Uterine dilation and curettage

Uterine curettage consists of dilating the cervix with dilators and removing the surface layer of the uterine lining (endometrium) with a curette, forceps or biopsy device. The extracted tissue is subsequently investigated in the laboratory.

This procedure is performed to investigate the endometrium, to remove polyps, or remaining tissue
proliferated in excess, to open a uterine synechia or to stop a hemorrhage.
It is indicated in the following situations:
● Abnormal uterine bleeding
● Tissue retention after abortions
● Suspicion of uterine cancer
● Persistent uterine polyps
● Infertility

The risks associated with the procedure are:
● Pain during the procedure, in the absence of general anesthesia
● Bleeding that requires transfusion or other surgery
● Infection
● Perforation of the uterus and neighboring organs
● Uterine synechia
● Abnormal reaction to medication
● Incomplete tissue removal and repetition of the procedure
● Cancer cells may not be detected, even if they exist

Removing a remaining tissue, polyp, or endometrial fragment can help:
● Diagnosed the cause of bleeding or infertility
● Stopping a bleeding
● Removed the cause of infertility
● Prevention of complications (infections, fulminant hemorrhage, cancer)

The alternative to uterine curettage is operative hysteroscopy, similar in procedure but with differences in the possibilities of visualizing the cavity or using electrical equipment. Depending on the volume of bleeding or proliferated tissue, one or the other of the two techniques may be indicated.

Failure to perform the procedure can lead to persistence or complications: massive hemorrhage, infection, infertility, cancer.

The probability of obtaining the desired result is high, and complications are rare.
However, patient particularities and other uncontrollable variables can significantly influence the estimated outcome. Medicine is not an exact science and, therefore, no guarantees or assurances can be offered on the final result.

Investigations:

The following investigations are necessary before performing uterine curettage:
● Pap smear performed in the last 12 months
● Culture with the uterus
● Blood count, transaminases, blood sugar, creatinine, APTT
● Serology of communicable diseases: HBs, HCV, HIV, VDRL

Written consent: To perform uterine curettage it is necessary to fill in a consent form, after reading
information and clarification of doubts. Consent may be withdrawn before the procedure is performed.

Medication: Your doctor should be informed of any medications or natural remedies taken regularly.

Lifestyle: Food and fluids are prohibited 6 hours before the intervention.

Sexual contact should be avoided 48 hours before surgery.
It is recommended to epilate and use bactericidal soaps for the genital toilet.

The procedure begins by administering local or general anesthesia and disinfecting the vagina. The neck is checked and dilated, with dilators of progressively increasing size. This maneuver can cause uterine contractions, perceived by the patient, if awake, as menstrual cramps. Scrape the cavity and extract the polyp, endometrial or other tissue. The extracted tissues are sent to the laboratory for analysis. In the case of endometrial biopsy, no neck dilation is required, and the extracted fragments are much smaller.

Clinical supervision period:
Clinical supervision is required for at least 30 minutes. from the end of the procedure.
Driving the vehicle is not allowed on the day of the intervention, in case of using general anesthesia.

Medication:
After curation, anti-inflammatory medication may be prescribed to reduce pain and other postoperative symptoms. The doctor may administer an antibiotic during the procedure to prevent infection.

Lifestyle:
The usual activities can be resumed starting with the day following the intervention. There are no special restrictions on diet.
Sexual contact is prohibited in the first 7 days after the intervention.

Possible symptoms:
In the first hours after uterine curettage, there may be nausea, vomiting, headache, which subsides the next day. Pelvic pain may persist for several days, but is usually bearable.
Bleeding is normal in the first 7 days, if it does not exceed the amount of a regular menstruation.

Symptoms that require immediate medical attention:
● Fever over 38∘C
● Intense pain that does not yield to painkillers
● Persistent heavy bleeding

The control after uterine curettage is scheduled after the end of the first menstruation, 5-6 weeks after the procedure. On this occasion, the result of the clinical and laboratory examination is evaluated