RDV in gynecology: what is separate diagnostic curettage? RDV in gynecology

Hysteroscopy (cervicohysteroscopy, HS, CGS) is an endoscopic method for examining and treating the cervical canal, cavity and walls of the uterus using a hysteroscope inserted through the vagina and cervical canal.

GS is especially valuable for identifying various pathologies of the endometrium, tumors and abnormalities of the structure of the uterus. In addition, using the hysteroscopic examination method, the tactics for further management of the patient can be determined.

In addition to standard HS, there are the following areas of intrauterine diagnostics and surgery:

1. Hysteroresectoscopy (HRS) – endoscopic surgical procedure, which differs from HS by the presence of a high-precision electrosurgical device - a hysteroresectoscope. The therapeutic value of HRS is higher than that of standard hysteroscopy.
2. Intrauterine morcellation - separation of pathological formations of the cervix and uterine body with a special device - shaver, followed by removal of these fragments. This method has limited use in gynecological oncology, since on April 17, 2014, experts from the United States announced that this technology can lead to the spread of tumor cells.
3. Radio wave surgery, for example, the Surgitron complex.
4. Laser surgery.

Types of hysteroscopy

There are three main types of HS:

1. Diagnostic. Most often, this research method is used for various disorders of the menstrual cycle, vaginal discharge during the reproductive, menopausal and postmenopausal periods, as well as to monitor the results of treatment. In this case, both a regular panoramic examination using a standard hysteroscope and microhysteroscopy with 20-, 60-, 80- and 150-fold magnification are possible. During diagnostic hysteroscopy, it is possible to perform separate diagnostic curettage (SDC). This procedure occupies an intermediate place between diagnostic and therapeutic HS. This involves not only examining the cervix, cavity and walls of the uterus, but also obtaining material for microscopic and cytological examination. The procedure is carried out in two stages: first, the epithelium of the cervix is ​​taken, then the epithelium of the uterine cavity.
2. Medical (surgical). An important advantage of hysteroscopy is the ability to quickly transition from diagnostic procedure to medicinal. Surgical hysteroscopic operations are conventionally divided into simple and complex. TO simple may include polypectomy (for small polyps), removal of small nodes of uterine fibroids, tubal sterilization and removal of thin synechiae. Such operations are carried out only under the control of a hysteroscope, using standard instruments. Preliminary intake of hormones in these cases is not required. Complex operations, such as excision of large uterine fibroids, endometrial resection and foreign body removal, in some cases require laparoscopic control and preliminary hormonal preparation.
3. "Office". Outpatient (office) hysteroscopy occupies a special place in the list of intrauterine operations. Some authors recognize it as the most advanced method for diagnosing uterine diseases. The main advantages of office GS:

• high sensitivity of the method in diagnosing intrauterine pathology;
• small number of contraindications;
• no discomfort for the patient; the need for anesthesia or local anesthesia;
• absence of complications such as bleeding, electrical burns, formation of synechiae; the only theoretically possible consequence - infection of the uterus - is extremely rare;
• no mechanical expanders or expansion media required;
• the ability to perform some operations: removal of polyps up to 2 cm, myomatous nodes, parts of the endometrium;
• significant savings in material and time resources.

All these advantages are achieved by using a small diameter hysteroscope - 3.5-4.5 mm (in some cases, an instrument with a diameter of 1.8 mm is used).

Indications for hysteroscopy

The range of indications for diagnostic and surgical hysteroscopy is very wide.

Endometrial hyperplasia

This disease can be suspected if there is uterine bleeding outside of menstruation, delayed menstruation or prolonged menstrual flow. In the usual form of hyperplasia, the endometrium is pale pink, swollen, folded, covered big amount transparent points (gland ducts). In the polypoid form, the endometrium is covered with many pale pink formations resembling polyps. In doubtful cases, hysteroscopy is supplemented with a biopsy for subsequent histological examination endometrial area.

Polyps

Endometrial polyps may be asymptomatic or manifest as vaginal bleeding. There are several types of polyps:

• fibrous - pale, round or oval, dense, smooth formations on the stalk, up to 1.5-2.5 cm in size;
• glandular-cystic - large (up to 6 cm), oblong, smooth, pale pink, gray-pink or yellowish;
• adenomatous - dull gray formations up to 1.5 cm in size.

During polypectomy by curettage without hysteroscopic control, it is difficult to completely remove these formations. Therefore, removal of uterine and cervical polyps is always recommended under the supervision of a GS.

Endometrial cancer

Main clinical sign malignant lesion endometrium is bloody, clear or purulent vaginal discharge. Hysteroscopy for this pathology has 100% sensitivity, allowing not only to visualize the oncological focus, but also to perform a biopsy for further histological verification of the process. Hysteroscopic is represented by papilloma-like grayish formations with foci of dead and bleeding tissue. Crater-like destruction of the muscular layer of the uterus is often detected.

Uterine fibroids

There are several types of myomatous nodes:

• Submucosal. They occur most often in women of fertile age. The main symptom is profuse and painful metrorrhagia. Infertility, miscarriages, and premature birth often develop. During hysteroscopy, whitish dense round formations with clear contours, deforming the inner surface of the uterus.
• Interstitial submucosal nodes are defined as areas of swelling on the wall of the uterus.
• Intramural nodes are located deep in the myometrium and may not be visible during hysteroscopy.
• Subserous nodes cannot be examined using hysteroscopy.

Hysteroscopic removal of submucosal myomatous nodes is the “gold standard” of treatment, but only if endometrial cancer and adenomyosis are excluded. Surgical myomectomy is usually performed under epidural or intravenous anesthesia. Endotracheal anesthesia is used when removing large nodes and when laparoscopic control is necessary. If the size of the nodes is more than 5 cm and if there is wide base node is preliminarily taken with hormones.

Adenomyosis (internal endometriosis)

This benign disease, which is based on the germination of the endometrium into the muscular layer of the uterus (myometrium). The main symptoms to suspect adenomyosis are menstrual irregularities, intense dull pain in the lower abdomen, pain during sexual intercourse, and “chocolate”-colored discharge in the middle of the cycle. Diagnostic hysteroscopy with internal endometriosis, it reveals polypoid, whitish yellow-gray formations. Due to the nonspecific clinical and endoscopic picture accurate diagnosis established after histological examination of endometrial biopsy.

Intrauterine synechiae (Asherman's syndrome)

Synechiae are those that partially or completely narrow the lumen of the uterus. They occur after undergoing inflammatory diseases uterus, curettage and traumatic childbirth. Clinically, Asherman's syndrome is manifested by a decrease or complete cessation of menstruation, infertility and recurrent miscarriages. Hysteroscopically, synechiae look like whitish cords between the walls of the uterus, partially or completely occupying its lumen. It is also advisable to treat synechiae using the hysteroscopic method. In this case, adhesions can be excised either with the hysteroscope itself or with a hysteroresectoscope. To avoid perforation of the uterine wall, it is recommended to perform the operation under laparoscopic control.

Septum in the uterine cavity

This is a malformation of an organ that occurs in the prenatal period due to exposure to unfavorable factors. As a result, the uterus is divided into two cavities, which are either completely isolated from each other (complete septum) or communicate with each other at the cervix (incomplete septum). Clinically, a uterine septum is manifested by habitual miscarriages, and less commonly by the inability to become pregnant. During HS, the length of the septum and its thickness are determined. To differentiate from a bicornuate uterus, hysteroscopy is always combined with laparoscopy. The main method of treating the uterine septum is also hysteroscopy. A thin septum is excised with flexible scissors, and a thick septum is excised with a hysteroresectoscope.

Foreign bodies in the uterine cavity

These include:

• Intrauterine contraceptive. If the IUD remains in the uterine cavity for a long time, it can become tightly attached and grow into the wall of the organ. GS allows you to remove the IUD in the least traumatic way. In case of wall perforation, hysteroscopy is combined with laparoscopy.
• Silk or lavsan threads in women who have undergone uterine surgery or caesarean section. In case of inflammation of these threads, patients experience continuous purulent vaginal discharge. Hysteroscopically, the general plethora of the uterine wall is revealed, against the background of which dull colored threads are determined.
• Remnants of the placenta with HS they are represented by brown or dirty yellow formations of indeterminate shape. Hysteroscopy allows not only to accurately localize the pathological formation, but also to remove it without damaging the surrounding tissue.

Chronic endometritis

It occurs due to prolonged use of an IUD, postpartum complications, and curettage. Clinically, this pathology is manifested by menstrual irregularities, pain during sexual intercourse, and sometimes purulent discharge from the vagina. GS is the main method for diagnosing chronic endometritis. Hysteroscopic signs are most clearly manifested on the first day of proliferation: the mucous membrane is bright scarlet, congested, swollen, bleeding when touched with a hysteroscope. When magnified, you can see glands of a dull color, reminiscent of a “strawberry field.” A histological report is required to confirm the diagnosis.

Bicornuate uterus

A congenital structural anomaly in which in the fundus the organ is divided into two horns that connect at the neck. Clinically, this deviation is manifested by menstrual irregularities, miscarriages and infertility. The hysteroscopic picture resembles that of an incomplete uterine septum. For differential diagnosis Laparoscopy is required. For the surgical treatment of a bicornuate uterus, a hysteroscopic technique can also be used.

Perforation of the uterus

This is a through perforation of the organ wall. The causes of injury may be medical manipulation (artificial termination of pregnancy, probing, curettage, hysteroscopy) or a contraceptive remaining in the uterine cavity for a long time. Clinically, uterine perforation is manifested by vaginal bleeding and abdominal pain. With significant blood loss, hemorrhagic shock occurs - a drop in pressure, pale skin, general weakness, fainting. GS allows you to localize the damage, assess the intensity of bleeding and determine further tactics management Treatment of uterine perforation is most often performed laparoscopically.

HS as a preparatory stage for IVF

Diagnostic hysteroscopy in mandatory carried out before IVF in cases of previous unsuccessful attempts at this procedure, endometriosis, synechiae. This makes it possible to diagnose and, in some cases, eliminate the reason why natural pregnancy is impossible. Thus, the effectiveness of IVF after hysteroscopy increases tenfold.

Preparing for surgery

Hysteroscopy, like any operation, requires preparation.

First of all, this preparation involves taking tests and undergoing instrumental examinations:

1. General blood and urine tests.
2. Biochemical blood test, including sugar.
3. Determination of group and Rh blood affiliation.
4. Coagulogram.
5. Blood test for HIV carriage, viral hepatitis B and C, syphilis.
6. Jet pregnancy test or blood test for hCG.
7. Smear test for sterility of the genital tract (only patients with I-II degree of sterility are allowed for routine hysteroscopy).

The list of tests before the hysteroscopy procedure can be supplemented by the attending physician if indicated.

Preparation for hysteroscopy includes a mandatory preliminary bimanual gynecological examination. On the eve of hysteroscopy, all patients undergo a cleansing enema. You need to shave the hair from the external genital area before HS.

The choice of date for hysteroscopy is important. The most favorable conditions for conducting diagnostic HS are created on days 5-7 of the cycle.

Psychological preparation for HS is carried out during a conversation between the patient and the attending physician. The doctor must provide the woman with complete information about the upcoming procedure and possible complications.

If it is necessary to perform hysteroscopy after childbirth (removal of placental remnants, monitoring the integrity of sutures on the uterus after cesarean section), preparation is carried out according to the standard scheme.

Progress of the operation

The intervention is carried out using special equipment. The hysteroscope is the main element of the entire endoscopic system. It is a metal tube with optics. There are two main types of hysteroscopes:

1. Diagnostic– has a small telescope diameter. Equipped with an optical tube with a light element. Diagnostic hysteroscopes also include instruments for office hysteroscopy with a diameter of up to 5 mm.
2. Surgical– has a larger telescope diameter, an optical system with an LED and a pipe through which forceps, scissors, and electrodes are inserted into the uterine cavity.

Most modern hysteroscopic systems are equipped with a video complex that allows you to record the entire progress of the operation on video in HD or FullHD format. Such hysteroscopes make it possible to take photographs of certain areas of the uterus in order to monitor the condition of the organ over time.

Anesthesia

Hysteroscopy itself is painless, so theoretically the entire procedure could be performed without anesthesia. But in some cases (psychological characteristics of the patient, long duration of the operation, need for laparoscopic control), local anesthesia or general anesthesia is required.

Outpatient (office) hysteroscopy does not require general anesthesia, so it can be performed without anesthesia or under local anesthesia. Office hysteroscopy allows you to remove small polyps, excise adhesions, or remove small submucous fibroids without anesthesia.

The choice of anesthesia during diagnostic hysteroscopy depends on the need to expand the internal space of the uterus. Most often, intravenous anesthesia is used. It is also possible to perform HS under epidural anesthesia.

Surgical HS is most often performed under intravenous anesthesia or epidural anesthesia. If the duration of hysteroscopy is expected to be long, endotracheal anesthesia is used.

Sequencing

Hysteroscopy occurs in several stages. The first stage of the operation is to give the patient the correct position. During hysteroscopy, the Trendelenburg position is most often used - lying on the back with the pelvic end of the body elevated.

The external genitalia are treated with a 5% iodine solution or alcohol-containing disinfectant solutions. Then the cervix is ​​fixed by the anterior lip and the cervical canal is expanded using Hegar dilators.

Next comes the stage of creating a working space - expansion of the uterus. For this they can be used carbon dioxide or various liquids (distilled water, sodium chloride solution, glucose, dextran, mannitol).

Then the main stage of the operation begins. The hysteroscope is inserted into the cervical canal and, under visual control, gradually moved deeper into the cavity. Inspect all the walls of the uterus, then the mouths of the tubes. If focal pathological changes, take a targeted biopsy of the endometrium. If we are talking about diagnostic HS, after examining the uterine cavity, they begin to remove the hysteroscope and, at the exit, examine the cervical canal. In the case of surgical HS, the necessary manipulations are performed, suturing is performed, electrocoagulation of bleeding vessels is performed, if necessary, and the remote pathological formation is removed. Then a final inspection of the uterine cavity is carried out, the hysteroscope is removed and the dilating medium is removed.

The duration of hysteroscopy depends on the purpose of the procedure and the extent of the pathological process. An office GP can last from 15 to 30 minutes. Diagnostic hysteroscopy lasts up to 45 minutes. The duration of hysteroscopic operations can be up to 1.5 hours or more, depending on the volume of intervention.

Recovery after the procedure

The tactics for managing patients after hysteroscopy depends on the general condition of the woman, the type of pathological process and the extent of the operation. Outpatient hysteroscopy does not require compliance with any restrictive measures.

Drugs after hysteroscopy

In the postoperative period of hysteroscopy, the combination drug Safocid (Azithromycin + Fluconazole + Secnidazole) has proven itself well. Safotsid is prescribed to all women who have undergone hysteroscopy on the day of surgery. If surgical intervention does not carry the risk of infectious complications in the postoperative period (removal of endometrial polyp, myomectomy, excision of adhesions); the medicine is prescribed once. When high risk infections (excision of the septum, chronic endometritis, adenomyosis, foreign bodies), an additional dose of Safocid is taken a week after the operation.

After the hysteroscopy procedure in combination with therapeutic and diagnostic curettage (LDC) of the uterine cavity in the first few hours, it is necessary to observe bed rest. The next day, if there are no signs of complications, the patient can be discharged home.

After hysteroscopic plastic surgery of the uterine septum, in some cases, estrogen drugs are prescribed to speed up the restoration of the endometrium.

After surgical HS (removal of the septum, synechiae and myomatous nodes, RDV), it is recommended to perform a three-time control ultrasound - after 1, 3 and 6 months. This study is carried out to monitor the functional state of the endometrium after hysteroscopy and identify possible relapses.

Preventive actions

To restore the body after hysteroscopy, it is necessary to observe a number of restrictions and recommendations:

1. You should not have sex for a month after hysteroscopy. Regular sex life can be carried out only after an ultrasound scan and a gynecologist’s conclusion about the absence of complications of HS.
2. It is strongly recommended to stop taking medications that have an antiplatelet effect (acetylsalicylic acid).
3. In the first 3 weeks after HS, you need to follow a regimen of restrictive physical activity. From the third week, light aerobic exercise is allowed. Heavy physical activity accompanied by increased intra-abdominal pressure, should be excluded for 3 months.
4. For 4 weeks after hysteroscopy, you should not take hot baths, visit saunas, steam baths, swimming pools or solariums.
5. Constipation should not be allowed to develop, as this leads to increased intra-abdominal pressure and increases the likelihood of bleeding.
6. It is necessary to empty the bladder as often as possible, since its overflow disrupts the blood supply to the uterus, preventing the restoration of the endometrium after hysteroscopy.
7. The use of sanitary tampons and the use of vaginal suppositories for 3 months after hysteroscopy.

The length of sick leave after hysteroscopy depends on the scope of the intervention. During office hysteroscopy, a certificate of incapacity for work is not issued. Diagnostic HS requires a short period of hospital stay, so sick leave is issued for 2-3 days. Surgical HS sometimes requires a certain period of rehabilitation. Therefore, in some cases, the period of stay on sick leave reaches a week, and if complications develop, up to a month.

In some cases, it is necessary to do a repeat hysteroscopy. Many women worry about the potential harm of this procedure. But it should be said that HS is a rather gentle procedure, especially when it comes to the “office” option. Therefore, even repeated performance of HS is justified if there are appropriate indications.

Complications and consequences

Hysteroscopy, like any surgical intervention, entails a number of possible consequences or complications. In some cases, they are associated with the pathological process for which HS is performed, and with concomitant diseases. In other situations, complications are caused by the body's reaction to certain drugs (hormonal preparation, anesthetic drugs, dilating fluids). Complications can also be caused by the intervention itself (gas embolism, uterine perforation, postoperative bleeding, infection).

Bloody issues. It should be noted that mucous or ichorous discharge almost always occurs within 2-5 days after hysteroscopy and does not require treatment. This complication occurs especially often after HS with curettage and removal of submucosal myomatous nodes. After a large-volume HS, bleeding may take much longer - up to 4 weeks. In this case, pieces of the endometrium may come out. This situation requires observation, but does not require treatment. If the bleeding is intense, up to the development of hemorrhagic shock, a therapeutic measures. Bleeding in this case can be stopped by tight vaginal tamponade or by applying ligatures to the vessels of the uterus.

Pain after hysteroscopy are most often associated with expansion of the uterine cavity during surgery. Painful sensations are nagging, stupid character, are localized in the lower abdomen. IN in this case the pain gradually subsides and disappears within 2-5 days. If the pain is sharp, increasing, or accompanied by nausea, fever, bleeding, you should consult a gynecologist as soon as possible. These pains may be associated with the development of infectious complications or bleeding.

Temperature increase body after hysteroscopy is most often short-term in nature, is not accompanied by a disturbance in general well-being and does not reach high numbers. This phenomenon can be considered as natural reaction body for surgery. If the temperature rises to high levels (above 38°C), accompanied by weakness, chills, and purulent discharge from the vagina, the development of an infectious complication should be assumed. In this case, it is carried out antibacterial therapy using antibiotics wide range action or antibiotic, taking into account the sensitivity of the isolated microflora.

Pregnancy after hysteroscopy

You should plan a pregnancy after hysteroscopy no earlier than a month after the procedure. If, based on the results of an ultrasound and gynecological examination, the doctor concludes that the endometrium and cervix have completely recovered, you can prepare for conception.

In some cases, restoration of the endometrium and myometrium requires more time. After curettage, pregnancy should be planned after 2-3 menstruation. If hysteroscopic treatment of endometriosis was carried out, you should get pregnant after completing the course hormone therapy. As a rule, this takes from 3 to 6 months. After myomectomy, excision of synechiae and removal of the septum, sufficient a long period restoration of the uterus, which lasts on average from 4 months to six months.

Contraindications

Contraindications to GS are:

1. Chronic diseases in the stage of decompensation.
2. Acute infectious diseases.
3. Sterility of the genital tract III-IV degree, including thrush; in this case, before performing hysteroscopy, preliminary treatment is required, followed by re-analysis of smears.
4. Cervical stenosis.
5. Common cervical cancer.
6. Pregnancy.
7. Previously rescheduled uterine bleeding.
8. Pathology of the blood coagulation system.

It should be noted that some of these contraindications are relative. Therefore, in emergency situations, the doctor is required to weigh the benefits of hysteroscopy and potential harm due to the presence of these contraindications.

Price

Prices for hysteroscopy vary significantly depending on the purpose of the study, region, and type of hysteroscopy:

• The cheapest option is to perform an office HS, which does not require anesthesiological support and a hospital stay. Prices for outpatient HS range from from 5500 to 10000 rubles;
• diagnostic hysteroscopy costs within 10000-15000 rubles;
• prices for operative HS vary significantly depending on the volume of intervention. The minimum price for this procedure is 18,000 rubles;
• The most expensive procedure is hysteroscopy in combination with laparoscopy. The price for this procedure can reach 60,000 rubles.

Where is the best place to do hysteroscopy?

Hysteroscopy has now become a fairly common procedure. There are doctors who have the technique to perform HS in most large cities.

Preference should be given to large clinics where hysteroscopic operations are routinely performed. Whether a private clinic or a public one is not of fundamental importance, since in most cases the same doctors work there.

Probably, many women have found themselves in situations where, after conducting an examination and examination, the gynecologist says that it is necessary to perform curettage for one reason or another. Popularly, this procedure is often called cleansing the uterus, which quite accurately reflects its essence.

But not every doctor considers it necessary to explain to patients what exactly this operation is and how it is performed, and therefore many women begin to panic as soon as they see the appointment in the chart - curettage of the uterine cavity.

But in most cases, worries are simply not justified.

The female uterus is a pear-shaped muscular organ where the development of the unborn child occurs from a fertilized egg. The inner surface of the uterus has protective layer in the form of a special mucous membrane called the endometrium.

Every month, certain changes occur in the uterine cavity, which are cyclical in nature. At the beginning of each menstrual cycle, the uterine cavity begins to prepare for the reception of a fertilized egg and the further development of the baby; if this does not happen and pregnancy does not occur, at the end of the cycle the prepared layers are rejected and the woman begins menstruation.

Carrying out curettage involves removing the functional layer of the uterine mucosa, which is a protective shell, after which the damaged endometrium is quickly restored. When cleansing is carried out correctly, the growth layer of the endometrium is not affected and due to this, rapid recovery occurs.

Curettage of the uterine cavity can be carried out in two types:

1. Separate, when at the first stage the cervical canal is cleansed, after which the doctor begins to clean the uterus itself. The scraping obtained during the procedure is sent to the laboratory for testing to determine the disease or make a more accurate diagnosis. Today separate curettage It is carried out simultaneously with hysteroscopy, when a special optical device is placed into the uterine cavity, allowing full control of the cleaning process. This approach to the procedure allows you to make it safer and more convenient, as well as eliminate some possible consequences.
2. When cleaning in the usual way, the operation is carried out blindly, which often leads to complications, since the uterus can be injured, which is excluded when performing hysteroscopy.

As a rule, cleaning the uterus is prescribed 1-2 days before the start of menstruation, since in this case the restoration of the damaged endometrium occurs faster and easier.

Indications for surgery

Curettage is carried out exclusively as prescribed by a doctor for the purpose of diagnosing or eliminating certain diseases.

The indications in this case are:

• Endometrial disorders, changes in its structure detected by ultrasound. Curettage for endometrial hyperplasia and other disorders is usually carried out for diagnostic purposes. Endometrial hyperplasia is said to occur in cases where its thickness deviates significantly from the norm upward. In addition, ultrasound can detect various local formations. In these cases, cleaning the uterus is necessary to make an accurate diagnosis and remove the disorder.
• Polyps on the surface of the uterus. As a rule, during a normal operation, polyps removed along with the endometrial layer do not appear again.
• Menstrual irregularities.
• Long and very heavy menstruation.
• Intermenstrual bleeding.
• Not the onset of a planned pregnancy without obvious reasons.
• The presence of bleeding during menopause.
• Pathological processes of the cervix, especially in cases where the doctor suspects that they are malignant.
• Spontaneous. Curettage after a miscarriage is often a necessary measure, since this is the only way to remove all remnants of the placenta from the uterus if this does not happen naturally.
• Stopping the development of pregnancy. Unfortunately, not every pregnancy ends in childbirth. In some cases, under the influence various factors The development of the fetus stops and it dies. Curettage during a frozen pregnancy is necessary to remove the dead fetus and prevent inflammatory processes.
• Remains of the placenta or fertilized egg after natural birth.
• Cleaning the uterus after an abortion.
• The presence of intrauterine adhesions (synechias).

In addition, the procedure is carried out in front of many planned operations, for example, before removing fibroids in cases where the uterus itself will be preserved.

Complications after surgery

After curettage, some complications may occur, but they are rare. These include:

• Damage to the cervix, its tear. Sometimes this consequence is observed after curettage and the cause of its appearance in most cases is the dislodgement of bullet forceps. If the tear is small, no measures are taken; such damage heals on its own. A large tear will require one or more stitches.
• Hematometra. After surgery, spasm of the cervix often occurs, which can lead to infection and the onset of an inflammatory process.
• Perforation of the uterus. Sometimes during the procedure, due to the carelessness of the doctor or the inappropriate behavior of the patient (under local anesthesia), the uterus can be pierced by the instruments used. Larger injuries will require additional surgery to close the perforation.
• Inflammation of the uterine cavity. Inflammatory processes are usually caused by various disorders requirements for antiseptics, as well as not prescribing antibiotics to a woman after surgery. The onset of the inflammatory process is indicated by the appearance high temperature after childbirth or curettage.
• Causing damage to the growth layer of the endometrium during cleaning. This consequence is very difficult to eliminate and is difficult to treat. Often it is this type of damage that causes further problems with the onset of pregnancy, since the damaged endometrium cannot recover.
• Improper conduct of the procedure, when the reason for the operation, for example, some pathological formation in the uterine cavity, was not completely removed or was partially removed. In such a situation, the woman will need to have the operation repeated.

To avoid complications, you must trust the operation only to a qualified doctor who will do everything not only correctly, but also carefully.

Recovery after curettage

For several days after the operation, spotting may be observed. Their duration may vary and on average ranges from 3 to 9–10 days.

If there is no discharge, but pain appears in the abdomen, this may indicate that due to spasm of the cervix, hematometra has formed. In this case, you must immediately consult a doctor. The presence of spasm can be confirmed using ultrasound.

To avoid the appearance of hematomas after surgery in the first days after it, you can take No-shpa or its Russian analogue, 1 tablet 2 or 3 times a day.

After the operation, the doctor must prescribe antibiotics, which is necessary to prevent the occurrence of possible inflammatory processes. You should not neglect this appointment after cleaning the uterus.

10 days after the scraping, you need to visit a doctor to get the results of a histological examination of the scraping and discuss their details with your doctor.

It is important to remember that pregnancy after a normally performed procedure can occur within 2-3 weeks, so you should not mistakenly assume that curettage will be a temporary means of contraception.

In this case, complications usually do not occur during childbirth. If the planned pregnancy does not occur within 6–9 months after such an operation, you need to consult a doctor and undergo an examination.

Impaired ability to conceive after cleaning the uterus appears in in rare cases, but in medical practice such cases have been noted.

The recovery period usually lasts about 14–15 days and during this time some restrictions should be observed, for example:

• You should abstain from sexual intercourse.
• Douching is not allowed.
• Vaginal tampons should not be used to absorb discharge.
• You cannot administer suppositories without a doctor’s prescription.
• You should refrain from any physical activity, especially heavy lifting and bending work.
• It is important to maintain personal hygiene.
• Hypothermia should be avoided.
• You should avoid visiting baths, saunas, solariums, swimming pools and gyms for 3-4 weeks after cleaning.
• During this period, you should not take baths, especially hot ones, or swim in the sea or other body of water.

Compliance with all regulations in recovery period allows you to avoid complications. But you should not be afraid of such an operation, since modern equipment and the qualifications of many doctors make it possible to obtain excellent results from such a procedure without harm to health.

Just a few decades ago, curettage often led to problems with conception or complications during childbirth in the future. Today, such operations often help eliminate problems of female infertility and allow a woman to experience the joy of motherhood.

Useful video about the scraping procedure

Replies

Scraping (cleaning)Most women in their lives are faced with a situation where the gynecologist, after an examination, prescribes curettage. Women often call this operation among themselves "cleaning". Not all patients accessible form talk about what this operation is, and this ignorance breeds unreasonable worries.

Let's figure it out.

What is scraped out (a little anatomy)?

curettage occurs

What is scraped out (a little anatomy)?

The uterus is a muscular organ shaped like a “pear”, in which there is a cavity communicating with external environment through the cervix, which is located in the vagina. The uterine cavity is the place where the fetus develops during pregnancy. The uterine cavity is lined with mucous membrane (endometrium). The endometrium differs from other mucous membranes (for example, in the oral cavity or in the stomach) in that it is capable of attaching a fertilized egg to itself and giving rise to the development of pregnancy.

During the entire menstrual cycle, the lining of the uterus (endometrium) thickens, various changes occur in it, and if pregnancy does not occur, it is rejected in the form of menstruation and begins to grow again in the next cycle.

In curettage time– it is the mucous membrane of the uterus – the endometrium – that is removed, but not the entire mucous membrane is removed, but only the superficial (functional layer). After curettage, a germinal layer of the endometrium remains in the uterine cavity, from which a new mucous membrane will grow.

For example, every autumn a rose bush is cut at the root and in the spring a new rose bush grows from this root. In fact, curettage is similar to regular menstruation, only performed with an instrument. Why this is done - read below.

During this operation scraping is also performed cervical canal(the place where the entrance to the uterus is located). This is where the curettage procedure usually begins - the mucous membrane that lines this canal also down to the germ layer is scraped off. The resulting scraping is sent for examination separately.

Explanation of names.

Scraping- this is the main action during manipulation, but the manipulation itself can have different names.

Russian Far East– separate diagnostic (sometimes an addition: therapeutic and diagnostic) curettage of the uterine cavity. The essence of this name: will be fulfilled

separate(first curettage of the cervical canal, then the uterine cavity)

A thorough examination, which will make it possible to make an accurate diagnosis, is “treated” - since in the process of curettage, the formation (polyp, hyperplasia) for which it was prescribed is usually removed.

RDV+ GS– separate diagnostic curettage under control hysteroscopy- This is a modern modification of curettage. Conventional curettage is performed virtually blindly. When using hysteroscopy (“hystero” - uterus; scopia - “look”), the doctor inserts a device into the uterine cavity with which he examines all the walls of the uterine cavity, detects the presence of pathological formations, then performs curettage and finally checks his work. Hysteroscopy allows you to evaluate how well the curettage was performed and whether there are any pathological formations left.

Why is curettage performed - indications?

Scraping carried out for two purposes: get material(scraping of the mucous membrane) for histological examination - this allows us to diagnose final diagnosis; second goal – remove pathological formation in the uterine cavity or cervical canal.

Diagnostic purpose:

if a woman's ultrasound finds mucosal changes– Ultrasound does not always allow an accurate diagnosis; most often we see signs indicating the presence of a pathological process. Sometimes ultrasound is performed several times (before and after menstruation). This is necessary in order to be sure that the pathological formation actually exists and is not just a variant of the structure of the mucous membrane only in this cycle (an artifact). If the formation that was found remains after menstruation (that is, rejection of the mucous membrane), then it is a true pathological formation, it has not been rejected along with the endometrium, curettage should be performed.

If a woman abundant, long periods with clots, intermenstrual bleeding, pregnancy does not occur for a long time and other, more rare conditions, and according to ultrasound and other research methods it is not possible to establish the cause

about uterine fibroids, in which the uterus will be preserved.

Therapeutic purpose:

Polyps mucous membrane (polypoid growths of the uterine mucosa) - there is no other type of treatment, they do not disappear with medication or on their own (there will be a separate article on the website)

rong>Synechia

– fusion of the walls of the uterine cavity – is performed using a hysteroscope and special manipulators. Under visual control, adhesions are dissected

What is the preparation for curettage?

If curettage is not carried out according to emergency indications(as, for example, with uterine bleeding), and as planned, the operation is performed before menstruation, a few days before its onset. This is necessary so that the scraping process itself is practically coincided in terms of the physiological period of rejection of the uterine mucosa(endometrium).

If curettage is carried out in the middle of the cycle or at the beginning - this can lead to prolonged bleeding in the postoperative period. This is due to the fact that the uterine mucosa grows synchronously with the growth of follicles in the ovaries - if the uterine mucosa is removed significantly before the onset of menstruation, hormonal background created by the ovaries "will come into conflict" with the absence of a mucous membrane and will not allow it to fully grow. This condition is normalized only after synchronization between the ovaries and the mucous membrane occurs again.

It would be logical to propose curettage during menstruation so that the natural rejection of the mucous membrane coincides with the instrumental one. However, they do not do this, because the resulting the scraping will not be informative, since the rejected mucous membrane has undergone necrotic changes.

Before curettage, the patient must undergo the following tests (basic set):

General blood analysis

you are invited to a small operating room, where you sit on a table with legs, like a gynecological chair. The anesthesiologist will ask you about the diseases you have suffered and the presence of allergic reactions to medications (prepare in advance for these questions). Lat, that is, during the entire operation you may have pleasant hallucinations - these are no longer used now, although the skill of the anesthesiologist in administering anesthesia is of great importance) .to expose the cervix. Using special forceps (“bullet pins” there is a tooth at the ends of this instrument) it catches the cervix and fixes it. This is necessary to ensure that the uterus remains motionless during the procedure - without fixation, it easily moves, as it is suspended by ligaments. cervix. Extenders are a set of iron sticks of varying thickness (in ascending order from the thinnest to the thickest). These sticks are alternately inserted into the canal of the cervix, which leads to a gradual expansion of the canal to a size that freely passes the curette, the instrument used to perform curettage. It is an instrument similar to a spoon with a long handle, one edge of which is sharpened. A sharp edge is used to scrape. The scraping obtained from the cervical canal is placed in a separate jar. given after dilation of the cervical canal, a hysteroscope (a thin tube with a camera at the end) is inserted into the uterine cavity. The uterine cavity and all walls are examined. After this, the lining of the uterus is scraped. If a woman had a curette during the curettage process. After the curettage is completed, the hysteroscope is reinserted and the result is checked. If something remains, reinsert the curette and scrape it out until the result is achieved. rong> special instruments are introduced into the uterine cavity and, under visual control, these formations are removed. ng>forceps are removed from the cervix, the cervix and vagina are treated with an antiseptic solution, ice is placed on the stomach so that under the influence of cold the uterus contracts and the small blood vessels of the uterine cavity stop bleeding. The patient is transferred to a ward where she wakes up. She is a day patient, and the hospital is discharged the next day.) new and unpleasant sensations for a woman

It takes about 15-20 minutes, and the woman can go home the same day.

Complications of curettage

Generally scraping in the careful hands of a doctor enough safe The operation is rarely accompanied by complications, although they do occur.

Complications of curettage:

Perforation of the uterus– the uterus can be perforated using any of the instruments used, but most often it is perforated with a probe or dilators. Two reasons: the cervix is ​​very difficult to dilate and excess pressure on the dilator or probe causes it to pierce the uterus; Another reason is that the uterus itself can be greatly changed, which makes its walls very loose - because of this, sometimes the slightest pressure on the wall is enough to pierce it. Treatment: small perforations are healed on their own (observation and a set of therapeutic measures are carried out), other perforations are sutured - an operation is performed.

“flabby” and the bullet forceps do not hold well on them - at the moment of tension, the forceps fly off and tear the cervix. They cut on their own, if the tear is large, they put sutures.

After scraping within a few days (from 3 to 10) you may have spotting and spotting. If the bleeding immediately stops and abdominal pain appears, this is not very good, since there is a high probability that spasm of the cervical canal occurred, and formed hematometer. Need it right away contact your doctor and let him know about it. He will invite you for an ultrasound and if the spasm is confirmed, they will quickly help you.

As prevention of hematometers in the first days after curettage, you can take 1 tablet 2-3 times a day.

In the postoperative period you should be prescribed short course of antibiotics– this is necessary to prevent inflammatory complications.

Results of histological examination Usually ready 10 days after surgery, be sure to pick them up and discuss them with your doctor.

IN conclusion I would like to note that curettage is one of the most frequent and most necessary minor operations in gynecology. In the treatment and diagnosis of certain gynecological diseases can't do without her. This operation is now being postponed very comfortable and probably it can be called one of the most comfortable interventions, which are in gynecology, since you do not experience pain or discomfort. Of course, if you get to a careful gynecologist and anesthesiologist...

Video. scraping

Diagnostic uterine curettage- a form of biopsy during which the doctor takes samples of the mucous membrane from the uterine cavity for cytological examination.

Curettage is considered a minor gynecological operation and is widespread in the practice of gynecologists. It allows you to accurately diagnose and carry out effective treatment for many diseases of the female reproductive system.

The procedure is carried out under intravenous anesthesia, so the woman does not experience pain at the time of curettage. The operation is not considered highly traumatic; in fact, curettage is the mechanical removal of that part of the mucous membrane that itself is rejected during menstruation. After curettage, a germ layer of the endometrium remains, from which a new mucous membrane grows after 2-3 weeks.

Synonyms. You may come across different names for this procedure: endometrial biopsy, diagnostic cleaning of the uterine cavity.

Types of uterine curettage

• diagnostic curettage of the uterus- an operation that is performed to diagnose the condition of the endometrium. The inner layer of cells lining the uterine cavity is removed, followed by an examination of their structure;
• separate diagnostic curettage– removal of the inner layer of the cervical canal and the uterine cavity. At the first stage, remove upper layer the mucous membrane of the cervical canal, followed by the upper layer of the mucous membrane lining the uterine cavity.

Purposes of curettage

• diagnostic– allow you to take material to study the characteristics of cells. The main task is to confirm or refute the presence of cancer cells in the thickness of the endometrium;
• medicinal-diagnostic– when curettage of the endometrium, polyps, pathological foci and growths of the endometrium are removed, which became the reason for prescribing curettage. Subsequently, the resulting material is sent for research.

Anatomy of the uterus

The uterus performs two main functions:

• reproductive– a fertilized egg is attached here, from which the fetus subsequently develops;
• menstrual– if fertilization does not occur, the inner lining of the uterus peels off at the end of the cycle, which is manifested by menstrual bleeding.

• Bottom – top part, lying above the entrance of the fallopian tubes, through which the egg enters the uterus;
• Body– the lateral walls of the uterus, which taper towards the cervix. In the body of the uterus is cavity, in which fetal development occurs during pregnancy. Due to the significant thickness of the walls, the size of the cavity does not exceed several cubic centimeters;
• Neck – Bottom part uterus, which is a tube 2-3 cm long connecting the uterine cavity to the vagina. The cervical canal, or cervical canal, runs inside the cervix.

• Outer– perimeter is the peritoneum, the connective membrane covering the outside of the uterus.
• Average– myometrium – muscle layer. It is represented by non-striated smooth muscle fibers that intertwine in various directions to form a dense muscle wall.
• Interior– endometrium is a mucous membrane richly supplied with blood vessels. In the body of the uterus, it is smooth and represented by ciliated epithelium. In the cervical canal, the mucous membrane is folded and lined with columnar epithelium.

Endometrium or mucous layer - the inner mucous membrane of the uterine cavity. It has a smooth surface and contains uterine glands which open into the uterine cavity. The endometrium is a hormonally sensitive tissue and therefore undergoes changes depending on the phase of the menstrual cycle. So after menstruation its thickness is 2 mm, and in the second half of the cycle it can exceed 2 cm.
In the endometrium there are:

• Functional layer– the outer layer of the endometrium, which lines the uterine cavity and is shed with each menstrual cycle. Its thickness and structure largely depend on the phase of the cycle and the hormonal state of the woman, which must be taken into account when analyzing the results of curettage. Ciliated cells with numerous cilia make up the majority epithelial cells. Their function is to promote the fertilized egg to the site of attachment.
• Basal layer the lower layer of the endometrium adjacent to the muscular layer. Its function is to restore the mucous membrane after menstruation, childbirth, and curettage. Contains vesicle cells, from which ciliated cells of the functional layer are subsequently formed. The bases of the glands and blood capillaries. Weakly responds to cyclical fluctuations of hormones.
• Stroma– the basis of the endometrium, which is a network of connective tissue cells. It is dense and rich in connective fibers. In the basal layer lie the uterine glands. Meet light cells– immature ciliated epithelial cells. True lymphatic follicles– accumulations of lymphocytes without signs of inflammation.
• Uterine glands simple tubular glands that secrete a mucous secretion that ensures the normal functioning of the uterus. They have a convoluted but not branched structure. The glands are lined in a single row with columnar epithelium. They are subject to changes under the influence of hormones.

Indications for separate diagnostic curettage

• menstrual irregularities;
• intermenstrual (acyclic) bleeding;
• spotting after menopause (menopause);
• suspicion of endometrial tuberculosis;
• suspected endometrial cancer;
• Ultrasound of the uterus during 2 cycles revealed changes that require clarification;
• suspicious changes on the cervix;
• after spontaneous abortions;
• to establish the causes of infertility;
• preparation for planned gynecological surgery for fibroids.

• inflammatory processes in the uterus or other genital organs;
• general infectious diseases;
• suspicion of pregnancy.

Methodology for separate diagnostic curettage of the uterus

Timing for curettage

• 2-3 days before menstruation– in most cases with infertility, if a malignant neoplasm is suspected. The procedure is carried out within these periods so that the removal of the mucous membrane approximately coincides with physiological process her rejection.
• On the 7-10th day after the start menses and with menorrhagia - prolonged heavy menstrual bleeding;
• Immediately after bleeding starts with acyclic bleeding in the middle of the cycle;
• Between the 17th and 24th day of the cycle– to assess the response of the endometrium to hormones;
• Immediately after the end of menstruation– for uterine polyps. In this case, the polyp is clearly visible against the background of the thin endometrium.

Pain relief during uterine curettage

• Intravenous anesthesia– short-term general anesthesia– the patient is administered sodium thiopental or propofol. She falls asleep for 20-30 minutes. Pain sensations are completely absent;
• Local paracervical anesthesia- a type of local anesthesia. The tissue around the uterus and cervix is ​​soaked in an anesthetic. Painful sensations are significantly dulled, but do not disappear.

Where and how is uterine curettage performed?

1. Two-handed examination of the uterus to determine its size and position.
2. Treatment of the external genitalia with alcohol and iodine solution.
3. Dilatation of the vagina using gynecological speculum.
4. Fixation of the cervix using bullet forceps.
5. Studying the depth and direction of the uterine cavity using a probe - a metal rod with a rounded end.
6. Expansion of the cervical canal using Hegar dilators - metal cylinders of small diameter. The width of the channel must correspond to the size of the curette (surgical spoon).
7. Curettage of the mucous membrane of the cervical canal. A curette (a metal spoon with a long handle) is carefully inserted to a depth of 2 cm to the internal pharynx. The curette is pressed against the wall of the cervical canal and brought out with an energetic movement. In this case, the curette scrapes out the epithelium. The action is repeated until all the mucous membrane from the walls of the cervical canal has been collected.
8. Collecting material from the cervical canal into a container filled with a 10% formaldehyde solution.
9. Curettage of the mucous membrane of the uterine cavity. Using the largest curette, the mucous membrane is scraped out, vigorously pressing on the wall of the uterus. Start from the front wall, then move to the back and side walls. The gynecologist successively uses smaller and smaller curettes until the uterine wall feels smooth.
10. Collect material from the uterine cavity into a container with formaldehyde solution.
11. Treatment of the cervix and vagina with an antiseptic solution.
12. Stop bleeding. Ice is placed on the abdomen for 30 minutes to stop bleeding.
13. Postoperative rest. The woman is transferred to a ward, where she rests for several hours. The first 6 hours check the pressure, the nature of vaginal discharge on the pad, and the possibility of emptying the bladder.
14. Extract. On day hospital discharge is carried out on the same day. The hospital discharges the woman the next day.

Modern version of the procedure – separate diagnostic curettage under hysteroscopy control(RDV+GS). If ordinary curettage is performed “by touch,” then in this case a hysteroscope is inserted into the uterine cavity - a miniature device that allows you to see everything that happens in the uterine cavity. This makes it possible to reduce trauma and check whether there are any areas of mucous membrane or formations that have not been removed.

In the laboratory, the resulting material is treated with paraffin and thin sections are made from it, which are then examined under a microscope.

How to prepare for the procedure?

Required research:

• gynecological examination;
• Ultrasound of the uterus and pelvic organs.

• clinical blood test ;
• blood test for coagulation - coagulogram;
• blood test for HIV;
• blood test for syphilis - RW;
• blood test for hepatitis B and C;
• bacteriological examination contents of the genital tract;

What are the possible histology results?

The conclusion contains two parts:

• Macro description– description of tissues and discovered fragments. The color of the fabric, its consistency, and the weight of the sample are indicated. Presence of blood, mucus, blood clots, polyps. For example, material from the uterine cavity in large quantities may indicate the growth of the mucous membrane - endometrial hyperplasia.
• Microdescription– description of the detected cells and deviations in their structure. The detection of atypical cells indicates a precancerous condition (the risk of developing a cancerous tumor); the appearance of malignant cells indicates endometrial cancer.

Terms that may appear in a cytological report:

• Endometrial atrophy– thinning of the endometrium of the uterus associated with age-related or hormonal changes in the body.
• Endometrial hyperplasia without signs of atypia– thickening of the uterine mucosa. An increase in the size and number of cells of the uterine mucosa without disrupting the structure of these cells.
• Endometrial hyperplasia with atypia– in the thickened endometrial mucosa, atypical cells are found that differ from normal ones, which indicates a precancerous condition. In 2-3% of women, it may develop cancer tumor.
• Remains of fertilized egg(the membranes surrounding the embryo at early stages) – detection of residues indicates termination of pregnancy.
• Cystic dilated glands– glands with an expanded lumen. May be a variant of the norm on late stage proliferation (11-14th day of the cycle) or indicate endometrial hyperplasia.
• Multinuclear epithelium- may be a sign of hyperplasia, as well as endometrial cancer.
• Lymphoid accumulations– accumulations of lymphocytes that may appear in healthy women before menstruation, and in other phases of the cycle indicate inflammation - chronic endometritis.
• Endometritis– inflammation of the uterine mucosa.
• Focal inflammation– foci of lymphocytes and leukocytes are found in the endometrium, which may indicate chronic inflammation.
• Endometrial metaplasia- degeneration of the epithelium. Unusual cells appear in the endometrium. In the presence of atypical cells, it may be a precancerous condition. In some cases it may indicate cancer.
• Endometrial adenocarcinoma– malignant tumor of the endometrium.

What diseases can be detected by this study?

What to do after curettage

Bloody discharge, as during menstruation, can last up to 10 days. During this period, pads are used. Tampons are prohibited.

It is necessary to carefully observe genital hygiene. Water procedures are recommended in the morning and evening, as well as after each bowel movement.

For the first days after surgery, it is advisable to remain in bed. The sitting position is limited to reduce pressure on the uterus.

Medications after curettage:

• Analgesics(baralgin, renalgan, diclofenac) - eliminate pain and slightly reduce bleeding. For the first 1-2 days, take 1 tablet 3 times a day after meals. On the 3rd day, analgesics are taken once a day - at night.
• Antispasmodics(no-shpa) - to prevent uterine spasms and accumulation of blood in its cavity. Use 1 tablet 2-3 times a day for 3 days.
• Antibiotics a short course of up to 5 days (cefixime, cedex) to prevent the development of infection in the uterus. Take 400 mg orally 1 time per day, regardless of meals.
• Suppositories with iodine(iodoxide, betadine) prevent the development of infection in the vagina. 7 days, 1 suppository at night.
• Antiflex drugs(fucis, fluconazole). Prevention of the development of fungal infections - thrush. Orally 150 mg after meals once.

• sexual intercourse;
• physical activity - lifting weights more than 3 kg, visiting the gym;
• swimming in the pool and open water;
• taking a bath, only showers are allowed;
• visits to the bathhouse, sauna, solarium;
• applications vaginal medications without the consent of the doctor.

• The absence of bloody discharge during the first 2 days with severe abdominal pain indicates spasm of the uterus and accumulation of blood in its cavity;
• An increase in temperature above 37.5 may indicate inflammation;
• Severe pain in the abdomen and lower back – inflammation or infection;
• Deterioration in general condition may indicate an infection. It must be taken into account that on the first day, weakness and dizziness are the result of intravenous anesthesia;
• Heavy bleeding after scanty discharge may indicate new bleeding.

Typically, indications for diagnostic curettage of the uterine cavity are:

• Endometritis. This disorder provokes inflammation of the uterine mucosa. As a rule, it is treated by medication, but uterine curettage is used for diagnosis.
• Hyperplasia. This term refers to excessive thickening of the endometrium. In this case, curettage is used for diagnosis and treatment. The presence of dysfunction can be definitively determined only after RVD.
• Polyps of the uterine mucosa. These irregularly shaped formations occur in the uterine cavity as a result of pathological processes. It is not possible to get rid of the disease using medications. Curettage in the uterine cavity in this situation is the only method of treatment.
• Uterine bleeding. It is often very difficult to determine its cause. To avoid anemia and stop the flow of blood, separate curettage is used.
• Disturbances after abortion. Sometimes this procedure is performed incorrectly, and the patient requires additional curettage.
• Synechiae. This term refers to the phenomenon in which the opposite walls of the uterus grow together. With RDV, the uterine space is partially scraped out. Only the top layer is removed. New cells then grow in its place.

Preparatory procedures for the Russian Far East

Diagnostic curettage of the uterine cavity should be performed only in a hospital setting. Carrying out WFD may lead to various complications, and then the patient will immediately need help.

RDV of the uterus— curettage of the uterine cavity, which is carried out according to the rules of asepsis and antiseptics in a gynecology hospital.

Before scraping, you need:

• blood test for hepatitis, HIV infection, syphilis;
• clotting test, which will help avoid bleeding after medical intervention;
• smear of the vaginal mucosa;
• fluorography;
• electrocardiogram.

Surgery is performed before eating, since the intestines must be free. It is advisable to empty the bladder as well. This preparation will help the patient feel more comfortable during RDV.

Progress of the Russian Far East

Diagnostic curettage of the uterine cavity is performed in the operating room. It is best to do the procedure 3-4 days before menstrual bleeding. This is the most favorable period for curettage. In case of bleeding from the uterine cavity - immediately after diagnosis.

In terms of time, the RDV of the uterus lasts no more than half an hour. It is performed under anesthesia - local or general. When choosing a local anesthesia, the cervix is ​​punctured. In the second case, the medicine is administered intravenously.

To avoid infection, the vulva and cervix are treated aqueous solution alcohol or iodine. The doctor needs to expose the cervix with gynecological speculum, after which he catches and fixes it. Then it enters the cervical canal with a special probe, penetrates the cavity and measures its depth. After this, you can proceed to dilation of the cervix. Expanders - metal sticks of different thicknesses - are inserted into the canal one by one. The cervical canal gradually increases and reaches a size capable of passing a curette, with the help of which curettage occurs. This tool resembles a spoon with a handle and one sharpened edge.

The operation takes place in 2 stages:

• scraping the mucous membrane of the cervical canal of the cervix without penetrating into the internal cavity;
• curettage of the internal cavity of the uterus.

The mucous membrane of the cervix is ​​scraped out with the smallest curette.

If diagnostic curettage of the uterine cavity is carried out together with hysteroscopy, then after dilation of the cervical canal, a hysteroscope is inserted into the cavity and an examination is performed. Then curettage of the uterine cavity is performed. Some formations cannot be removed in this way. Then you have to use special instruments, they are inserted into the cavity and then the formations are removed.

In order to make a diagnosis, scrapings of the mucous membrane are placed in containers and then sent for histological or other analysis.

At the end of the diagnostic separate curettage, the patient, who has no visible complications, can be sent home after 3-4 hours. A follow-up examination and ultrasound should be performed after a week.

Rehabilitation after RDV

In the future, in order to avoid the development of inflammatory processes, the woman is prescribed medication. Although immediately after the operation you can return to your normal lifestyle. Just during the recovery period, you should not expose yourself to excessive physical activity which can lead to complications. Scanty vaginal discharge or minor pain in the genital area is not considered a pathology.

Can complications occur after RDV of the uterine cavity and cervical canal?

In general, in skillful hands, curettage of the uterine cavity and cervical canal is rarely accompanied by complications, but they still occur. These include:

• Perforation of the uterus. You can perforate an organ with any instrument, but most often this happens with a dilator or probe. If the perforation is insignificant, it heals itself, in otherwise she has to be sutured.
• Cervical tear. Most often this happens when the forceps holding it fall off the cervix.
• Inflammation of the uterus. It occurs if separate curettage was performed during inflammation or in violation of septic and antiseptic requirements.
• Damage to the mucous membrane. It occurs when excessive scraping occurs when the germinal layer of the membrane is damaged.
• Hematometra. If cervical spasm occurs after curettage, the blood that should flow out accumulates, becomes infected and can cause pain.

In general, complications can be avoided if this operation is performed carefully and correctly.

Complications of curettage also include those situations when, after the procedure, a pathological formation or part of it remains in place. As a rule, this happens when curettage is performed without hysteroscopy, that is, when it is impossible to evaluate the result at the end of the operation. In this case, curettage must be repeated, since the pathological neoplasm cannot be left in the uterine cavity.

Biological tissue samples obtained during RDV of the uterus are sent for testing to the laboratory. These data allow the gynecologist to confirm the preliminary diagnosis and choose methods and directions of treatment. This is especially important to confirm suspicions of the formation of a malignant tumor.

Finally

Separate diagnostic curettage is complex, but necessary procedure, which allows you to diagnose various diseases. RDV of the uterus can also be used to treat certain pathologies.

Carrying out the procedure correctly is unlikely to entail any negative or dangerous consequences for the body. A woman can lead her previous lifestyle immediately after surgery. Therefore, if a gynecologist insists that curettage of the uterine cavity and cervical canal is necessary, you should not be afraid. In some cases this will help save lives.