Gynecological curettage indications. Diagnostic curettage or curettage of the uterine cavity: indications and contraindications

Curettage refers to minor surgical interventions. It is performed after childbirth, abortion, to remove tumors in the uterus. Most women tolerate the procedure well. But some patients observe pathological changes in the body, including discharge.

We will tell you how many days the bleeding continues, when it is within normal limits, and in what cases requires consultation with a doctor.

About curettage

Curettage is a gynecological operation aimed at cleansing the uterine cavity of various formations, blood clots, remnants of the placenta and fertilized egg. It is carried out mechanically - by introducing special instruments into the uterine cavity or through vacuum aspiration.

Curettage is indicated for women:

• after childbirth, if remnants of the placenta or large blood clots are detected in the uterus;
• after an abortion, while retaining parts of the fertilized egg;
• for removal of fibroids and plolips;
• for diagnostic purposes, to obtain a piece of tissue and examine it for the presence of cancer cells.

Repeated cleaning, for example, after hysteroscopy with curettage, causes particular harm to the body. The operation leads to injury to the walls of the uterus, and bleeding wounds appear on it. And if not enough time has passed after the operation, then repeated intervention can cause the wound to become infected. Therefore, a woman should know what discharge should be after curettage in order to promptly consult a doctor for help.

Discharge within normal limits

After diagnostic curettage or to cleanse the uterine cavity, spotting is normal. The reason for their appearance is the rejection of the upper layer of the endometrium and injury to the uterine cavity. The doctor should warn you how long the discharge lasts and what intensity it is.

The nature of the discharge after curettage largely depends on the disease for which the operation was required.

After childbirth

Curettage is prescribed for women in labor whose uterus does not contract or where placenta remains in the uterus are diagnosed. To remove blood clots, vacuum aspiration or mechanical cleansing is performed. There should be no bleeding after curettage; the woman continues to experience lochia - postpartum discharge. In intensity they resemble menstruation in the first 2-3 days. The discharge lasts no more than 1.5 months.

After an abortion

Often after an abortion, remnants of the fertilized egg remain in the uterine cavity. If you do not remove them, infection may occur. Curettage is performed to cleanse the uterus and normalize its functioning. Due to injury to the walls, the wife begins to discharge. The ichor is observed for 5-10 days, after which the vaginal secretion becomes brown and stops on the 14th day.

After removal of tumors

There may be no discharge after curettage of the uterine cavity to remove tumors. If the procedure was carried out using modern methods, without damaging the mucous membranes, then the woman feels good. But for the first 3-4 days, small pink discharge is not considered a deviation from the norm. The main thing is to control their quantity and, in case of changes, consult a doctor.

Nature of discharge and duration

Normal discharge after mechanical curettage has the following symptoms:

• average volume, like menstruation, for no more than 3 days;
• there are no large blood clots;
• abdominal pain is tolerable;
• there is no unpleasant, putrid odor.

We examined earlier what discharges are observed in a particular case. It is worth focusing on the presented standards in order to promptly diagnose the presence of infection in the uterine cavity.

Blood discharge after curettage lasts a maximum of 5-7 days. An exception is the postpartum period, where the appearance of blood is allowed within 14 days. After curettage on the 7th day, brown discharge replaces ichor. They are quite scarce, do not cause discomfort and completely stop after 2-3 days.

Possible complications

Ichure is normal after surgery. If there is no discharge after curettage, in some cases complications may be suspected:

• During the operation, the tumor or blood clots were not removed;
• blood accumulates inside the uterus.

The uterus rejects the endometrium after childbirth and abortion. If disturbances occur in the functioning of the reproductive organ, then there is a lack of vaginal secretion. This is not normal and requires an ultrasound examination.

The opposite situation is also possible - the discharge intensifies and lasts longer than expected. This may indicate complications:

• Internal bleeding associated with inflammation of the uterine cavity.
• Cervical rupture. This happens due to increased elasticity of the cervix and careless actions of surgeons. With minor damage, the tissues repair themselves. If the wounds are numerous or deep, then suturing is required.
• Deformation of the uterus. When cleansing the uterine cavity, the doctor acts “blindly,” which can cause injury to the organ. With minor injuries, slight bleeding is observed. If the wounds are serious, the woman may lose a lot of blood.
• Violation of the integrity of the mucous membrane. Hysteroscopy of an endometrial polyp may damage the uterine mucosa.
• Hematometra. After surgery, the uterus begins to contract to expel blood clots. If this does not happen, blood accumulates inside. This condition is characterized by the fact that brown discharge first appears after curettage, and then bleeding begins.

If the discharge suddenly stops, then this is a reason to consult a doctor.

An alarming symptom is severe, cutting pain in the abdomen. It occurs when the uterus becomes inflamed and the wound becomes infected. Severe pain combined with bleeding is a reason for immediate hospitalization of a woman.

Other secretions

After surgery, the risk of infection and inflammation of the genital organs increases. The disease can be identified by its characteristic symptoms:

• yellow discharge after curettage and the end of bleeding indicates inflammation of the appendages or uterus;
• green or gray vaginal secretion indicates an infectious pathology;
• curdled leucorrhoea is the first sign of thrush.

Additional signs include an unpleasant odor from the genitals, itching and burning. Pain in the lower abdomen is possible.

Within normal limits, only colorless mucous discharge that does not cause discomfort. They occur before the onset of menstruation and 5 days before ovulation. The absence of other discharge indicates a successful operation.

Menstruation after curettage: norm and pathology

The menstrual cycle after gynecological manipulations is disrupted in most women. Less or more blood is released, the duration is shortened or increased. As a rule, after treatment of the disease, periods become less painful and more abundant. Also within the normal range of delays are the first 2-3 months.

The first period may appear only a month after the operation. A woman should not worry; cycle disruption is possible due to a hormonal cycle failure.

How to prevent complications

Knowing how long the discharge lasts after curettage, you should focus on this indicator. If deviations occur, you should consult your doctor. Also, a woman must follow a number of rules to prevent possible complications:

• carry out treatment only in a qualified clinic with experienced staff;
• monitor genital hygiene, especially in the first days after surgery;
• maintain sexual rest until the discharge ends;
• take a course of medication prescribed by a doctor to restore the body;
• undergo examination one month after surgery;
• enrich your diet with fresh fruits and vegetables;
• choose a suitable method of contraception if pregnancy is not planned.

Curettage refers to minor gynecological operations. It is prescribed in a number of situations when it is necessary to cleanse the uterine cavity of various formations. A woman should know the nature of the discharge after curettage in order to control the healing process of the uterus and prevent the development of complications.

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!

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

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 for a final diagnosis; second goal – remove pathological formation in the uterine cavity or cervical canal.

Diagnostic goal:

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 heavy, prolonged menstruation 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 site)

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 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 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 curettage of the uterus is also called curettage or gynecological cleansing. This is a procedure that is carried out with special instruments or using a vacuum system to remove the upper layer of the endometrium, which is then sent for Sometimes diagnostic curettage is combined with hysteroscopy to examine the uterine cavity after the procedure.

Preparation for this manipulation

As a rule, diagnostic curettage is performed several days before menstruation, which reduces blood loss and promotes faster recovery of the uterus. It is considered a surgical procedure, so before undergoing it, a woman must undergo a general clinical blood test, a coagulogram, a vaginal smear and tests to detect sexually transmitted diseases.

It is advisable not to take any medications 14 days before the procedure. If a woman has pathologies that require constant pharmacological therapy, then taking medications should be agreed with a doctor.

3 days before the procedure, sexual intercourse and douching should be avoided. It is forbidden to wash yourself with hygiene products; during this period, you can only use warm water. You should also not use vaginal suppositories, tablets or sprays. You should not eat 12 hours before curettage, as eating may make it difficult to administer anesthesia.

Diagnostic curettage of the uterine cavity: methodology

Before surgery, the bladder and bowels are emptied. The perineum, as well as the external genitalia, are treated with alcohol and iodine solution. The same substances are used to disinfect the vaginal mucosa and cervix and provide pain relief. For easier expansion, antispasmodics are administered 30 minutes before surgery. For pain relief, adrenaline with novocaine is injected into the cervix and the cervix is ​​dilated using Hegar dilators, starting with the smallest diameter of this instrument.

Diagnostic curettage is performed with curettes. They also come in different sizes. The scraping is collected in a tray, after which it is washed with water to remove blood, after which it is lowered into a bottle, filled with a solution of formaldehyde or 96% alcohol and sent to the laboratory.

Indications for diagnostic curettage

This manipulation is carried out in the following conditions:

Irregular periods and bleeding between periods;

Excessively painful or heavy periods;

Bloody discharge after menopause;

Infertility;

Suspicion of a malignant tumor in the uterus.

Separate diagnostic curettage is carried out by separate curettage of the cervical canal and the uterine cavity to identify polyps, endometriosis and it is also performed for uterine fibroids or endometrial hyperplasia.

Gynecological cleansing is not carried out for infectious diseases, decompensated pathologies of the heart, kidneys or liver, as well as for diseases of the genital organs.

It is worth noting that curettage can also be performed for therapeutic purposes in case of frozen pregnancy, miscarriages, or ectopic pregnancy.

Uterine fibroids are a benign tumor of the muscle tissue of the uterine walls. It can appear at any period of a woman’s life: before and after childbirth, as well as during premenopause. In 30-50% of cases, the disease is asymptomatic and does not require any medical intervention. In other situations, patients are prescribed treatment.

Before deciding on one or another method of tumor therapy, almost all women are sent for diagnostic curettage. But diagnostic curettage of the uterine cavity for uterine fibroids should not be a routine procedure. Such a tumor in itself is not an indication for “cleaning”. So in what cases should curettage be included in the examination, and in what cases is it inappropriate? Let's find out in this article. Let’s start by finding out what clinical types of fibroids are.

Types of uterine fibroids depending on the clinical course

Depending on the clinical picture of the disease, patients with uterine fibroids are conventionally divided into 2 groups:

• Women with an asymptomatic course of the disease (simple fibroids);
• Patients with fast-growing (or proliferating) fibroids.

Since fibroids usually begin asymptomatically, they can be detected accidentally during an ultrasound examination of the pelvic organs.

It is important to know

With this type of uterine fibroid, gynecological curettage is contraindicated. It is uninformative and is a meaningless operation. The resulting scraping from the uterine cavity “will not shed light on this disease,” but can reveal concomitant pathology.

Fast growing uterine fibroids

This is an active type of tumor. Progresses very quickly, gives pronounced clinical symptoms:

1. Pain. Appears when the fibroid leg is twisted or necrosis occurs and nutrition in the node is disrupted;
2. Uterine bleeding or irregular spotting. Pathological bleeding is the most characteristic sign of fibroids;
3. Dysfunction of neighboring organs. Occurs if the uterus with nodes reaches a large size;
4. Severe iron deficiency anemia – is a consequence of intense bleeding;
5. Impaired fertility and infertility. Myoma can create an obstacle to the movement of the egg through the tube and interfere with the implantation of the fertilized egg, causing miscarriages and premature birth.

With rapidly growing uterine fibroids, pathological bleeding is often observed.

Such fibroids not only do not decrease during menopause, but, on the contrary, may even increase. Its growth often accelerates during pregnancy.

You can read about how quickly fibroids can grow and how to stop their growth

What is the essence of diagnostic curettage of the uterine cavity?

Diagnostic curettage is the removal of the superficial functional layer of the endometrium (that which is normally rejected on its own during menstruation) along with the pathological formations located in it using a surgical instrument - a curette. The operation is carried out for diagnostic, therapeutic and treatment-diagnostic purposes. If possible, it is better to perform this manipulation under the control of a special optical device - a hysteroscope, which allows you to see what is happening inside the uterus on a monitor.

After cleaning the uterus, the resulting material must be sent for histological and cytological examination to the laboratory for close examination under a microscope. Based on the histology conclusion, the doctor can judge the condition of the inner lining of the uterus and choose the right treatment tactics. The examined scraping may indicate:

• About the presence of polyps;
• About endometrial hyperplasia;
• About adenomyosis;
• About the inflammatory process in the uterine cavity;
• About malignant degeneration of the endometrium.

When is the procedure really necessary?

Diagnostic curettage allows you to obtain material from the uterine cavity, namely the surface layer of the endometrium, and evaluate its condition. But this manipulation does not provide any information about the condition of the myomatous nodes.

Sometimes you hear that curettage is prescribed in order to “remove nodes from the uterus” or in order to “determine the benignity of the tumor.” This is fundamentally wrong.

For your information

Myoma is always a benign formation, and it never becomes malignant. It is technically impossible to scrape out fibroids! Only submucosal nodes that are connected to the uterine muscle by a thin and long stalk can be removed by curettage, so they can fall into the cervical canal and be accessible for removal. They say about such nodes: “a born submucosal node on a pedicle.”

Only pedunculated submucosal nodes can be accessed for removal during diagnostic curettage.

Progressive uterine fibroids almost never occur in isolation. and other hyperplastic processes of the endometrium, heavy acyclic uterine bleeding, prevents a woman from becoming pregnant and safely carrying a baby.

Therefore, there are usually two reasons for diagnostic curettage for uterine fibroids:

1. Existing concomitant disease (polyp or endometrial hyperplasia, uterine bleeding);
2. The need to exclude endometrial cancer. This is especially important for making a decision before removing fibroids, when you need to decide: to save the uterus and remove only the nodes or, given the malignancy of the process, to perform a hysterectomy - complete removal of the uterus.

Indications for surgery

So, when can curettage of the uterus be performed for fibroids:

• Prolonged, painful menstruation with clots;
• Random spotting;
• Acute pain in the lower abdomen;
• Frequent and painful urination or constipation;
• Weakness, dizziness, decreased hemoglobin;
• Bleeding in menopause;
• History of infertility or miscarriage.

Contraindications

• Asymptomatic small uterine fibroids;
• Infectious diseases or inflammatory processes of the genitals.

Is preparation necessary for surgery?

Curettage of the uterus is, of course, an operation, albeit a minor one. Therefore, it is necessary to undergo a medical examination for its successful completion. What tests need to be taken?

1. Clinical and biochemical blood tests;
2. Blood coagulation studies;
3. Blood for HIV infection, syphilis and hepatitis;
4. General urine analysis;
5. Vaginal smear for pathogenic microflora and sexually transmitted infections;
6. Electrocardiogram;
7. Ultrasound of the pelvic organs.

Before surgery, it is necessary to pass all general clinical tests.

Before the procedure, a therapist must be examined to identify somatic pathologies and contraindications for anesthesia. The day before the operation, the woman is examined by an anesthesiologist.

On the eve of the procedure, the following conditions must be met:

• Sexual abstinence;
• Do not use douching, vaginal suppositories or tablets;
• Carry out intimate hygiene only with running water;
• Be sure to shave the hair from the external genitalia;
• Cleanse the intestines;
• Take a shower;
• In the evening - light dinner.

On the day of surgery, do not drink or eat. Bring a clean shirt, slippers and a supply of sanitary pads. Before starting the procedure, empty your bladder.

How to perform the procedure

The operation is performed on the first day of menstruation or 1-2 days before menstruation. During menopause - on any convenient day.

Venue: small operating room at a antenatal clinic or gynecological hospital, gynecological chair.

Anesthesia - intravenous anesthesia or local anesthesia in the form of injection of the cervix with an anesthetic solution.

Duration – curettage surgery for uterine fibroids takes 5-10 minutes.

Operation stages

There is no need to be afraid of this procedure. After an intravenous injection of a narcotic drug, the woman falls asleep and does not feel anything. And the doctor at this time:

1. Conducts a vaginal examination to determine the position of the uterus and its size;
2. Treats the perineum with an antiseptic solution;
3. Opens the vagina with gynecological speculum and fixes the cervix with special forceps - bullets;
4. The uterine probe determines the length and direction of the uterine cavity;
5. Expands the cervical canal with medical dilators;
6. Performs curettage of the uterine cavity with a special spoon with a long handle, called a “curette.” The doctor’s movements should be careful and unhurried in order to cause minimal trauma to the walls of the uterus. The doctor collects all the material in a tray, then places it in a container and sends it for examination;
7. He removes the forceps from the neck and removes the mirrors.

Diagnostic curettage of the uterine cavity is performed with a curette - a special tool in the shape of a spoon with a long handle.

On a note

Carrying out curettage under the control of hysteroscopy or ultrasound allows you to achieve optimal results and reduce the risk of complications.

The operation is completed. A woman wakes up after anesthesia. For two hours she is under the supervision of medical personnel, who monitor her condition: measure her pulse, blood pressure, body temperature and monitor her discharge. In the first hours after surgery, the discharge may be bloody with small clots, which then become insignificant, mucous-sacral or brown.

As a result of intravenous anesthesia, a woman may experience weakness or drowsiness, which goes away on its own after a few hours. Moderate nagging pain in the lower abdomen may occur. The pain persists for several hours after curettage, then subsides.

If there are no complications during the observation period, she is sent home.

• Abstinence from sexual intercourse for 1 month;
• Taking antibacterial drugs prescribed by a doctor in the postoperative period;
• Do not use vaginal tampons or douches;
• Baths and saunas are prohibited;
• Perform hygiene procedures only in the shower;
• Do not take medications that thin the blood and cause bleeding.

What are the complications?

Negative consequences after curettage:

• Perforation (puncture) of the uterus with medical instruments;
• Inflammatory process of the genital organs.

After the procedure of curettage of the uterine cavity, if the doctor’s recommendations are not followed, an inflammatory process may begin under the influence of pathogenic microorganisms.