CURETTAGE

One of abortion technique

Indication
• Diagnostic :
• Abnormal Uterine Bleeding : Suspected Malignant/Premalignant condition
• Retained material in endometrial cavity
• Evaluation of intracavitary findings from imaging procedures
• Evaluation and removal of retained fluid from endometrial cavity:
hematometra, pyometra
• Endometrial biopsy
• Endometrial sampling in conjunction with other procedures : hysterosopy
Indication
• Therapeutic
• Removal of retained products of conception : Incomplete abortion, missed
abortion, septic abortion & induced pregnancy termination
• Suction procedures for management of uterine hemorrhage
• Treatment & evaluation of gestational trophoblastic disease
• Hemorrhage unresponsive to hormone therapy
• In conjunction with endometrial ablation for histologic evaluation of
endometrium
Contraindication
• Absolute :
• Viable desired intrauterine pregnancy
• Inability to visualize the cervical os
• Obstructed Vagina

• Relative :
• Severe cervical stenosis
• Prior endometrial ablation
• Bleeding disorder
• Acute Pelvic Infection
• Obstructing Cervical Lesion
Dilatation and Curettage (D&C)
• requires intravenously or orally administered sedatives or analgesics,
and some also use paracervical blockade with lidocaine
• Frankenhäuser plexus, which lies within connective tissue lateral to
the uterosacral and cardinal ligaments. Tus, a
paracervical block is effective to relieve pain
• Perioperative antibiotic prophylaxis
• require first dilating the cervix and then evacuating the pregnancy by
mechanically scraping out the contents—sharp curettage,
by suctioning out the contents—suction curettage, or both
• recommended for gestations ≤ 15 weeks
Cervical Preparation

• To soften & slowly dilate cervix  minimize trauma

from mechanical dilataion
• hygroscopic dilators : draw water from cervical
tissues and expand to gradually dilate the cervix.
• Laminaria algae that are harvested from the ocean floor
• Dilapan-S, composed of an acrylic-based gel.
Cervical Preparation

• Medication :
• Misoprostol : 400-600 μg administered orally,
sublingually, or placed into the posterior vaginal fornix.
• Progesterone antagonist mifepristone (Mifeprex). With
this, 200 to 600 μg
is given orally.
• prostaglandins E2 and F2a, which have unpleasant side
effects and are usually reserved as second-line drugs
Technique
• bimanual examination : determine uterine size and orientation
• Insert speculum
• cervix is swabbed with povidone-iodine or equivalent solution.
• anterior cervical lip is grasped with a toothed tenaculum
• Local anesthetic :
• 5 mL of 1- or 2-percent lidocaine, placed immediately lateral to the
insertion of
the uterosacral ligaments into the uterus at 4 and 8 o’clock
• 5-mL aliquots of 1-percent lidocaineinjected at 12, 3, 6, and 9 o’clock
• Dilute vasopressin may be added to the local anesthetic to decrease
blood loss
• Uterine Sounding : measures the depth and inclination of the cavity
 Technique
• Cervix Dilation : Hegar, Hank / Pratt
Dilators until suction cannula of appropriate
diameter can be inserted.
• Rest 4th & 5th fingers of hand introducing the
dilator on perineum & buttocks as pushing
dilator through internal os
• Move suction cannula toward fundus & back
toward os & turn circumferentially to cover
entire surface of uterine cavity.
• Use a gentle sharp curettage to remove
remaining fragments
Complication
• Uterine Perforation : common in retroverted uterus, observation
if small.
• Intraabdominal damage : If curette/suction pass through uterine
defect
• Severe consumptive coagulopathy : Rare & Sudden