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Dilatation & Curettage: DR Ayswarya Narayan

Dilatation and curettage (D&C) is a common gynecological procedure where the cervical canal is dilated followed by scraping of the uterine lining. It is done for both diagnostic and therapeutic purposes such as infertility, abnormal bleeding, polyps, and incomplete abortions. The steps involve dilating the cervix with graduated dilators and then scraping the uterine walls with a curette. Complications can include injury to the cervix, perforation of the uterus, infections, and in rare cases cervical incompetence or uterine synechiae from damage to tissues.

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Prajwal Kp
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129 views19 pages

Dilatation & Curettage: DR Ayswarya Narayan

Dilatation and curettage (D&C) is a common gynecological procedure where the cervical canal is dilated followed by scraping of the uterine lining. It is done for both diagnostic and therapeutic purposes such as infertility, abnormal bleeding, polyps, and incomplete abortions. The steps involve dilating the cervix with graduated dilators and then scraping the uterine walls with a curette. Complications can include injury to the cervix, perforation of the uterus, infections, and in rare cases cervical incompetence or uterine synechiae from damage to tissues.

Uploaded by

Prajwal Kp
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd

Dilatation & Curettage

Dr Ayswarya Narayan
• Operative procedure whereby Dilatation of
the cervical canal followed by Uterine
curettage is done.
• It is the most common gynecological
operation done.
Indications
Diagnostic
• Infertility
• DUB
• Pathological amenorrhea
• Endometrial TB
• Endometrial Ca
• Postmenopausal bleeding
• Chorionepithelioma
Therapeutic
• DUB
• Endometrial polyp
• Removal of IUD
• Incomplete abortion
Combined
• DUB
• Endometrial polyp
Steps of operation
• Patient is asked to empty the bladder prior to
operation.
• Operation is done under general anesthesia or
under diazepam sedation with or without
paracervical block.
• She is placed in lithotomy position.
• Local antiseptic cleaning and draping done.
• Bimanual examination is performed.
• Posterior vaginal speculum is introduced.
• Anterior lip of cervix is grasped with an Allis
tissue forceps/ Vulsellum.
• Uterine sound is introduced to confirm the
position and to note the length of the
uterocervical canal.
• Cervical canal is dilated with graduated
dilators. The tip of the dilator shoould be
directed anteriorly or posteriorly according to
position of the uterus.
• After desired dilatation, the uterine cavity is
curetted by uterine curette either in clockwise
or in anticlockwise direction starting from
fundus down to internal os.
• Sharp curette – benign lesion
• Blunt curette – suspected malignancy
• Curette should be gentle but thourough.
Vigourous curettege may damage the basal
layer of the endometrium and uterine muscle.
• Vulsellum and the speculum are removed.
• Curetted material is preserved in 10% formol
saline (NS in suspected tubercular endometritis),
Labeled properly and sent for histological
examination.
• Short history of case and first of LMP specially in
infertility cases and DUB should be mentioned.

• Discharge – after short period of observation (3-


4hrs) with passing off the anesthetic effect.
Complications
Immediate
• Injury to cervix
• Injury to gut
• Uterine perforation
• Infection
Injury to cervix
• Caused by vulsellum bite/ lateral tear by
dilator.
• Rx - stopped by gauze pressure/ hemostatic
suture.
• Lateral tear – if extends upwards involving
uterine artery – correction through
laparotomy
Uterine perforation
• More common in pregnant uterus
• Diagnosis is made by :
- sudden loss of resistance
- Passage of instrument more than the length of
uterine cavity.
- Undue mobility of instrument
- Vaginal bleeding
Management of perforation
• Procedure must be stopped.
• To watch the pulse, BP and vaginal bleeding.
• To formulate the definitive treatment.
Non infective / Non malignant uterus –
• Small perforation – watch vital signs,
administer antibiotics, if vitals are normal –
discharge after 24-48hrs.
• Large perforation – laparotomy for varying
degree of internal haemorrhage / injury to
gut.
Infective/ malignant uterus
• Laparotomy followed by definitive surgery.
• If perforation occurs in potentially infected
uterus of young women, conservative
treatment with antibiotics and to watch for
signs of peritonitis.
Remote complication
• Cervical incompetence due to injury of
internal os → cause recurrent midtrimester
abortion
• Uterine synechiae due to injury on uterine
muscle → may cause secondary amenorrhoea

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