Separate diagnostic curettage under hysteroscopy control. Therapeutic and diagnostic curettage of the uterine cavity: goals and methods of implementation What should be done after curettage

Curettage of the uterine cavity is prescribed for therapeutic or diagnostic purposes. It allows you to identify the exact cause of certain diseases and get rid of neoplasms (polyps, adhesions, etc.).

Curettage is a manipulation that comes down to removing the restored layer of the uterine mucosa using special instruments (curettes or vacuum aspirators).

The entire procedure sounds like “separate diagnostic curettage" “Separate” - since tissues from the wall of the cervix and the uterus itself are examined separately.

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During the intervention, it is preferable to use a hysteroscope, a system for a detailed examination of the uterus.

For better understanding the essence of the procedure, some definitions should be disclosed:

1. Scraping as such is only an instrumental manipulation, i.e., a designation of the action itself. The operation has different names depending on the method and purpose of its implementation.
2. Separate curettage involves the sequential removal of biomaterial first from the cervical canal, then from the uterine mucosa. After the operation, the removed tissue will be sent to a histology laboratory, and at the same time the neoplasm for which the operation was scheduled will be excised.
3. RDV + GS (hysteroscope)- this is an improved, more informative procedure. Previously, curettage was carried out mainly “blindly”. The instrument allows you to examine the uterine cavity in detail for pathological formations. Excision of tissue or neoplasm is carried out at the end of the manipulation. The final stage is the doctor’s assessment of the work done.

Which female organ is curetted?

The uterus is scraped out. This is a hollow pear-shaped organ, in which there are three sections:

• body– the largest part;
• isthmus– located between the body and the neck;
• neck- narrowed lower end of the uterus.

The uterine wall has three layers:

• inner layer(mucous) – endometrium;
• the middle layer is represented by smooth muscle tissue (myometrium);
• upper layer– serous (perimetry).

The uterus performs important functions:

1. childbearing;
2. menstrual;
3. participates in the birth act.

The operation consists of the following stages:

Technique

The operation is performed using the following technique:

The procedure is prescribed in all cases of suspected cancer. First, tissue is obtained from the cervical canal. The material is collected in a separate container. Next, they begin to scrape out the mucous membrane of the uterus itself, the material is placed in a second container. In the direction for histology, you must indicate exactly where the tissue was taken from.

Traditional curettage

Traditionally, curettes are used for curettage. The forward movement of the instrument must be very careful to avoid perforation of the uterine wall. The reverse movement is carried out more energetically, with slight pressure on the wall. In this case, parts of the endometrium or fertilized egg are captured and excised.

The sequence of curettage of the uterine body cavity is as follows:

1. front wall;
2. back;
3. side walls;
4. corners of the uterus.

The size of the instrumentation is gradually reduced. The manipulation is carried out until the feeling of smoothness of the uterine wall appears.

If the patient is indicated for curettage with a hysteroscope, an optical instrument is inserted into the uterine cavity after dilation of the cervical canal. A hysteroscope is a thin tube with a camera. The doctor carefully examines the uterine cavity and its walls.

After this, the mucous membrane is scraped. If the patient has polyps, they are removed with a curette in parallel with curettage. Upon completion of the procedure, the hysteroscope is reinserted to evaluate the result. If not everything is removed, the curette is inserted again to achieve the desired result.

Not all tumors can be removed using curettage (some polyps, adhesions, fibroids). In this case, special instruments are inserted into the uterine cavity through a hysteroscope, and the formation is removed under supervision.

Curettage for fibroids

The technique for curettage of the uterine cavity depends on the problem at hand. An uneven, bumpy surface of the walls occurs with submucous or interstitial fibroids.

In this case, manipulation is carried out extremely carefully so as not to disrupt the integrity of the fibroid node capsule.

Damage to the latter can provoke bleeding, necrotization of the node and infection.

If you suspect uterine cancer

If you suspect malignancy the material seized can be very copious. If the tumor has grown through all layers of the wall, intervention can seriously injure the uterus.

Curettage during frozen pregnancy

Removal and destruction of the fertilized egg is carried out after dilation of the cervix using curettes and an abortion forcemer. When the pregnancy is less than 6-8 weeks, parts of the destroyed fertilized egg are removed from the uterine cavity using an abortionist.

Curettage of the walls is performed with a blunt curette No. 6; later, as the myometrium contracts and the uterus shrinks, sharper, smaller instruments are taken.

The curette is carefully advanced to the bottom of the uterus, movements are made towards the internal os: first along the front, then along the back and side walls, the fertilized egg is separated from the bed.

At the same time, the fallen shell is separated and removed. Using a sharp curette, the area of ​​the corners of the uterus is checked and the manipulation is completed.

During pregnancy, the uterus cannot be scraped out until it “crunches”, as such an intervention is very damaging muscular apparatus organ.

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Postoperative period: how long to stay in the hospital?

After the procedure, an ice pack is placed on the abdomen to help the uterus contract better and stop bleeding. After some time, the woman is transferred to a ward, where she comes out of anesthesia.

They spend from several hours to several days in the ward, depending on the situation. With planned curettage, patients are usually sent home on the same day.

Normally, curettage takes place without any painful sensations, since anesthesia takes effect and generally takes about 20-30 minutes.

After manipulation, the muscular layer of the uterus begins to contract intensively. The body thus stops uterine bleeding.

The uterus is completely restored after curettage in about the same number of days as menstruation lasts. This process usually takes 3-5 days.

Blood clots will be released from the vagina for several hours after the procedure. At the same time, the woman experiences weakness, lethargy ( side effects anesthesia).

Along with bleeding, other symptoms may also occur.

Discharge after brushing

Blood clots may be released in the first few hours. This is quite normal, since a wound surface has formed on the mucosa.

A few hours after the intervention, the intensity of bleeding decreases. For the next few days, the patient continues to be bothered by yellow, pink or brownish spotting. The process of regeneration of the wound surface averages 3-6 days, but can last up to ten days.

A rapid cessation of discharge is not a favorable sign. This may indicate compression of the cervix, low contractile activity of the myometrium, or accumulation of clots in the uterus.

Painful sensations

After recovering from anesthesia, many women experience pain similar to menstrual pain. Unpleasant sensations may radiate to the lumbar region.

The pain lasts for several hours or days and usually does not require additional measures.

However, doctors usually advise women to take a pain reliever and anti-inflammatory medication (such as ibuprofen) after surgery.

Sexual relations

Women who have undergone curettage of the uterine cavity are advised to have sexual rest. Ideally, it should last one month or at least two weeks.

The need for abstinence is due to the fact that the cervix remains open for some time, and there is a wound surface on the mucous membrane. This suitable conditions for infection, which can lead to complications.

A negative aspect that may be associated with sex after curettage is the appearance of discomfort and pain during sexual intercourse. This is considered normal only if it lasts too long. If the pain persists for several months, you need to inform your gynecologist about it.

Pregnancy and childbirth after curettage of the uterine cavity

The first menstruation after curettage may occur with some delay (in some cases up to four weeks or more), which is associated with hormonal imbalance. This is also considered normal after curettage.

You should sound the alarm if your period does not come for more than two months - this is serious reason consult a gynecologist.

In general, most women get their period within two to three weeks, which means that in the new cycle (i.e., with the arrival of their period), there is theoretically a chance of becoming pregnant.

Childbirth after the procedure usually proceeds well.

If a woman tries to conceive a child for six months or more after curettage, but there are no results, it is necessary to undergo additional examination by a gynecologist. Curettage should not negatively affect fertility; on the contrary, this procedure is often performed in complex treatment infertility.

The pregnancy planning plan after curettage is built depending on what caused the need for the operation. If a woman sets a goal to become pregnant after curettage, she must inform her gynecologist about this. The specialist will give an adequate assessment of the situation and recommend the timing of pregnancy planning.

Possible complications after surgery

After curettage, the following complications may occur:

So, under what conditions should you immediately seek medical help:

1. The bloody discharge after the operation stopped very quickly, and my stomach hurts a lot.
2. The temperature rose to 38 o C and above.
3. Expressed pain syndrome, not controlled by analgesics, antispasmodics and anti-inflammatory drugs.
4. Abundant bleeding, which do not stop for several hours (three or more pads are consumed in two hours).
5. Copious discharge with an unpleasant, putrid odor.
6. General deterioration in health: severe weakness, dizziness, lightheadedness.

The appearance of an acute (or exacerbation of a chronic gynecological disease) after curettage is also a reason for a visit to the doctor.

Treatment after the procedure

Therapeutic measures after the procedure:

The results of the histological test are usually obtained on the tenth day after cleaning. It is important to see a doctor at the specified time to discuss further treatment tactics.

Rehabilitation

You need to abstain from sexual activity for at least two weeks (ideally a month).

What else you can't do:

1. You can use tampons (pads).
2. Douche.
3. Go to the bathhouse, sauna, sit in hot bath(shower is possible and necessary).
4. Engage in intense fitness and physical labor.
5. Take tablets containing acetylsalicylic acid(aspirin) – promote bleeding.

During treatment gynecological diseases quite often there is a need to establish a diagnosis using small surgical intervention. Detection of most female pathologies reproductive system when using non-invasive diagnostic methods, it is based on indirect signs, for example, expansion of the echo contour of the inner lining of the uterus during ultrasound may indicate endometrial hyperplasia. However, you can accurately find out about the nature of the changes taking place only with the help of operational diagnostics.

Modern hysteroscopy opens up a lot of possibilities both diagnostically and treatment point vision, allowing you to restore the functioning of the female reproductive system and prevent the development of complications. It is advisable to use hysteroscopy as a independent method, and as a complement to classical treatment methods, for example, curettage of the uterine cavity.

The last option finds everything greater application and is called “hysteroscopy with RDV”. Hysteroscopy with RDV, what is it? Most effective diagnostic method or a universal method for treating almost all types of intrauterine pathologies? More on this further...

General concepts

Hysteroscopy with RDV (separate diagnostic curettage) is operative method diagnostic, used to make a diagnosis and surgical treatment intrauterine pathologies. At the same time, hysteroscopy itself can be performed for exclusively diagnostic purposes (the so-called “”), which does not involve any surgical manipulations during the procedure and is performed under local anesthesia. But may also include simultaneous (with diagnostics) or delayed surgical intervention.

In the latter case, the design of the hysteroscope provides an instrumental channel through which the surgical instruments, allowing you to perform the following manipulations:

• resection;
• puncture;
• laser ablation.

Important! During hysteroscopy, a visual examination of the uterine cavity is performed, followed by removal of detected pathologies.

What is curettage?

The uterus is a hollow muscular organ, the entire inner surface which is lined with a mucous layer - the endometrium. Characteristic feature endometrium is its ability to grow in accordance with the phases menstrual cycle and be rejected with the arrival of menstruation. At the same time, the basal layer of the mucosa, which remains unchanged, with the beginning of a new cycle, begins the formation of new endometrial cells, the main purpose of which is to facilitate the fixation of the fertilized egg on the wall of the uterus.

Pathological deviations in the process of endometrial growth are the most common diseases found in gynecology. These include the following types of tissue growths that may be malignant:

• atypical hyperplasia endometrium;
• glandular hyperplasia;
• glandular cystic hyperplasia;
• endometrial polyps;
• endometrial dysplasia;
• endometriosis of the muscular layer of the uterus.

Important! The main purpose of curettage is to remove the upper layer of the endometrium (functional layer) with all existing formations (polyps, thickenings and cysts).

The wording “separate diagnostic curettage” implies removal of the mucous membrane of the cervical canal (cervix) and only then curettage of the uterine cavity. In this case, the removed mucosa (separately from the cervix and uterus) is sent for histological analysis in order to identify atypical cells(that is, cancerous).

Anatomical structure uterus

Indications

Indications for hystroscopy with RDV are the following: pathological conditions:

• uterine bleeding;
• endometriosis of the muscular layer of the uterus;
• suspicion of endometrial hyperplasia;
• infertility;
• tumor processes ovaries;
• ovarian cysts;
• the need to monitor the effectiveness of the treatment (repeated curettage).

Depending on the purpose of hysteroscopy with RDV, the timing may vary. The operation on days 5-10 of the menstrual cycle is performed in cases where it is necessary to examine the condition of the uterine walls for foreign formations. During this period, the endometrium has a slight thickness, which allows a clear view of the uterine cavity and the mouth of the fallopian tubes.

Carrying out the operation 2-3 days before the onset of the next menstruation allows you to maintain the menstrual cycle and obtain a large amount of material for histological examination. For dysfunctional uterine bleeding curettage is performed during bleeding in order to stop it, since removal of the endometrium in the vast majority of cases leads to the cessation of bleeding until its next formation.

Preparation

From the Russian Far East includes the following actions. The first is passing a set of tests, including blood tests. venereal diseases, blood for AIDS, determination of blood clotting rate, general analysis blood and general urine analysis. An electrocardiogram is also required, and hair from the pubis and perineum should be removed on the eve of the operation. Due to the use of anesthesia, a cleansing enema should be performed the day before and immediately before the operation. When going for an operation, you should take with you a robe (if the clinic does not provide disposable clothing), slippers and pads.

Execution technique

Classic hysteroscopy with RDV is performed in a hospital setting under general anesthesia for the patient (anesthesia). The operation takes no more than 20 minutes, after which the patient is transferred to the ward, where she regains consciousness. The operation begins with processing antiseptic solution external genitalia and insertion into the vagina of an instrument that helps expose the cervix (gynecological speculum). Next, using bullet forceps, the neck is fixed in a certain position, preventing its displacement in any direction, and it is scraped out with the smallest curette.

After dilating the cervical canal with Hegar dilators up to 10 mm, a hysteroscope is inserted into the uterine cavity and the mouth of the cervical canal and the uterine cavity are examined. Then using a curette bigger size scrape the entire uterine cavity, changing curettes according to the need for scraping hard to reach places. At the end of the operation, the hysteroscope is reinserted and the result obtained is examined.

If the detected polyps or myomatous nodes could not be removed using a curette, for example, due to their deep location in the muscle layer, then their further excision is performed using a resectoscope or laser under vision control.

Important! All removed fragments of the mucous membrane, polyps, etc. are necessarily sent for histological examination to exclude the possibility of development malignant process.

Set of curettes for curettage

Alternative methods

No less effective surgical removal endometrium using electrical destruction and laser ablation. In the first case, endometrial resection is performed using a resectoscope, and in the second case, using a laser.

The initial stages of the procedure occur in the same way as with the classical method of curettage, however, the actual process of removing hyperplastic endometrium is carried out using a loop electrode. Hard-to-reach areas in the area of ​​the orifices of the fallopian tubes and the fundus of the uterus are treated with a roller electrode.

Despite the high efficiency of endometrial removal, this method is not without drawbacks. The main disadvantage of using a resectoscope is the rigidity of the structure used, which significantly complicates the removal of the endometrium from the side walls and fundus of the uterus and increases the risk of damage in these areas. Damage to large vessels, leading to bleeding, is also common during resectoscopy.

The use of a dual-wavelength laser system for hysteroscopy with RDV significantly reduces the risk of perforation and bleeding due to the effect of ablation (soldering of vascular walls). A laser light guide is introduced into the uterine cavity through the instrumental channel of the hysteroscope and the entire uterine cavity is processed, changing the length and power during the procedure laser beam depending on the need to destroy the upper and inner layer of the endometrium.

Important! Destruction of the basal (inner) layer of the endometrium is necessary to prevent recurrent growth of hyperplastic tissue. As a rule, such measures are resorted to when atypical (malignant) changes are detected in endometrial cells.

As a rule, the penetrating power of the laser is limited to 0.6 mm, which allows, without the risk of damage, to remove the myometrium in areas where its thickness is minimal. The main disadvantage of both methods is the lack of tissue samples for histology. Therefore, removal of the myometrium using electrical destruction and laser ablation is carried out after taking tissue samples for analysis.

Modern equipment for hysteroscopy allows doctors not to look directly into the eyepiece of the hysteroscope; all manipulations are visualized on the monitor

Consequences

After curettage, during a control hysteroscopic examination, all evenly treated areas of the uterine cavity should be clearly visible. Immediately after surgery are considered normal nagging pain in the lower abdomen, and their severity may vary. If the patient complains about the intensity of pain, then the use of painkillers in the form of tablets or intramuscular injections(Analgin, Baralgin).

Within 3-4 days there should be slight bleeding, the absence of which may indicate the formation of a hematomer (an accumulation of blood in the uterine cavity). A slight increase in temperature (no more than 37.2º) is also acceptable.

As an anti-inflammatory prophylaxis, antibiotics are prescribed immediately after surgery and antimicrobials:

• Ciprofloxacin;
• Azithromycin;
• Metronidazole.

In rare cases, spotting may occur for 2-3 weeks. Menstruation after hysteroscopy with RDV should be expected after the allotted time, considering the day of the operation as the first day of the cycle, that is, after 4 weeks. Within six months after the procedure, for further monitoring of health, it is necessary to perform diagnostic hysteroscopy and ultrasound of the uterus and appendages.

Ultrasound performed using a transvaginal sensor is used to diagnose intrauterine pathologies and monitor the condition after operations.

Thus, the use of hysteroscopy with RDV, regardless of the technologies used, is the most the best way treatment of hyperplastic processes of the endometrium, resistant to treatment with hormones, and combined with polyps, cysts and submucous myoma. The laser ablation method is extremely effective in the treatment of postmenopausal women, since during this period it is permissible complete removal endometrial layer in all parts of the uterus. Modern methods of anesthesia make the procedure as comfortable as possible.

Content

Curettage (curettage) is a gynecological operation during which the doctor, using special instruments, removes the mucous membrane - the functional upper layer of the uterine cavity. The procedure is carried out both in diagnostic and therapeutic purposes.

The appointment of diagnostic curettage of the uterine cavity is justified if it is necessary to collect material for histological examination. Traditional cavity curettage is practiced to remove altered endometrium, pathological neoplasms, and also when removing the fertilized egg (abortion).

Consequences of curettage

Since uterine curettage is a traumatic operation, it may have certain adverse consequences. Conventionally, they can be divided into postoperative and long-term complications.

Intense bleeding

Endometrial scraping can have quite serious consequences. Since the uterine mucosa is permeated with many blood vessels, then when removing the endometrium, the risk of bleeding cannot be excluded. The reason is careless work with a curette, which provoked deep damage to the walls of the organ.

Tissue debris can also cause bleeding. This is a serious condition that requires medical intervention. Either repeated curettage is prescribed uterine cavity, or taking hemostatics (hemostatic drugs).

Perforation (breakthrough) of the uterine walls

Violation of the integrity of the walls of the uterus can occur when using any of the medical instruments involved. The causes of perforation are increased looseness of the walls and insufficient expansion of the cervical canal.

Perforation of the uterus is life-threatening state. In case of untimely provision medical care peritonitis develops and internal bleeding. An operation is prescribed during which sutures are placed on the area of ​​the rupture. IN severe cases the uterus is removed.

Damage to the cervix

With existing stenosis ( pathological narrowing) the cervix is ​​at high risk of irreversible damage. It's pretty serious consequence, which negatively affects the possibility of bearing a child.

A neck tear is also possible. The cause of the damage is the dislocation of the bullet forceps used to facilitate the opening of the cervical canal.

The prerequisite for injury is tissue laxity, which is why the instrument slips during tension. It is this sudden movement that causes the neck to tear. Minor injuries heal on their own without prescription drug therapy, but significant damage requires sutures.

Formation of adhesions

Curettage of the uterine cavity can also have long-term consequences. One of the most common is the formation of synechiae (adhesions).

When curettage of the uterine cavity, the entire upper layer of the endometrium is removed, which severely injures the organ and provokes the development of inflammatory process. It is with curettage that the risk of developing adhesive disease in the future is especially high.

If a woman does not follow the recommendations of doctors regarding the postoperative period, then the development of Asherman's syndrome is possible - a rather serious consequence of endometrial curettage. The condition is characterized by the formation of numerous synechiae and cicatricial changes that can lead to deformation of the uterus.

The adhesions formed after curettage of the endometrium are characterized as follows.

• Localization location – internal cavity uterus.
• Synechiae look like thin bridges connecting the opposite walls of the organ.
• Adhesions after curettage can also form outside the organ. Violation of the integrity of the uterus, spread of inflammation from the uterine cavity to the fallopian tubes, peritoneum and ovaries can cause the formation of connective tissue cords that envelop all internal genital organs. Such a violation of the integrity of the walls and inflammation can lead to pelvioperitonitis, significant inflammation and bleeding. With the development of such consequences of curettage, adhesive disease can affect any pelvic organs.
• Adhesions can be an obstacle to fertilization and pregnancy. Sometimes after curettage the endometrium is replaced connective tissue, which reduces its “useful” area. In the future, the woman may have difficulty implanting the fertilized egg. Increased risk of developing ectopic pregnancy, premature chorion detachment and other pathologies.

Cycle disorders

Excessively heavy or scanty monthly bleeding and intermenstrual spotting after curettage against the background general deterioration conditions require consultation with a gynecologist.

Hematometer

This condition is typically characterized by the accumulation of blood inside the uterus after the procedure is completed. It causes excessive spasms of the cervix, which makes it difficult to evacuate its contents. To relieve spasm and restore the process of bleeding, medications are prescribed.

What is the danger of hematometra? The blood retained in the uterine cavity becomes a substance favorable for the proliferation of pathological microorganisms.

The main and most dangerous consequences hematometers become:

• endometritis;
• metroendometritis;
• pyometra (purulent endometritis);
• pyosalpinx;
• pelvioperitonitis.

The development of such conditions can cause infertility, as well as lead to the removal of the appendages and the uterus itself. The formation of sepsis cannot be ruled out.

To carry a hematometra pregnancy without complications in the form of inflammatory processes, is not an obstacle.

Injury to the growth layer

Injury to the growth layer of the endometrium during curettage is one of the most serious consequences of the procedure. Excessively active movements of the curette, as well as non-compliance with the rules for performing curettage, can cause injury. The danger of injury is the development of infertility and menstrual irregularities.

The mucous membrane of the uterus at the site of damage to the growth layer of the endometrium no longer grows. In the future, this may cause difficulties with the attachment of the fertilized egg.

Endometritis

The disease is an inflammation of the inner layer of the uterus.

Infection and the formation of an inflammatory process in the organ cavity, as a consequence of curettage, develops in three cases.

• After performing a procedure to remove the endometrium against the background of existing inflammation.
• If doctors do not comply with the rules of asepsis and antisepsis. Infection of the endometrium as a result of medical negligence– poorly sterilized instruments, dirty gloves and other reasons.
• Inappropriate antibiotic therapy after manipulation.

Signs of endometrial inflammation are dirty yellow discharge, accompanied by unpleasant smell, separated type of meat slop. It is possible that the temperature may rise to high levels and pain in the lower abdomen.

In this case, a treatment regimen is used aimed at stopping the inflammatory process and preventing chronic infection

Complications after anesthesia

Complications can develop in the form of the body’s response to the administration of painkillers and narcotics. But the risk of such problems is minimal, since the anesthesiologist conducts a conversation with the patient before the operation begins. The specialist selects anesthetics based on the information received from the woman.

Diagnostic curettage

Separate diagnostic curettage (SDC) of the uterine cavity takes place in two stages:

• curettage of the cervical canal of the cervix;
• scraping the lining of the uterus.

Diagnostic curettage of the uterine cavity also has adverse consequences. Complications with RDV will be the same as with traditional endometrial curettage.

But to the already discussed consequences of curettage, it is worth adding the incomplete removal of the pathological formation, which became the reason for cleaning the uterine cavity and removing the endometrium.

The cause of this complication is the performance of curettage of the uterine cavity without visualization (hysteroscopy). In this case, curettage is performed again.

To avoid severe consequences After curettage of the endometrium of the uterine cavity, following all medical recommendations will help. Antibiotics are prescribed to prevent inflammation.

Curettage is a therapeutic and diagnostic procedure in which the inner layer of endometrial cells is removed from the uterine cavity. The percentage of complications after curettage is low. But every woman should know how to prevent and what symptoms may indicate an emerging complication after the procedure.

Curettage

Abdominal curettage (curettage) in gynecology is performed for diagnostic or therapeutic purposes. The procedure is performed on an outpatient basis, under general anesthesia.

With an instrumental curettage procedure, the surface layer of the endometrium of the uterine cavity is removed, which is then examined to make a final diagnosis. Curettage is also used as an auxiliary method for the treatment of gynecological disorders.

How diagnostic procedure Curettage is prescribed if a woman experiences prolonged heavy bleeding from the uterine cavity. In this case, the doctor usually examines the organ using a hysteroscope, takes a scraping for histological examination, and establishes possible reason pathologies: fibroids, polyps, malignant neoplasms.

At heavy bleeding it also serves as a necessary therapeutic procedure with prolonged monthly cycle, when the endometrium of the uterine cavity occupies a large volume, and normal menstrual flow is not enough to “push out” it.

Therapeutic curettage is also prescribed after a frozen pregnancy, miscarriage, or ectopic pregnancy. This procedure is also known as abortion before 12 weeks, which can be performed according to indications, at the request of the woman.

During the period from 12 to 18 weeks of pregnancy, the procedure is carried out exclusively according to medical indications (frozen pregnancy, severe pathologies of the pregnant woman, fetal malformations).

In what cases is curettage of the uterine cavity also indicated:

• To stop severe uterine bleeding.
• If after drug treatment polyps and hyperplasia do not disappear.
• For any bleeding after menopause.

Curettage - small gynecological surgery, is not considered highly traumatic. But after it, the woman must undergo a recovery period, which includes several mandatory procedures.

Recovery period

After scraping, before full recovery integrity of blood vessels, the uterine cavity will bleed. It is considered normal if bloody issues after curettage last from 3 to 10 days. To relieve pressure in the uterus, during the first three to four days it is better for a woman to observe bed rest, exclude physical exercise, do not sit for a long time.

During this period, a woman should use only pads. The use of tampons is prohibited.

Discharge

For the first 5 days after the procedure, a woman may feel pain in the vagina and may be bothered by pain in the lower abdomen.

To remove unpleasant symptoms In the first two days, a woman is recommended to apply an ice pack to her lower abdomen (for half an hour every two hours).

Discharge after curettage in the form of bloody clots should continue until the vessels damaged during the procedure are restored. Red clots normally turn brown after a few days, and by day 10 they turn yellow or whitish. The day of intervention is equal to the first day of the menstrual cycle, which means that normal menstruation should begin in 24-32 days.

In women after a frozen pregnancy or abortion, the onset of menstruation is delayed. If menstruation does not occur for more than 2 months, a woman should urgently consult a doctor.

Maintenance therapy

Relieve pain, prevent infection and possible complications– the task of the next, recovery stage.

IN recovery period The doctor may prescribe the following drug therapy:

1. Analgesic drugs (Ibuprofen, Analgin). Relieves pain, reduces discharge after curettage. In the first two days, the drug is prescribed three times a day. From the third day, the analgesic can be taken only at night.
2. Antispasmodic drugs (No-spa). Antispasmodics cause smooth muscle contraction, and discharge after curettage does not accumulate in the uterine cavity.
3. Well antibacterial drugs Antibiotics after curettage are indicated with for preventive purposes. To prevent the development of infection, gentle drugs are prescribed: Metronidazole, Cefixime, Cedex, Ceftazidime.

Metronidazole is most often prescribed as monotherapy, but in some cases it is used in combination with other antibiotics.

During the recovery period, decoctions of stinging nettle and oregano are prescribed to contract the uterus.

You should not drink salicylates after curettage.

If by the tenth day the discharge after curettage does not decrease, the number of clots increases, and the pain persists, this is a reason to urgently consult a doctor. The opposite condition, when the discharge after cleansing is very scanty, is also dangerous and indicates the onset of a complication.

After the curettage procedure, a woman should abstain from sexual intercourse, not take a bath, not swim in bodies of water, and not visit the pool or sauna.

What else you can't do:

• Use vaginal suppositories, tablets, sprays without a doctor's prescription.
• Douche.
• Use any intimate hygiene products.
• Lift weights.

After two weeks, the woman should visit her doctor. By this time, the results of the histological examination will be known. The doctor may prescribe a control ultrasound. Based on the collected data, repeat curettage may be prescribed.

Possible complications

If the discharge after curettage continues for a long time, more than two weeks, and the woman is bothered by pain in the lower abdomen, it can be assumed that complications have arisen.

Bleeding from the uterus

Severe bleeding after curettage usually develops in women with impaired blood clotting.

What are the signs that indicate bleeding has developed?

1. There is no brown discharge.
2. The blood after scraping is scarlet, with a large number of clots.
3. In 1 hour large gasket completely wet.
4. The discharge is accompanied by severe or moderate pain in the lower abdomen.
5. The skin is pale and may have a bluish tint.
6. Dizziness, loss of consciousness.

This complication is attributed to emergency conditions, and the woman requires emergency hospitalization.

Hematometer

If the discharge after curettage is scanty or stops completely, the lower abdomen hurts - these are symptoms of hematometra. This is a complication caused by cervical spasm. Ordinary Brown color The discharge disappears and acquires an unnatural shade with an unpleasant odor. From the attached infection, as the complication progresses, the woman begins to develop a fever. The pain in the lower abdomen intensifies, radiating to the tailbone and lower back.

The woman needs urgent hospitalization and drug therapy antispasmodic drugs, repeated curettage.

Inflammation in the endometrium

After curettage, if pathogenic microorganisms enter the uterine cavity, another complication may develop - endometritis.

What are the signs of a developed ascending infection:

1. Temperature rises to 39°C.
2. Chills.
3. Lower abdomen hurts.
4. Weakness, general malaise.

A course is prescribed for treatment antibacterial therapy. What drugs are indicated: Metronidazole as a monocomponent, or in combination with Ampicillin, Doxycycline, Cefazolin, Clindamycin. For severe disease, Metronidazole is prescribed with intravenous administration Metrogyla.

Conception, pregnancy

If the curettage procedure goes without complications, after two to three weeks the uterus contracts and the mucous membrane returns to normal.

By this time hormonal background stabilizes and the woman can become pregnant again. For gestation and labor at healthy woman Scraping has no effect.

But if you cannot conceive a child within six months after the procedure, you need to consult a specialist. He will objectively assess the situation and tell you how to properly prepare for conception.

The scraping procedure, which is popularly called cleansing, causes concern among many women. The fact is that doctors do not always clearly explain why it needs to be done and what the consequences are.

So any woman who has been prescribed a cleansing should ask the attending physician in detail about the features of the procedure, possible consequences, what anesthesia will be used, etc. The event should be carried out only by a qualified gynecologist, because the occurrence of complications will largely depend on his experience.

In addition, a woman must strictly follow the appointments and instructions of a specialist, treat her body responsibly and with care.

Curettage – cleansing the uterine cavity

In this pear-shaped muscular organ, a fertilized egg grows and develops - unborn child. Inside, it is protected by a special membrane – the endometrium. During the menstrual cycle, this mucous membrane changes.

When the egg is not fertilized, it is rejected, that is, menstruation begins. When performing cleaning, the doctor removes only the top layer of the endometrium. After this, the protective layer is restored on its own.

Cleaning can be done separately or normally. Separate involves cleansing the cervical canal and then the organ cavity. The scraping obtained by this method is sent for histological examination, which allows the doctor to give the patient a more accurate diagnosis.

Hysteroscopy of the uterus and conventional curettage

The hysteroscopy procedure is more modern method rather than separate diagnostic cleaning. It is safer and more convenient. The process uses a small device that is inserted into the organ cavity and allows you to see the entire therapeutic/diagnostic process.

At the same time, traditional curettage is carried out “blindly”, and this, in turn, increases the risk of disorders and complications, for example, trauma to the genital organs. Hysteroscopy allows you to fully control the course of the procedure and its results.

Indications for use

There is therapeutic and diagnostic curettage of the uterine cavity. The main indications for this procedure are:

• Miscarriage. The procedure is prescribed to remove parts of the placenta from the uterus;
• Pathology of the cervix. If, during the examination, the doctor discovers neoplasms, especially of a malignant nature, then they are referred for a similar procedure;
• Frozen pregnancy;
• Cycle disruption. Intermenstrual bleeding, failure to achieve pregnancy, heavy and prolonged periods, bleeding during menopause are indications for cleansing for diagnostic purposes. It is carried out if the causes of the above phenomena are not found;
• Changes in the endometrium detected by ultrasound. Carry out in the presence of thickenings and local formations. When the endometrium is thicker than normal, mucosal hyperplasia occurs. Endometrial polyp is also an indication. It is worth noting that after the procedure, in most cases, it no longer grows;
• Synechiae – intrauterine adhesions;
• Endometriosis;
• Remains of the fertilized egg after abortion/birth.

When does your period start after cleansing?

The first period comes after 4-5 weeks. But this period is influenced by the individual characteristics of the body and the state of health. Delay may occur in case of abortion. Termination of pregnancy is stressful for the body, so it needs more time to recover.

Too much or too much scanty discharge, too painful contraction of the uterus after the procedure, elevated temperature - reasons to visit a doctor. Regular cycle recovers in about 3 months. If violations are still observed, then you need to contact a specialist.

Consequences of curettage of the uterine cavity

Infrequently, but still the following unpleasant phenomena may occur:

• Hematometra. Due to cervical spasm, blood accumulates inside the genital organ, which increases the risk of infection;
• Neck tear. The main cause of such complications is the nipple of the bullet forceps. Organs with minor injuries recover on their own; large ones require stitches;
• Perforation of the uterus. The organ may be punctured by the instruments used during the operation. Large injuries require suturing;
• Inflammation of the genital organs. It is usually provoked by the absence of a course of antibiotics and violation of antiseptic rules. Symptom this complication most often it is a high temperature;
• Damage to the growth layer of the endometrium. This type of injury is difficult to treat. There is a high probability that he will not recover;
• Pathological formation that was not completely or not completely removed during cleaning. The situation requires repeating the procedure. Sometimes formations (eg polyps) appear again.

Pathological bleeding

After the procedure, bleeding will continue for several days. Contraction of the uterus, as well as bleeding, after curettage is disturbing for a maximum of 10 days.

The discharge may be clotted or spotty. If this phenomenon is alarmingly abundant or prolonged, it means that some complication has arisen.

Also, a rapid cessation of discharge, accompanied by a rise in temperature and pain, requires medical attention. A rise in temperature to 37.5° is considered acceptable.

Discharge after brushing

• Brownish ones indicate blood clotting, that is, the bleeding will soon stop;
• Abundant, bloody, accompanied by pain and elevated temperature, with an unpleasant odor. We can talk about the presence of complications;
• Yellow. They indicate that there is an infection in the body and it is necessary to take antibiotics.

White mucous discharge is normally restored when blood discharge stops and there are no complications.

Painful sensations

After the general or local anesthesia, which is done during curettage of the uterus, patients complain of significant pain. The sensations can last from several hours to two to three days. To alleviate the patient’s condition, the doctor prescribes painkillers.

Many women complain of nagging abdominal pain. This phenomenon occurs quite often. To prevent blood clots from accumulating in the organ cavity and to eliminate pain, antispasmodics (pr. no-spa) are prescribed. They are usually taken three times a day, one tablet at a time.

Sexual relations

For 2 weeks, a woman is strictly not recommended to have sex. It is optimal to abstain for a month. The uterus remains open for some time after the procedure, and its endometrium is injured, so there is a high risk of infection, which can lead to serious complications.

In addition, sexual intercourse may be painful at first. If this continues for more than 2 months, it is necessary to undergo an examination by a gynecologist.

Pregnancy and childbirth after curettage of the uterine cavity

The body will be ready for conception very soon - in 2-3 weeks. As a rule, the procedure does not affect the course of the birth process.