Dilation and curettage

A. Dilation and curettage is performed as either a diagnostic or therapeutic procedure. Indications for diagnostic D&C include:

1. A nondiagnostic office biopsy in women who are at high risk of endometrial carcinoma.

2. Insufficient tissue for analysis on office biopsy.

3. Cervical stenosis prevents the completion of an office biopsy.

B. Diagnostic D&Cs are usually performed with hysteroscopy to obtain a visual image of the endometrial cavity, exclude focal disease, and prevent missing unsuspected polyps.

C. Examination under anesthesia. After anesthesia has been administered, the size, shape, and position of the uterus are noted, with particular attention to the axis of the cervix and flexion of the fundus. The size, shape, and consistency of the adnexa are determined. The perineum, vagina, and cervix are then prepared with an aseptic solution and vaginal retractors are inserted into the vagina.

D. Operative technique. A D&C is performed with the woman in the dorsal lithotomy position.

1. Endocervical curettage (ECC) is performed before dilation of the cervix. A Kevorkian-Younge curette is introduced into the cervical canal up to the internal os. Curetting of all four quadrants of the canal should be conducted and the specimen placed on a Telfa pad.

2. Sounding and dilation. Traction is applied to align the axis of the cervix and the uterine canal. The uterus should be sounded to document the size and confirm the position. The sound should be held between the thumb and the index finger to avoid excessive pressure.

3. Cervical dilation is then performed. The dilator is grasped in the middle of the instrument with the thumb and index finger. The cervix is gradually dilated beginning with the #13 French Pratt dilator. The dilator should be inserted through the internal os, without excessively entering the uterine cavity.

4. Sharp curettage is performed systematically beginning at the fundus and applying even pressure on the endometrial surface along the entire length of the uterus to the internal cervical os. The endometrial tissue is placed on a Telfa pad placed in the vagina. Moving around the uterus in a systematic fashion, the entire surface of the endometrium is sampled. The curettage procedure is completed when the "uterine cry" (gritti-ness to palpation) is appreciated on all surfaces of the uterus. Curettage is followed by blind extraction with Randall polyp forceps to improve the rate of detection of polyps.

Pregnancy Nutrition

Pregnancy Nutrition

Are You Expecting? Find Out Everything You Need to Know About Pregnancy and Nutrition Without Having to Buy a Dictionary. This book is among the first books to be written with the expertise of a medical expert and from the viewpoint of the average, everyday, ordinary,

Get My Free Ebook

Post a comment