. After 2 hours you are allowed to get up. Discharged under the supervision of a antenatal clinic on the 3rd day, if there are no complications.

Every woman tries to take care of her health. After all, many gynecological diseases, if not treated in time, can lead to infertility or even threaten life. One of the popular ways to eliminate pathologies associated with the reproductive system is curettage of the cervical canal and uterine cavity. But many girls, having heard about the method there, refuse it. Everything, because not everyone knows what it is and why curettage is needed.

What is curettage?

Curettage of the uterine cavity is a gynecological operation, the purpose of which is to scrape the upper functional layer of the mucous cavity (endometrium). In gynecology, separate diagnostic curettage (RDC) is also used, separate because cleaning is performed in stages, first the cervical canal is scraped, and only then the uterine cavity.

The cervical canal is the space connecting the uterine cavity and vagina. It is through this passage that active sperm move to fertilize a mature egg. For example, inflammation can occur not only in the cavity, but also in the cervical canal itself. Sexually transmitted infections are diagnosed quite often.

During the examination, the gynecologist can only see the presence of incomprehensible mucus, then a smear is taken and sent for analysis. If the true cause cannot be determined, curettage of the cervical canal is prescribed.

Many are interested in why it is diagnostic, but everything is simple: after collecting highly informative material, it is sent for histology to accurately establish the diagnosis or confirm it.

During the cleaning process, only the top layer of the endometrial mucosa is collected, so the lining of the uterine cavity is easily restored.

The main goal of separate diagnostic curettage is to make sure that the collected material does not degenerate into cancer cells.

An important stage of this procedure is the examination of the endometrial mucosa, since the results can reveal the following abnormalities:

uterine fibroids;
dysplasia;
internal endometriosis;
hyperplasia;
erosion;
damage to myomatous nodes;
nature of formations;
polyposis;
cervical cancer;
hyperplasia of the uterine cavity, glandular-cystic type.

Based on the results obtained and if indicated, the gynecologist develops an individual course of treatment for the patient. Separate curettage is not only a diagnostic procedure, but also a therapeutic one, during which the immediate focus of inflammation in the uterine cavity is removed.

Indications, contraindications and complications

Of course, a procedure such as curettage has its own indications and contraindications. Also, before the procedure, the gynecologist must prescribe a series of laboratory and medical tests to make sure that there are no contraindications, for example, infections, inflammations and concomitant gynecological diseases.

Separate curettage is indicated for the following deviations:

systematic disruptions in the menstrual cycle;
bloody vaginal discharge between periods (if the spotting is constant, this is a reason to urgently visit a gynecologist);
heavy discharge and unbearable pain during menstruation (danger of uterine bleeding);
vaginal discharge of blood after menopause;
diagnosis of infertility or difficulties with fertilization;
suspicion of oncology;
manipulations related to uterine fibroids;
before planned surgery;
with changes in the endometrium;
unsuccessful abortion or remaining parts of the fetus or placenta in the uterine cavity;

Contraindications include acute inflammatory and infectious diseases of the female reproductive organs. Such contraindications are considered absolute.

In fact, whether there will be complications or not depends on the experience and accuracy of the operation by the surgeon. Therefore, if the specialist is experienced and did everything correctly, complications should not arise.

Complications after RDV:

perforation of the uterus;
tear or rupture of the neck;
inflammation and infection in the uterus, if infection or microbes are introduced, in such a situation antibacterial drugs are prescribed;
hematometra - accumulation of blood in the cavity; in order to relieve spasm of the cervix, antispasmodic drugs are prescribed for several days after curettage;
excessive curettage, which damages the mucous layer, threatens that the walls may not recover.

Stages of preparation for the procedure

It is imperative to prepare for diagnostic curettage. The first thing you need to do is pass all the prescribed medical and laboratory tests.

Preparatory activities:

general blood analysis;
smear of vaginal microflora;
transvaginal ultrasound examination;
coagulogram;
electrocardiogram;
eliminate inflammation and infections;
analysis for syphilis, HIV infection, hepatitis A, B, C.

To minimize the risk of uterine bleeding during manipulation, curettage is carried out before menstruation, a couple of days. For such a diagnostic operation, anesthesia is used, because the process of dilation of the cervix is quite unpleasant and painful.

During the operation, the patient sleeps deeply. Curettage is performed on a gynecological chair using a medical instrument - a curette. With its help, the operating surgeon carefully removes the top layer from the mucous membrane of the cervical canal and uterus. The sampling information material is collected in a test tube and sent for histology. The procedure lasts about 40 minutes, after which the patient is placed in a ward, where she is under the supervision of medical personnel for several hours.

A week before the proposed operation, it is necessary to abstain from intimacy and douching. On the day of surgery you should not eat or drink. Immediately before the operation, the woman performs toileting of the genitals.

How does the Russian Far East go:

To begin with, the doctor carefully treats the necessary organs with disinfectants.
Intravenous anesthesia is administered.
A speculum is inserted into the vagina to help determine the location of the uterus.
A dilator is carefully inserted into the vagina; it allows you to fix the cervix and expand the cervical canal.
Curettage is performed using a curette.
A scraping of a sample of the material is placed in a sterile tube, which is sent for histological analysis.

Only the upper mucous layer of the endometrium is taken, the basal layer is not affected and does not suffer.

All materials on the site were prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative in nature and are not applicable without consulting a doctor.

A huge number of women of reproductive age and menopause experience uterine curettage. The intervention is quite traumatic, but it happens that you cannot do without it, because gynecological pathology is very common, and in many medical institutions more gentle diagnostic methods are simply not available.

Nowadays, curettage has ceased to be the main method of diagnosis and treatment. They are trying to replace it with more modern and safe manipulations, which provide no less information for the further management of the patient. In developed countries, curettage has long given way to diagnostics, and curettage is performed very rarely and more often for therapeutic purposes.

At the same time, it is not possible to completely abandon the method: not all clinics have the necessary endoscopic equipment, not all have trained specialists, and some endometrial diseases require urgent treatment, and then curettage is the fastest and most reliable way to eliminate the pathology.

Curettage of the endometrium and cervical canal is one of the most radical methods of treatment in gynecology. In addition, it makes it possible to obtain a large volume of material for histological analysis. However, the traumatic nature of the operation causes many risks and dangerous complications, so curettage, or curettage, is usually prescribed for really good reasons.

curettage of the uterus

Uterine curettage is carried out only in an operating room - this is one of the main and mandatory conditions of the operation, the reason for which is that during the procedure serious complications can arise, for the quick elimination of which there are no conditions in any antenatal clinic. In addition, general anesthesia required for curettage should also be performed exclusively in a hospital and by a competent anesthesiologist.

Typically, a woman who is scheduled for curettage experiences a well-founded fear of the procedure itself and its consequences, especially if there are plans for childbearing in the future, so a qualified gynecologist must explain to the patient the advisability of intervention in her case and take all measures to prevent dangerous consequences.

Indications and contraindications for uterine curettage

Separate curettage of the uterine cavity and cervical canal is most often indicated for tissue collection for histological analysis, which is why it is called diagnostic. The therapeutic goal of the intervention is to remove the altered tissue and stop bleeding. The reasons for curettage of the uterine cavity are:

Metrorrhagia - intermenstrual, postmenopausal and dysfunctional bleeding;
Diagnosed hyperplastic process, polyp formation, tumor pathology of the mucous membrane;
Incomplete abortion, when fragments of placental tissue or an embryo could remain in the uterus;
Termination of short-term pregnancy;
Dissection of adhesions (synechias) in the uterus.
Postpartum endometritis.

Uterine bleeding, perhaps, remains the most common cause of curettage. In this case, the operation has, first of all, a therapeutic purpose - to stop the bleeding. The resulting endometrium is sent for histological examination, which makes it possible to clarify the cause of the pathology.

curettage for endometrial polyp

Curettage for polyp and endometrial hyperplasia, diagnosed by ultrasound, eliminates the pathological process, and histology clarifies or confirms the existing diagnosis. If possible, polypectomy is performed through hysteroscopy, which is less traumatic but just as effective as curettage.

Curettage is not uncommon after medical abortion and childbirth, when continued bleeding may indicate retention of fragments of placental tissue, an embryo, in the uterine cavity, and the formation of a placental polyp. Postpartum acute inflammation of the inner lining of the uterus (endometritis) is also treated by removing the inflamed tissue and is supplemented by subsequent conservative treatment with antibiotics.

Curettage can be performed as a medical abortion. Thus, curettage of a frozen pregnancy diagnosed at a short term is one of the main methods of removing pathology, widely practiced in most countries of the post-Soviet space. In addition, a pregnancy that is developing favorably is terminated in this way if it is not possible or the deadline for vacuum aspiration is missed.

A woman who decides to undergo curettage during a normally developing pregnancy is always notified by the doctor about the possible consequences of the procedure, including the main one - infertility in the future. There are also certain risks when curettage of a frozen pregnancy, so a competent specialist will try to avoid this operation altogether or suggest a vacuum abortion.

Adhesions (synechias) in the uterine cavity can be eliminated with a curette, but this pathology is increasingly becoming an indication for curettage due to the introduction of hysteroscopic techniques. After instrumental dissection of synechiae, there is a risk of their re-formation and inflammatory complications, so gynecologists try to avoid such radical action.

hysteroscopy

If there are absolute indications for curettage, then it is advisable to supplement it with hysteroscopy, because acting blindly, the doctor cannot rule out that the operation is not radical enough, and a hysteroscope makes it possible to examine the surface of the uterus from the inside and make the treatment as effective as possible.

Diagnostic curettage The uterus can be performed as planned when, during examination and ultrasound, the gynecologist suspects hyperplasia or tumor growth. The purpose of such an operation is not so much treatment as obtaining fragments of the mucosa for pathohistological analysis, which makes it possible to accurately say what exactly is happening to the endometrium.

In the vast majority of cases, during curettage, the gynecologist sets the task of obtaining not only the endometrium, but also the lining of the cervical canal, which will somehow be passed through by the instrument, so curettage of the cervical canal is usually a stage of one large operation.

The mucous membrane of the cervical canal has a different structure from the endometrium, but polyp formation and tumor growth also occur in it. It happens that it is difficult to determine where exactly the process comes from, but the pathology can also be combined, when one thing happens in the endometrium, and something completely different happens in the cervical canal.

Separate curettage of the cervical canal and uterine cavity necessary to obtain tissue from both parts of the organ, and to prevent it from mixing, the gynecologist first takes samples from one part, placing them in a separate container, and then from the other. This approach allows the most accurate assessment of the changes occurring in each area of the uterus through histological analysis of the tissue obtained.

When prescribing curettage, the doctor must take into account the presence contraindications, which are considered to be inflammatory changes in the genital tract, acute general infectious diseases, suspicion of perforation of the uterine wall, severe concomitant decompensated diseases. It is worth clarifying, however, that when curettage is performed for health reasons (massive uterine bleeding), in the case of acute endometritis after childbirth or abortion, the doctor may neglect some obstacles, since the benefits of the operation are incommensurate with the possible risks.

Video: separate diagnostic curettage

Preparation for curettage

In preparation for separate curettage, a woman will have to undergo a series of studies if the procedure is scheduled. In case of urgent surgery, you will have to limit yourself to a minimum of general clinical tests. When preparing for treatment, you should not only take with you the examination results, clean linen and a gown, but also do not forget about disposable hygiene products, because after the operation there will be bloody discharge from the genital tract for some time.

Preoperative preparation includes:

General and biochemical blood tests;
Urine examination;
Determination of blood clotting;
Clarification of group affiliation and Rh factor;
Examination by a gynecologist with taking a smear for microflora and cytology;
Colposcopy;
Ultrasound of the pelvic organs;
Electrocardiography, fluorography;
Examination for syphilis, HIV, viral hepatitis.

Upon admission to the clinic, the attending physician talks with the patient, who ascertains the obstetric and gynecological history, clarifies the presence of allergies to any drugs, and necessarily records what medications the woman takes constantly.

Aspirin-based medications and anticoagulants are discontinued before surgery due to the risk of bleeding. On the eve of curettage, the last meal and water are allowed 12 hours in advance if general anesthesia is planned. Otherwise, eating and drinking is allowed, but you should not get carried away, because the load on the gastrointestinal tract can affect the course of the postoperative period.

In the evening before the operation, you should take a shower, thoroughly hygienically wash the genitals, and shave your hair. Douching and the use of vaginal medications are completely excluded at this point. According to indications, a cleansing enema or mild laxatives will be prescribed. If you are nervous on the eve of surgery, you can take mild sedatives (valerian, motherwort).

Technique for uterine curettage

Curettage of the uterine cavity is the excision of the upper, regularly renewed, layer of the mucous membrane using sharp surgical instruments - curettes. The basal layer should remain intact.

The introduction of instruments into the uterus through the cervical canal implies its expansion, and this is an extremely painful stage, so pain relief is a necessary and mandatory condition for the operation. Depending on the woman’s condition and the characteristics of the pathology, it can be used local anesthesia(paracervical injection with anesthetic), but most women still experience severe pain. General intravenous anesthesia can be considered more preferable, especially in patients with a labile psyche and a low pain threshold.

Curettage of the uterus is carried out in several steps:

The genital tract is treated with antiseptic agents.
Exposing the uterine cervix in the speculum and fixing it with special forceps.
Slow instrumental expansion of the cervical foramen.
Manipulation with a curette with excision of the upper layer of the endometrium - actually curettage.
Removal of instruments, final treatment of the cervix with antiseptics and removal of fixing forceps.

Before the intervention begins, the bladder is emptied by the woman herself or a special catheter is inserted into it for the entire duration of the manipulation. The patient lies in a gynecological chair with her legs apart, and the surgeon performs a manual examination, during which he clarifies the size and location of the uterus relative to the longitudinal axis. Before inserting the instruments, the genital tract and vagina are treated with an antiseptic, and then special surgical mirrors are inserted, which are held by an assistant throughout the procedure.

uterine cavity curettage technique

The uterine cervix, exposed in the speculum, is grabbed with forceps. The length and direction of the organ cavity are determined by probing. In most women, the uterus is slightly tilted towards the symphysis pubis, so the instruments face the concave surface anteriorly. If the gynecologist has determined that the uterus is deviated backwards, then the instruments are inserted in the opposite direction to avoid injury to the organ.

To access the inside of the uterus, you need to widen the narrow cervical canal. This is the most painful stage of the manipulation. Expansion occurs using metal Hegar dilators, starting with the smallest and ending with the one that will ensure subsequent insertion of the curette (up to No. 10-11).

Tools must be carried out as carefully as possible, using only the brush, but not pushing them inside with the force of the whole hand. The dilator is inserted until it passes the internal uterine os, then it is held motionless for several seconds, and then changed to the next one of larger diameter. If the next dilator does not pass or is very difficult to advance, then the previous smaller size is reintroduced.

Curette- this is a sharp metal instrument that resembles a loop moving along the wall of the uterus, as if cutting off and pushing the endometrial layer towards the exit. The surgeon carefully brings it to the bottom of the organ and moves it to the exit with a faster movement, lightly pressing on the wall of the uterus and excising areas of the mucous membrane.

Scraping is carried out in a clear sequence: front wall, back, side surfaces, pipe corners. As mucosal fragments are removed, the curettes are changed to a smaller diameter. Curettage is carried out until the surgeon feels the smoothness of the inner layer of the uterus.

Supplementing the operation with hysteroscopic control has a number of advantages over “blind” curettage, Therefore, if you have the necessary equipment, it is unacceptable to neglect it. This approach not only provides a more accurate diagnosis, but also helps minimize some of the consequences. With hysteroscopy, the doctor has the opportunity to specifically take material for histology, which is important if cancer is suspected, as well as examine the wall of the organ after cutting off pathologically altered tissues.

When curettage, only the functional layer of the endometrium is removed, which undergoes cyclic changes, “growing” towards the end of the menstrual cycle and sloughing off during the menstrual phase. Careless manipulation may damage the basal layer, due to which regeneration occurs. This is fraught with infertility and menstrual dysfunction in the future.

Particular care should be taken in the presence of uterine fibroids, which with their nodes makes the lining tuberous. Careless actions by a doctor can cause injury to myomatous nodes, bleeding and tumor necrosis.

Curettage for endometrial hyperplasia gives abundant scraping of the mucous membrane, but even with a tumor, a large volume of tissue can be obtained. If the cancer grows into the wall of the uterus, it can be damaged by the curette, which the surgeon must remember. During an abortion, curettage should not be carried out until there is a “crunch”, since such a deep impact contributes to traumatization of the neuromuscular structures of the organ. An important point when removing a frozen pregnancy is the subsequent histological examination, which can help determine the cause of the embryo development disorder.

At the end of curettage, the doctor removes the forceps from the cervix, performs a final treatment of the genitals with a disinfectant, and removes the speculum. The material obtained during the intervention is placed in a bottle with formaldehyde and sent for histology. If carcinoma is suspected, separate curettage is always performed - the first step is to scrape the cervical canal, then the uterine cavity with tissue taken for histology in different bottles. The mucous membrane of different parts of the reproductive system is necessarily marked when sent for analysis.

Postoperative period and possible complications

In the postoperative period, the patient is prescribed a gentle regimen. For the first 2 hours, it is forbidden to stand up; an ice pack is placed on the lower abdomen. By the evening of the same day you can get up, walk, eat and shower without any significant restrictions. If the postoperative period is favorable, you will be allowed to go home for 2-3 days. for observation by an obstetrician-gynecologist at the place of residence.

For pain, analgesics can be prescribed, and antibiotic therapy can be prescribed to prevent infectious complications. To facilitate the outflow of bloody masses, antispasmodics (no-spa) are prescribed for the first 2-3 days.

Bloody discharge is usually not profuse and can persist for up to 10-14 days, which is not considered a pathology, but if bleeding develops or the nature of the discharge changes (unpleasant odor, color with a yellowish or green tint, increase in intensity), you should immediately inform your doctor.

In order to avoid infection, the gynecologist will prohibit the woman from any douching, as well as the use of hygienic tampons during the period of postoperative discharge. For these purposes, it is safer to use regular pads, controlling the volume and type of discharge.

For successful recovery, hygiene procedures are important - you need to wash yourself at least twice a day, but it is better not to use any cosmetics, even soap, limiting yourself to only warm water. You will have to give up baths, saunas and swimming pools for up to a month.

Sex after curettage is possible no earlier than a month later, and it is better to postpone physical activity and going to the gym for a couple of weeks due to the risk of bleeding.

The first menstruation after curettage usually occurs after about a month, but a delay is possible, associated with ongoing mucosal regeneration. This is not considered a violation, but it would not be a bad idea for a doctor to see it.

During the first 2 weeks you should monitor your well-being very carefully. Of particular concern are:

Increased body temperature;
Pain in the lower abdomen;
Change in the nature of discharge.

With such symptoms, the development of acute endometritis or hematometra cannot be ruled out, which requires urgent treatment through reoperation. Other complications are less common, among them are possible:

Perforation of the uterine wall - can be associated both with the characteristics of the pathology (cancer), and with the careless actions of the doctor and technical errors during curettage;
Development of synechiae (adhesions) inside the uterus;
Infertility.

The possibility and timing of planning a pregnancy after curettage worries many patients, especially young women, as well as those who have undergone surgery for a missed abortion. In general, if you follow the correct surgical technique, there should be no difficulties with pregnancy, and it is better to plan it no earlier than six months later.

On the other hand, infertility is one of the possible complications, which may be associated with infection, secondary inflammation, and the development of synechiae in the uterus. An unqualified surgeon can affect the basal layer of the endometrium, and then significant difficulties may arise with the restoration of the mucosa and implantation of the embryo.

To avoid complications, it is advisable to choose in advance a clinic and a gynecologist whom you can trust with your health, and after the intervention carefully follow all his appointments and recommendations.

Uterus curettage is performed both free of charge in all public hospitals and for a fee. The cost of curettage of the uterine cavity averages 5-7 thousand rubles; separate curettage of the cervical canal and the uterine cavity with subsequent histology will cost more - 10-15 thousand. The price for the service in Moscow clinics is slightly higher and starts on average from 10 thousand rubles. Hysteroscopic control significantly increases the cost of the operation - up to 20 thousand rubles or more.

Women who are indicated for curettage are interested in reviews of patients who have already undergone such treatment. Unfortunately, it cannot be said that the impressions of the procedure were entirely good, and reviews are often negative. This is due to the pain that one has to experience during local anesthesia, as well as the very fact of intervention in such a delicate and important organ of the female body.

However, there is no need to panic in advance. A qualified doctor, confident in the absolute necessity of the procedure as the only possible method of diagnosis and treatment, will not cause irreparable harm, and curettage will allow the disease to be detected in time and get rid of it most radically.

In most cases, curettage of the cervical canal is prescribed to those patients during whose treatment conservative treatment did not produce the desired results. Curettage of the cervical canal is used in the presence of the following symptoms:

extramenstrual bleeding;
heavy menstrual flow;
pain in the lower abdomen.

Diagnostic curettage of the cervical canal is also necessary in the following cases:

if the patient shows pathological changes in the uterine mucosa on ultrasound. Only after the procedure of curettage of the uterine cavity and cervical canal can one find out the cause of endometrial hyperplasia. To do this, two ultrasound examinations are performed - before and after menstruation;
in the presence of pathological changes in the cervix;
before performing gynecological surgery (for example, breast-conserving surgery to remove fibroids).

Curettage of the cervical canal is an important component in the process of diagnosing the condition of the endometrium of the uterus. Using this study, the following diseases of the female genital area can be identified:

uterine fibroids;
cervical dysplasia;
endometrial hyperplasia (glandular-cystic and other types);
endometriosis;
neoplasms in the cervix.

Curettage is an effective method for diagnosing the causes of infertility. The main thing is to contact a qualified specialist in a timely manner and begin treatment.

Curettage of the cervical canal is carried out not only for diagnostic, but also for therapeutic purposes. The main indications for this procedure are the presence of polyps in the mucous membrane of the cervical canal. In addition, therapeutic curettage of the cervical canal is prescribed to those women who have been diagnosed with endometrial hyperplasia.

Preparing for surgery

Before performing curettage, it is necessary to follow all the doctor’s recommendations, since the accuracy of the results obtained and the absence of complications will largely depend on proper preparation for the procedure. In cases where curettage of the cervical canal is carried out on an emergency basis, no preliminary preparation is provided. In all other cases, when the procedure is carried out as planned, curettage is carried out shortly before the start of menstruation.

Women who are scheduled for hysteroscopy with the removal of polyps must undergo the operation exclusively immediately after menstruation. This is due to a decrease in the thickness of the endometrium, which is important for accurately determining the location of polyps.

Experts do not recommend routine curettage of the cervical canal in the middle of the cycle, since after such a procedure severe uterine bleeding may begin and serious complications may arise. The main cause of bleeding in the postoperative period is disturbances in the functioning of the ovaries, caused by the removal of the endometrium of the uterus much earlier than the onset of menstruation. To normalize all processes in a woman’s body after surgery, synchronization in the work of the ovaries and endometrium is necessary.

In addition, the patient is prescribed several basic tests before curettage:

general blood analysis;
blood clotting test;
tests for hepatitis, syphilis, and HIV infection;
vaginal smears, which are needed to identify possible inflammatory processes (if they are detected, the operation will need to be rescheduled and treated).

Methodology of the procedure

Curettage of the cervical canal is carried out in a small operating room on a gynecological chair. Before the procedure, the anesthesiologist asks the patient about the presence or absence of allergies to certain types of medications.

Curettage is performed under intravenous anesthesia; the main difference from endotracheal anesthesia is its short duration and quick awakening. In most cases, it takes the doctor 15-20 minutes to perform the operation.

After the patient falls asleep, the doctor inserts a speculum into the vagina (this is necessary to expose the cervix). Next, using special dilators, the surgeon dilates the cervix and inserts a special instrument for curettage of the cervical canal - a curette. Curettage is carried out slowly, and the resulting samples are placed in a separate container and sent for histological examination.

If curettage is carried out in conjunction with hysteroscopy, after dilating the cervical canal to the required size, the doctor inserts a hysteroscope. With its help, a thorough examination of the mucous membrane is carried out and the presence of polyps and/or areas of endometrial hyperplasia is determined. At the same time, polyps are removed not separately, but in the process of endometrial curettage. Upon completion of the curettage procedure, the vagina is treated with antiseptics. A few hours after the operation, the woman can go home.

Postoperative period

There are a number of restrictions that must be observed in the postoperative period:

you should avoid visiting baths, saunas and swimming pools;
it is necessary to observe sexual rest for 2 weeks;
Do not use intravaginal products or manipulations (tampons, suppositories, douching) for a month;
Physical activity should be limited for a while.