Diagnostic curettage of the cervical canal and uterine cavity: purpose of the procedure, preparation and rehabilitation. Separate diagnostic curettage of the cervical canal and uterine cavity

Gynecology uses a lot of different methods to diagnose a patient’s condition. Some studies are carried out quickly and painlessly. For example, ultrasound. Others require the use of anesthesia and a hospital stay (laparoscopy). Today’s article will tell you about what RDV is in gynecology. You will learn about the features of this manipulation and indications for its implementation.

General information

What is hysteroscopy and RDV in gynecology? These are two diagnostic procedures that are combined with each other. Let's look at them in detail. The interpretation of the RDV in gynecology is as follows: “Separate diagnostic curettage.” This procedure is necessary to confirm or refute the existing diagnosis. The doctor prescribes it when he himself is not sure or cannot confirm his verdict in other ways. It is worth noting that RDV in gynecology allows you to give a 100% reliable result. Whereas other diagnostic methods cannot provide such accuracy.

Hysteroscopy is an examination performed using a special magnifying device. It is called a hysteroscope. Diagnostics allows you to examine the uterine cavity and, if necessary, carry out therapeutic manipulations: remove polyps, take a biopsy, and so on. The study is carried out exclusively in a hospital. The combination of hysteroscopy and RDV in gynecology has given specialists greater opportunities to examine the patient and further prescribe the correct therapy.

When research is needed: indications

Separate diagnostic curettage is provided in the following situations:

• Neoplasms in the uterus or suspicions of them: fibroids, polyps, cysts, septums.
• Structural changes in the endometrium: hyperplasia or dysplasia.
• Menstrual irregularities of unknown origin. We are talking about long delays or heavy bleeding.
• Cancer of the cervix or genital organ at any stage. Including if there is a suspected pathology.

If the doctor suspects that you have these diseases, he will give you a referral to the RDV. Gynecology provides free diagnostics for women according to indications. Manipulation is also carried out in private clinics. But such medical institutions charge a fee for providing their services.

Contraindications for manipulation

Some women are prohibited from such diagnostics. Let's consider the conditions under which you need to abandon the procedure:

1. Inflammatory process. If during preparation it turns out that a woman has infectious diseases of the genital organs, then they must first be eliminated. Carrying out manipulation during the inflammatory process can increase the likelihood of complications.
2. Stenosis of the cervix or cervical canal. With this pathology, narrowing of blood vessels occurs. The doctor simply cannot dilate the cervix without damaging it. Therefore, before manipulation it is necessary to relieve the spasm and undergo treatment.
3. Pregnancy. If the patient is in an interesting position and wants to save the fetus, then such actions are strictly contraindicated. Any intervention in the reproductive organ and manipulation of the cervix can lead to termination of pregnancy.
4. Viral and bacterial diseases. The separate curettage procedure is postponed if the patient is sick. Even a common cold, fever or flu become a contraindication.
5. Use (spirals). Before diagnosis, such a device must be removed from the cavity of the reproductive organ.

Some sources indicate that RDV is not appropriate for advanced cervical cancer. However, this condition is doubtful. After all, the indication for surgery is cancer of the cervix and cervical canal. Therefore, in each individual case, the possibility of the procedure should be determined by the doctor.

Preparation for the Russian Far East

Before the procedure, the patient must undergo examination. A woman needs to donate blood for clotting. The presence of antibodies to HIV, syphilis, and STDs is determined. The gynecologist will also take a smear from the vagina, the examination of which will show the state of the microflora. Before the RDV, a woman needs to have a cardiogram, fluorography, and also visit a therapist. If you are allergic to any medications, be sure to inform your doctor. The manipulation involves preliminary hygiene procedures. The patient needs to wash and shave. When going to the hospital, take with you a change of underwear, sanitary pads and documents.

Progress of the operation

Reviews about the RDV procedure (in gynecology) say that the manipulation is always carried out under anesthesia. Experts prefer intravenous. In this case, the patient sleeps and does not feel anything. Therefore, it cannot interfere with the work of doctors. If such anesthesia is not possible (for example, if there is an allergy), then the woman is simply injected into the cervix with painkillers. Next, the following actions are carried out:

• the vulva and cervix are treated with an alcohol antiseptic or iodine solution;
• the cervical canal is expanded with a probe;
• A hysteroscope is inserted into the cavity of the reproductive organ, which allows you to monitor the progress of the operation;
• Alternate curettage is done using a curette.

Separate diagnostic curettage got its name because material is first collected from and then from the uterine cavity. The procedure is carried out 2-3 days before menstruation or immediately after it.

During menstruation: the opinion of some doctors

There are gynecologists who prefer to perform manipulation during bleeding. They talk about the RDV procedure (in gynecology) that these are the same menstruation, only artificial. Surgery performed during this part of the cycle reduces the risk of severe bleeding and complications. When scraping, only the surface of the mucous membrane is separated, which grows over the course of a month. The basal layer, responsible for new cells, is not affected. However, performing RDV during menstruation has its risks.

Condition after the procedure

The manipulation lasts no more than 20 minutes. After this, the woman is transported to the ward, where she recovers from anesthesia. During this time, the patient is closely monitored. Usually during the day the woman remains within the walls of the hospital, where she receives antimicrobial therapy. In the absence of contraindications and complications, discharge is carried out the next day. However, after 7-10 days the woman must return to the clinic and undergo additional examination. It includes a gynecological examination and ultrasound diagnostics. The doctor assesses the condition of the mucous membrane and finds out how its healing is progressing.

Consequences of manipulation

Has RDV (in gynecology) consequences. But they occur quite rarely. Much depends on the qualifications of the doctor, the capabilities of the clinic and the modernity of the equipment. Among the complications are the following conditions:

1. Perforation of the walls of the reproductive organ. Small lesions heal on their own, and large areas are sutured during additional surgery.
2. Tear in the cervical region. It is fraught with the appearance of scars and difficulties during natural delivery.
3. Formation of hematomas and hematometra. Blood accumulates in the uterine cavity, which cannot be released due to cervical spasm.
4. Damage to the basal layer. There is no cure for this condition.
5. Inflammatory process. It begins due to failure to observe asepsis and requires the use of antibiotics.

Almost all of the described complications have their own symptoms. This is an increase in body temperature, pain in the abdominal cavity, discharge from the genital tract with an unpleasant odor. Contact your doctor if you find any.

Material research and result

After separate scraping, the resulting material is placed in sterile containers. In this state, it is sent to the laboratory. Specialists stain the cells in different colors, after which they determine their reaction. The diagnostic result is ready 10-14 days after the RDV. You can get a conclusion from the doctor who performed the procedure or your gynecologist. After this, you should definitely go to the next appointment with the doctor. The specialist will tell you about the values ​​​​entered in the form.

The rest of the tactics are determined in accordance with the data received. Therapy depends entirely on the result of the operation. If polyps, fibroids, or cysts are found, hormonal correction is prescribed. Sometimes surgery is required. Endometritis and inflammatory processes require antibacterial therapy with the use of immunomodulators and vitamin complexes. Treatment tactics are chosen in accordance with the patient’s age and desire to have children in the future.

Instead of a conclusion

You learned about the RDV procedure in gynecology. operations, indications for its implementation - everything is described in the article. Such manipulation is always planned; it has its limitations. If you are prescribed separate curettage, then you should not refuse and be scared. After all, this is the only way you can accurately know about your health. The results obtained reflect the condition of the cervical canal mucosa and the health of the reproductive organ. The manipulation allows you to evaluate the functioning of the reproductive system and hormonal levels in general. Good luck and good results!

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 are told in an accessible form what this operation is, and this ignorance gives rise to unfounded worries.

Let's figure it out.

• What is scraped out (a little anatomy)?
• Explanation of names
• Why is curettage performed?
• What preparation for curettage
• How does scraping happen?
• Complications of curettage
• What's next?

What is scraped out (a little anatomy)?

The uterus is a muscular organ shaped like a “pear”, in which there is a cavity that communicates with the 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.

During curettage, 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, the cervical canal (the place where the entrance to the uterus is located) is also scraped. 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)
• treatment and diagnostic– the resulting scraping will be sent for histological examination, which will allow an accurate diagnosis to be made, “treated” - since in the process of curettage, the formation (polyp, hyperplasia) for which it was prescribed is usually removed.
• scraping- process description.

RDV+ GS– separate diagnostic curettage under hysteroscopy control 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?

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

Diagnostic purpose of curettage

• If a woman’s ultrasound shows changes in the mucous membrane, 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 has heavy, prolonged menstruation with clots, intermenstrual bleeding, pregnancy and other, rarer conditions do not occur for a long time, and according to ultrasound and other research methods it is not possible to establish the cause
• If there are suspicious changes on the cervix, a diagnostic curettage of the cervical canal is performed
• Before planned gynecological surgery or a procedure for uterine fibroids, in which the uterus will be preserved.

Therapeutic purpose of curettage

• Mucosal polyps (polyp-like 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 site)
• The hyperplastic process of the endometrium (hyperplasia) - excessive thickening of the uterine mucosa - is treated and diagnosed only by curettage, followed by drug therapy or instrumental methods (there will be a separate article on the site)
• Uterine bleeding – the cause may not be known. Curettage is performed to stop bleeding.
• Endometritis is an inflammation of the uterine mucosa. For complete treatment, the mucous membrane is first scraped off.
• Remains of membranes and embryonic tissues - treatment of complications after abortion
• Synechia - fusion of the walls of the uterine cavity - is performed using a hysteroscope and special manipulators. Under visual control, adhesions are dissected

How to prepare for curettage?

If curettage is not performed for emergency reasons (as, for example, during uterine bleeding), but as planned, the operation is performed before menstruation, a few days before its onset. This is necessary so that the curettage process itself practically coincides in terms of the physiological period of rejection of the uterine mucosa (endometrium). If you plan to undergo hysteroscopy with removal of a polyp, the operation, on the contrary, is performed immediately after menstruation so that the endometrium is thin and the location of the polyp can be accurately seen.

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 mucous membrane of the uterus grows synchronously with the growth of follicles in the ovaries - if the mucous membrane of the uterine cavity is removed significantly before the onset of menstruation, the hormonal background created by the ovaries will “come into conflict” with the absence of the 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 scraping will not be informative, since the rejected mucous membrane has undergone necrotic changes.

Tests before curettage (basic set):

• General blood analysis
• Coagulogram (assessment of the blood coagulation system)
• Tests for hepatitis B and C, RW (syphilis) and HIV
• Vaginal smear (there should be no signs of inflammation)

On the day of curettage, you need to come on an empty stomach, the hair in the perineum should be removed. You bring a robe, long T-shirt, socks, slippers and pads.

How does curettage occur?

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 your previous illnesses and any allergic reactions to medications (prepare for these questions in advance).

The operation takes place under intravenous anesthesia - this is a type of general anesthesia, but only it is short-term, on average 15-25 minutes.

After the drug is injected into a vein, you immediately fall asleep and wake up in the ward, that is, you sleep throughout the operation and do not experience any unpleasant sensations, but on the contrary, you may have sweet dreams. Previously, heavy drugs were used for anesthesia, which caused very unpleasant hallucinations - now they are no longer used, although the skill of the anesthesiologist in administering anesthesia is of great importance.

The operation itself is performed as follows. The doctor inserts a speculum into the vagina 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.

Using a special probe (iron rod), the doctor enters the cervical canal and penetrates the uterine cavity, measuring the length of the cavity. After this, the stage of cervical dilatation begins. 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.

When the cervical canal is dilated, the mucous membrane of the cervical canal is scraped. This is done with the smallest curette. A curette 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.

If curettage is accompanied by hysteroscopy, then 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 polyps– they are removed with 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.

Some formations in the uterine cavity cannot be removed with a curette (some polyps, synechiae, small myomatous nodes growing into the uterine cavity), then through hysteroscope Special instruments are introduced into the uterine cavity and, under visual control, these formations are removed.

After the process is completed curettage 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 the ward, where she wakes up.

The patient spends several hours in the ward (usually sleeping, with ice on her stomach) and then gets up, gets dressed and can go home (if this is not a day hospital, but a hospital, discharge is carried out the next day).

Thus, curettage proceeds without any painful or unpleasant sensations for the woman, takes about 15-20 minutes, the woman can go home the same day.

Complications of curettage

In general, curettage in the careful hands of a doctor is a fairly safe operation and 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 tube 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.
• Cervical tear– the cervix most often tears when the bullet forceps fly off. Some cervixes are very “flabby” and bullet forceps do not hold well on them - at the moment of tension, the forceps fly off and tear the cervix. Treatment: Small tears heal on their own; if the tear is large, stitches are applied.
• Inflammation of the uterus– this happens if curettage was performed against the background of inflammation, the requirements of septic and antiseptic conditions were violated, and a prophylactic course of antibiotics was not prescribed. Treatment: antibacterial therapy.
• Hematometer- accumulation of blood in the uterine cavity. If, after curettage, a spasm of the cervix occurs, blood, which normally should flow from the uterine cavity for several days, accumulates in it and can become infected and cause pain. Treatment: drug therapy, bougienage of the cervical canal (spasm relief)
• Damage to the mucous membrane(excessive curettage) - if you scrape very hard and aggressively, you can damage the germ layer of the mucous membrane, which will lead to the fact that the new mucous membrane will no longer grow. A very bad complication - practically untreatable.

Generally, complications can be avoided if this operation is performed carefully and correctly. Complications of curettage include situations when, after this operation, the entire pathological formation (polyp, for example) or part of it remains in place. More often this happens when curettage is not accompanied by hysteroscopy, that is, it is impossible to evaluate the result at the end of the operation. In this case, curettage is repeated, since it is impossible to leave the pathological formation in the uterine cavity.

What's next?

After curettage, you may have spotting and spotting for several days (from 3 to 10). If the bleeding immediately stops and abdominal pain appears, this is not very good, since there is a high probability that a spasm of the cervical canal has occurred and a 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.

To prevent hematomas in the first days after curettage, you can take No-Spa 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.

The results of histological examination are usually ready 10 days after surgery, do not forget 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. It is indispensable in the treatment and diagnosis of some gynecological diseases. Now this operation is very comfortable and can probably be called one of the most comfortable interventions available in gynecology, since you do not experience pain or discomfort. Of course, if you get to a careful gynecologist and anesthesiologist.

If the gynecologist suspects that the patient has a pathology of the uterus, he may recommend that she undergo separate diagnostic curettage (RDV with hysteroscopy). What is hysteroscopy of the uterus? When is this procedure indicated and how to prepare for it? Are there any contraindications? You will find the answers in this article.

Hysteroscopy with separate diagnostic curettage is a procedure during which an internal examination of the uterus is performed using a diagnostic device called a hysteroscope. During hysteroscopy with RDV, the doctor additionally performs curettage of the endometrium using a sharp curette. This operation affects only the endometrial layer.
Hysteroscopy should not be confused. Hysteroscopy with RDV is a diagnostic procedure that is prescribed to detect pathology. Hysteroresectoscopy is aimed at removing already identified tumors and is used for therapeutic and diagnostic purposes.
Only a doctor can decide which is better, a simple diagnostic hysteroscopy or curettage, based on the patient’s anamnesis and medical history.

Indications

Hysteroscopy with RDV is performed in the presence of the following factors:

• During an ultrasound examination, a questionable result was revealed and doctors find it difficult to make the correct diagnosis;
• the patient has difficult periods, she experiences severe pain during menstruation, and also notices discharge in the form of large blood clots;
• it is impossible to confirm the patient’s disease using other testing methods;
• there was a need to obtain biological material for laboratory research;
• the patient has uterine bleeding that is not associated with the menstrual cycle;
• a woman is unable to become pregnant for a long period of time, however, non-invasive methods have not made it possible to determine what is causing the fertility problems;
• there are suspicions of endometrial cancer;
• The patient had miscarriages several times, the causes of which were not identified during other examinations.

Hysteroscopy with RDV is a fairly accurate procedure. According to statistics, it can be used to confirm or refute a presumptive diagnosis in 90% of cases.

Limitations of hysteroscopy with RVD

Hysteroscopy with RDV has the following contraindications:

• the patient has inflammatory diseases of the genitourinary system;
• bearing a child;
• chronic heart diseases and vascular pathologies;
• malignant neoplasms of the uterus and cervix;
• liver diseases.

Contraindications must be taken into account when prescribing a procedure, so you should not hide information about your health status from your doctor.

Before the procedure

It is important to know how to properly prepare for hysteroscopy of the uterus. Several weeks before your medical appointment, it is recommended to stop taking medications that may affect blood clotting.
A week before the procedure, stop using vaginal suppositories. And also doctors do not recommend being sexually active for five to seven days before the test.
You can eat food on the eve of hysteroscopy with RDV at least 12 hours in advance.
Hysteroscopy and curettage is performed at the end of the menstrual cycle. Otherwise, it can cause bleeding caused by active growth of the endometrium. At the time of menstruation, hysteroscopy with RDV is also not performed: the endometrium changes greatly at this time, as a result of which the analysis will not be reliable.

How scary is this?

There is no need to fear that the operation will cause harm to the body. It is prescribed only in cases of urgent need, if other methods to diagnose and identify serious pathology do not work.
Curettage is carried out under visual control, so there is no risk of damage to the uterine wall. In addition, to further protect the patient, a thorough examination is carried out before the procedure. This allows us to exclude the development of negative results of hysteroscopy with RDV.

Hysteroscopy technique

Surgical hysteroscopy is performed as follows:

• the patient receives anesthesia. In this case, anesthesia can be either general or local: it depends on the patient’s condition, the presumptive diagnosis and a number of other factors;
• using a special instrument, the cervical canal is expanded;
• the genitals are treated with an antiseptic;
• A hysteroscope is inserted through the cervical canal. The doctor examines the inner surface of the uterus, which allows you to obtain additional diagnostic information;
• the endometrium is scraped with a curette;
• After curettage, tissue samples are sent to the laboratory.

Separate diagnostic curettage under hysteroscopy control lasts no more than half an hour. After the procedure, the patient must remain in a medical facility for several hours. In addition, antibiotics are indicated to avoid the development of various complications. How long the antibiotics will last is decided by the attending physician.
A week after hysteroscopy with RDV, you must undergo a gynecological examination. In some cases, an ultrasound examination of the uterus is additionally recommended.

Recovery period

To ensure recovery after hysteroscopy occurs as quickly as possible, you must follow medical recommendations:

• take medications recommended by the doctor. It is important to follow medical prescriptions and not look for advice on forums on the Internet;
• Avoid exhausting work and physical overload. You should avoid going to the gym or choose gentle workouts: lifting weights during the rehabilitation period is strictly prohibited;
• During menstruation after hysteroscopy, tampons should not be used: they can disrupt the natural microflora of the genital organs;
• it is important to take good care of intimate hygiene and use delicate detergents that do not disturb the natural microflora and acidity level of the genitals;
• Also, recommendations after hysteroscopy say that for two weeks it is strictly forbidden to take a bath, visit a sauna or bathhouse. This can lead to severe uterine bleeding.

Complications

Often patients experience pain after hysteroscopy, reminiscent of discomfort during menstruation. Reviews from women who have undergone hysteroscopy with RDV indicate that after a week these pains go away on their own. More serious complications after hysteroscopy with RDV develop extremely rarely. However, they are not excluded, so it is important to know the main signs that indicate that you should immediately seek medical help:

• uterine bleeding. If the bleeding is so severe that a woman has to change several pads in one hour, she should immediately consult a doctor. To avoid bleeding after hysteroscopy, it is important to monitor your menstrual cycle. The first menstruation after the procedure should come on time;
• there are no periods after hysteroscopy, but it is impossible that the woman became pregnant. A serious delay should be a reason to make an appointment with a gynecologist;
• endometritis (inflammation of the endometrium lining the uterine cavity). Endometritis develops if an infection gets inside the uterus or the rules of antiseptic treatment were not followed in preparation for the procedure. The first symptoms of endometritis are severe pain in the lower abdomen, as well as increased body temperature;
• perforation of the uterine wall. A similar complication develops if the intervention was performed without proper professionalism. When perforation bleeds, your health worsens, pain occurs in the lower abdomen;
• Asherman's syndrome. If the patient has recently experienced childbirth, then adhesions may form from the remnants of the placenta after hysteroscopy with curettage, which interfere with pregnancy. Adhesions, or, as they are called, uterine synechiae, are removed surgically;
• hemetometer. This pathology consists of the occurrence of a blood clot in the uterine cavity, which cannot exit through the cervical canal. The development of hemetometra is indicated by dizziness, increased body temperature, deterioration in general health, as well as nausea and vomiting.

After diagnostic curettage with hysteroscopy, it is important to carefully monitor your condition and consult a doctor at the first signs of deterioration in your health. Otherwise, the consequences of hysteroscopy may negatively affect your health.

As a rule, a woman can become pregnant within a month after hysteroscopy with curettage.

RDV with hysteroscopy is an accurate diagnostic procedure that allows you to identify many pathologies of the uterus and cervix in the early stages of their development. Follow all the doctor’s recommendations when preparing for the procedure and during the recovery period: this will help avoid the development of complications and quickly return to normal life!

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 informed 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:

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

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:

1. Increased body temperature;
2. Pain in the lower abdomen;
3. 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.

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.