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 some diseases and get rid of neoplasms (polyps, adhesions, etc.).

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

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

How to get rid of female disease? Irina Kravtsova shared her story of curing thrush in 14 days. In her blog, she told what drugs she took, whether it is effective traditional medicine what worked and what didn't.

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., the designation of the action itself. The operation, depending on the method and purpose of the implementation, has a variety of names.
2. Separate scraping includes sequential removal of the biomaterial first from the cervical canal, then from the uterine mucosa. After the operation, the removed tissue will be sent to the histological laboratory, at the same time, the neoplasm, for which the operation was scheduled, is excised.
3. RDV + GS (hysteroscope) is an improved, more informative procedure. Previously, curettage was carried out mostly "blindly". The tool also 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.

What female organ is scraped?

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

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

The wall of the uterus is three-layered:

• the 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 steps:

Technique

The operation is carried out according to the following technique:

The procedure is prescribed in all cases of suspected oncology. First, tissue is obtained from the cervical canal. The material is collected in a separate container. Next, they proceed to curettage of the mucous membrane of the uterus itself, the material is placed in the second container. In the direction of histology, it is necessary to indicate where exactly the tissue was taken from.

Traditional curettage

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

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

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

The size of the toolkit is gradually reduced. Manipulation is carried out until a feeling of smoothness of the uterine wall appears.

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

After that, scraping of the mucosa is performed. If the patient has polyps, they are removed with a curette in parallel with curettage. At the end of the procedure, the hysteroscope is inserted again to evaluate the result. If not everything is removed, the curette is inserted again to achieve the proper result.

Not all neoplasms can be removed with curettage (some polyps, adhesions, myoma nodes). At the same time, special instruments are introduced into the uterine cavity through a hysteroscope, and the formation is removed under supervision.

Curettage with myoma

The technique of curettage of the uterine cavity depends on the problem. An uneven, bumpy surface of the walls occurs with submucosal or interstitial myoma.

Manipulation in this case is carried out very carefully so as not to violate the integrity of the capsule of the myoma node.

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

If uterine cancer is suspected

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

Curettage for frozen pregnancy

Removal and destruction of the fetal egg is performed after the expansion of the neck with the help of curettes and abortion collet. With a gestational age of less than 6-8 weeks, parts of the destroyed fetal egg are removed from the uterine cavity by means of an abortion collet.

Scraping of the walls is performed with a blunt curette No. 6, in the future, as the myometrium contracts and the uterus shrinks, sharper instruments of a smaller size 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 fetal egg is separated from the bed.

In parallel, the fallen off shell is separated and removed. With a sharp curette, the area of ​​\u200b\u200bthe corners of the uterus is checked and the manipulation is completed.

The uterus during pregnancy should not be scraped to a "crunch", since such an intervention severely damages muscular apparatus organ.

Uterine fibroids - DOES NOT MEAN OPERATION!

Every year, 90,000 women undergo surgery to remove uterine fibroids. Just think about these numbers! The important thing is that simply removing fibroids does not eliminate the disease, so in 15% of cases, fibroids reappear. Myoma will go away by itself and without any surgery, if you drink on an empty stomach regular herbal tea...

Postoperative period: how long to stay in the hospital?

After the procedure, an ice pack is placed on the abdomen so that the uterus contracts better and the bleeding stops. After some time, the woman is transferred to the 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, they are usually released home on the same day.

Normally, curettage passes without any pain, as anesthesia works and takes about 20-30 minutes in general.

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

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

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

Along with bleeding, other symptoms may also occur.

Discharge after cleansing

In the first few hours, blood clots may be released. 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 spotting yellow, pink or brownish discharge. The process of regeneration of the wound surface averages 3-6 days, but can last up to ten days.

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

Pain

After coming out of anesthesia, many women experience menstrual pain. Unpleasant sensations may radiate to the lumbar region.

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

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

sexual relations

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

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

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

It is worth sounding the alarm if menstruation does not occur for more than two months - this is serious reason contact a gynecologist.

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

Childbirth after the procedure, as a rule, proceeds well.

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

The scheme of pregnancy planning after curettage is built depending on what caused the need for surgery. If a woman sets herself the goal of becoming pregnant after curettage, this must be reported to the gynecologist. The specialist will give an adequate assessment of the situation and recommend the timing of the start of pregnancy planning.

Possible complications after surgery

After scraping, the following complications may occur:

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

1. Bloody discharge after the operation stopped very quickly, while the stomach hurts a lot.
2. The temperature rose to 38 o C and above.
3. Expressed pain syndrome, not stopped 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. Profuse discharge with an unpleasant, putrid odor.
6. General deterioration of well-being: great weakness, dizziness, dizziness.

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 brushing. It is important to come to the doctor at the specified time to discuss further treatment tactics.

Rehabilitation

For at least two weeks, you need to refrain from sexual activity (ideally - a month).

What else can not be done:

1. Use tampons (pads - you can).
2. Douche.
3. Go to the bath, sauna, sit in hot tub(shower - you can and should).
4. Engage in intense fitness, physical labor.
5. Take pills containing acetylsalicylic acid(aspirin) - promote bleeding.

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

Modern hysteroscopy opens up a lot of possibilities both with diagnostic and healing 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 an addition to classical methods of treatment, for example, curettage of the uterine cavity.

The last option finds everything greater application and is called "hysteroscopy with RFE". Hysteroscopy with RFE, what is it? Most Efficient diagnostic method or a universal way to treat almost all types of intrauterine pathologies? More on this later…

General concepts

Hysteroscopy with WFD (Separate Diagnostic Curettage) is a operational method diagnostic tool used to diagnose and surgical treatment intrauterine pathologies. At the same time, hysteroscopy itself can be performed for exclusively diagnostic purposes (the so-called ""), which do not involve any surgical manipulations during the procedure and are 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 surgical instruments, allowing you to perform the following manipulations:

• resection;
• puncture;
• laser ablation.

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

What is scraping?

The uterus is a hollow muscular organ inner surface which is lined by a mucous layer - the endometrium. characteristic feature endometrium is its ability to grow in accordance with the phases menstrual cycle and reject with the advent 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 promote the fixation of a fertilized egg on the uterine wall.

Pathological abnormalities in the process of endometrial growth are the most common diseases encountered in gynecology. They include the following types of tissue growths that can 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 scraping is to remove the upper layer of the endometrium (functional layer) with all the existing formations (polyps, thickenings and cysts).

The wording "separate diagnostic curettage" implies the removal of the mucous membrane of the cervical canal (cervix) and only then curettage of the uterine cavity. At the same time, the removed mucosa (separately from the cervix and uterus) is sent for histological analysis in order to identify atypical cells(i.e. cancer).

Anatomical structure uterus

Indications

Indications for hystroscopy with WFD 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 goals of hysteroscopy with WFD, the timing may vary. The operation on the 5th-10th day of the menstrual cycle is performed in cases where it is necessary to examine the condition of the walls of the uterus for foreign formations. During this period, the endometrium has a slight thickness, which allows a good 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 save the menstrual cycle and get a large amount of material for histological examination. With dysfunctional uterine bleeding curettage is performed during bleeding in order to stop it, since the removal of the endometrium in the vast majority of cases leads to the cessation of bleeding until its next formation.

Training

With WFD includes the following actions. The first is the delivery of a complex of tests, including blood for venereal diseases, blood for AIDS, determination of the rate of blood clotting, general analysis blood and urinalysis. An electrocardiogram is also needed, on the eve of the operation, hair from the pubis and perineum should be removed. In connection with the use of anesthesia, on the eve and immediately before the operation, a cleansing enema should be given. Going to the operation, you should take a gown (if the clinic does not provide disposable clothes), slippers and pads.

Execution technique

Classical hysteroscopy with WFD is performed in a hospital under general anesthesia of the patient (anesthesia). The duration of the operation takes no more than 20 minutes, after which the patient is transferred to the ward, where she regains consciousness. The operation starts with processing antiseptic solution external genital organs and the introduction into the vagina of an instrument that helps to expose the cervix (gynecological speculum). Then, with the help of bullet forceps, the neck is fixed in a certain position, excluding its displacement in any direction, and it is scraped 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 with a curette bigger size scraping the entire uterine cavity, changing curettes in accordance with the need for curettage hard-to-reach places. At the end of the operation, the hysteroscope is reintroduced and the result 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 mucosa, polyps, etc. are mandatory sent for histological examination to exclude the likelihood of development malignant process.

Curette set for scraping

Alternative ways

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 process of removing the hyperplastic endometrium itself is carried out using a loop electrode. Hard-to-reach areas in the area of ​​the mouths of the fallopian tubes and the bottom 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 design used, which greatly complicates the removal of the endometrium from the side walls and bottom of the uterus and increases the risk of damage in these areas. It is also not uncommon for resectoscopy to damage large vessels, leading to bleeding.

The use of a two-wave laser system for hysteroscopy with WFD significantly reduces the risk of perforations and bleeding due to the effect of ablation (soldering of the vascular walls). The laser light guide is introduced into the uterine cavity through the instrumental channel of the hysteroscope and the entire uterine cavity is treated, changing the length and power during the procedure. laser beam depending on the need to destroy the upper and inner layers 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 in endometrial cells are detected.

As a rule, the penetrating power of the laser is limited to 0.6 mm, which allows, without the risk of damage, to carry out the removal of the myometrium in areas where its thickness is minimal. The main disadvantage of both methods is the lack of tissue samples for histology. Therefore, the 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

Effects

After the curettage at the control hysteroscopic examination, all evenly treated areas of the uterine cavity should be clearly visible. Immediately after surgery, are considered normal drawing pains in the lower abdomen, while their severity may be of a different nature. If the patient complains about the intensity of pain manifestations, 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 hematomere (accumulation of blood in the uterine cavity). A slight increase in temperature is also acceptable (no more than 37.2º).

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 WFD 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 the state of health, it is imperative to perform diagnostic hysteroscopy and ultrasound of the uterus and appendages.

To diagnose intrauterine pathologies and monitor the condition after surgery, ultrasound is performed using a transvaginal sensor.

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

Content

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

The appointment of diagnostic curettage of the uterine cavity is justified if it is necessary to take material to perform a histological examination. Traditional curettage of the cavity is practiced in order to remove the altered endometrium, pathological neoplasms, as well as when extracting the fetal egg (abortion).

Consequences of curettage

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

Intense bleeding

Curettage of the endometrium can have quite serious consequences. Since the uterine mucosa is permeated with many blood vessels, then when removing the endometrium, the risk of bleeding is not excluded. The reason is inaccurate 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 requiring medical intervention. Either repeated curettage is prescribed uterine cavity, or taking hemostatics (hemostatic drugs).

Perforation (breakthrough) of the walls of the uterus

Violation of the integrity of the walls of the uterus can be obtained using any of the medical instruments involved. The causes of perforation are increased friability of the walls, insufficient expansion of the cervical canal.

Perforation of the uterus is life threatening condition. In case of late delivery medical care peritonitis develops and internal bleeding. An operation is prescribed, during which sutures are applied to the area of ​​​​the gap. AT severe cases remove the uterus.

Cervical injury

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

Neck tear is not ruled out. The cause of the damage is the disengagement of the bullet forceps used to facilitate the opening of the cervical canal.

A prerequisite for injury is the flabbiness of the tissues, so the tool 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 suturing.

Formation of adhesions

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

When the uterine cavity is scraped, the entire upper layer of the endometrium is removed, which severely injures the organ and provokes the development inflammatory process. It is with curettage that the risk of 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 not excluded - a rather serious consequence of curettage of the endometrium. 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.

• Place of localization - internal cavity uterus.
• Synechia look like thin bridges connecting opposite walls of the organ.
• Spikes after curettage can also form outside the organ. Violation of the integrity of the uterus, the 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 pelvic peritonitis, 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 gestation. Sometimes after scraping, the endometrium is replaced connective tissue, which reduces its "useful" area. In the future, a woman may have difficulty fixing a fertilized egg. An increased risk of developing ectopic pregnancy, premature detachment of the chorion and other pathologies.

Cycle disorders

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

Hematometer

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

What is the danger of hematometers? The blood lingering in the uterine cavity becomes a substance favorable for the reproduction 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 is not excluded.

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

Germ layer trauma

Injury to the growth layer of the endometrium during curettage is one of the most serious consequences of the procedure. Excessive movements of the curette, as well as non-compliance with the rules for performing scraping, can cause injury. The danger of injury lies in 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, because of this, difficulties may arise with the attachment of a 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 the procedure to remove the endometrium against the background of existing inflammation.
• If physicians do not comply with the rules of asepsis and antisepsis. Possibility of infection of the endometrium medical malpractice- Poorly sterilized instruments, dirty gloves and other reasons.
• Irrational antibiotic therapy after manipulation.

Signs of inflammation of the endometrium are discharge of a dirty yellow color, accompanied by bad smell, detachable type of meat slops. It is possible that the temperature rises to high numbers and soreness in the lower abdomen.

In this case, a treatment regimen is applied 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 introduction of painkillers and narcotic drugs. But the risk of such problems is minimal, because before the start of the operation, the anesthesiologist conducts a conversation with the patient. Specialist selects anesthetics based on the information received from the woman.

Diagnostic curettage

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

• curettage of the cervical canal of the cervix;
• scraping of the uterine mucosa.

Diagnostic curettage of the uterine cavity also has adverse effects. Complications with RFE will be the same as with traditional curettage of the endometrium.

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

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

To avoid severe consequences after scraping the endometrium of the uterine cavity, compliance with 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 a complication that has begun after the procedure.

curettage

Cavity curettage (curettage) in gynecology is performed for diagnostic or therapeutic purposes. The procedure is performed on an outpatient basis, under 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 has prolonged severe bleeding from the uterine cavity. In this case, the doctor usually examines the organ using a hysteroscope, takes a scraping for histological examination, establishes possible cause pathologies: myoma, polyp, malignant neoplasm.

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 ordinary menstrual flow is not enough to "push" them out.

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

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

In some cases, curettage of the uterine cavity is 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 operation, does not apply to highly traumatic. But after her, the woman must go through a recovery period, which includes several mandatory procedures.

Recovery period

After scraping, before full recovery the integrity of the vessels, the uterine cavity will bleed. It is considered normal if bloody issues after scraping 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.

A woman during this period should use only pads. The use of tampons is prohibited.

Allocations

After the procedure, for the first 5 days, a woman may feel pain in the vagina, pain in the lower abdomen may be disturbing.

For removal unpleasant symptoms in the first two days, a woman is recommended to apply an ice pack to the lower abdomen (half an hour every two hours).

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

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

Supportive care

Relieve soreness, prevent infection and possible complications is the task of the next, recovery stage.

AT recovery period Your doctor may prescribe the following medications:

1. Analgesics (Ibuprofen, Analgin). Relieve pain, reduce discharge after scraping. In the first two days, the drug is prescribed three times a day. From the third day, the analgesic can be drunk only at night.
2. Antispasmodic drugs (No-shpa). From antispasmodics, smooth muscles are reduced, and discharge after curettage does not accumulate in the uterine cavity.
3. Well antibacterial drugs Antibiotics after curettage are indicated with preventive purpose. To prevent the development of infection, sparing 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.

In the recovery period, decoctions of stinging nettle and oregano are prescribed to reduce the uterus.

Salicylates after curettage should not be drunk.

If by the tenth day the discharge after scraping does not decrease, the number of clots increases, the pain persists - this is a reason to urgently consult a doctor. Dangerous and speaks of the onset of a complication is also the reverse state, when the discharge after cleansing is very scarce.

A woman after the curettage procedure should refrain from sexual intercourse, do not take baths, do not swim in ponds, do not visit the pool and sauna.

What else can not be done:

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

In two weeks, the woman should visit the attending physician. By this time, the results of the histological examination will be known. The doctor may prescribe a follow-up ultrasound. Based on the collected data, repeated curettage may be prescribed.

Possible Complications

If the discharge after scraping continues for a long time, more than two weeks, and the woman is worried about pain in the lower abdomen, it can be assumed that complications have appeared.

Bleeding from the uterus

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

What are the signs of bleeding that has developed?

1. There are no brown highlights.
2. Blood after scraping scarlet, with many clots.
3. For 1 hour big gasket gets completely wet.
4. The discharge is accompanied by severe or moderate pain in the lower abdomen.
5. The skin is pale, may be with a bluish tinge.
6. Dizziness, loss of consciousness.

This complication is referred to emergency conditions and the woman needs emergency hospitalization.

Hematometer

If the discharge after scraping is scarce or stops completely, the lower abdomen hurts - these are symptoms of hematomas. This is a complication that gives a spasm of the cervix. Normal Brown color discharge disappears, and acquires an unnatural shade with an unpleasant odor. From the attached infection, as the complication progresses, the woman begins to have a fever. The pains in the lower abdomen intensify, give to the coccyx and lower back.

Woman needs urgent hospitalization, drug therapy antispasmodic drugs, repeated scraping.

Inflammation in the endometrium

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

What are the signs of an ascending infection that has developed:

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

For treatment, a course is prescribed antibiotic therapy. Which drugs are indicated: Metronidazole as a monocomponent, or in combination with Ampicillin, Doxycycline, Cefazolin, Clindamycin. In severe disease, Metronidazole is prescribed with intravenous administration Metrogila.

conception, pregnancy

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

By this time hormonal background stabilizes, and the woman can become pregnant again. for bearing and tribal activity at healthy woman scraping has no effect.

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

The scraping procedure, which is popularly called cleaning, is a concern for many women. The fact is that doctors do not always explain in an accessible way why it needs to be carried out and what are the consequences.

So any woman who has been scheduled for cleaning should ask the attending physician in detail about the features of the procedure, possible consequences, what kind of anesthesia will be used, etc. The event should be carried out only by a qualified gynecologist, because the appearance 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 carefully.

Curettage - cleansing the uterine cavity

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

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

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

Hysteroscopy of the uterus and conventional curettage

The hysteroscopy procedure is more modern method 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 course of the entire medical/diagnostic process.

At the same time, traditional curettage is carried out "blindly", and this, in turn, increases the risk of violations 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 carrying out

There is a therapeutic and diagnostic curettage of the uterine cavity. The main indications for carrying out 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 found neoplasms, especially of a malignant nature, then they are sent for a similar procedure;
• Frozen pregnancy;
• Cycle breaking. Intermenstrual bleeding, non-pregnancy, heavy and prolonged periods, bleeding during menopause are indications for cleaning for diagnostic purposes. It is carried out if the causes of the above phenomena are not found;
• Changes in the endometrium detected on ultrasound. It is carried out in the presence of thickenings and local formations. When the endometrium is thicker than normal, mucosal hyperplasia occurs. An endometrial polyp is also an indication. It is worth noting that after the procedure, in most cases, it no longer grows;
• Synechia - intrauterine adhesions;
• endometriosis;
• The remains of the fetal egg after an abortion / childbirth.

When do periods start after cleansing?

The first menstruation occurs after 4-5 weeks. But this period is influenced by the individual characteristics of the organism and the state of health. A delay may occur in the event of an abortion. Termination of pregnancy is stressful for the body, so it needs more time to recover.

Too much or too much meager discharge, too painful contraction of the uterus after the procedure, fever - reasons to visit a doctor. regular cycle recovered 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 the following unpleasant phenomena can still occur:

• Hematometer. Due to spasm of the cervix, blood accumulates inside the penis, which increases the risk of infection;
• Neck tear. The main cause of such complications is the nipple of bullet forceps. Organs with minor injuries recover on their own, large ones need to be sutured;
• perforation of the uterus. The organ can be pierced by the instruments used during the operation. Major injuries require suturing;
• Inflammation of the genitals. As a rule, it is provoked by the lack of a course of antibiotics and violation of the rules of antiseptics. Symptom this complication the most common is high fever;
• Damage to the germ layer of the endometrium. Such an injury is difficult to treat. There is a high probability that he will not recover;
• A pathological formation that was not completely or not completely removed during cleaning. The situation calls for a repeat procedure. Sometimes formations (eg polyps) reappear.

Pathological bleeding

At the end of the procedure, spotting will disturb for several days. Uterine contraction, as well as bleeding, disturbs a maximum of 10 days after curettage.

The discharge may be clotted or smeary. If this phenomenon frightens with abundance or drags on, then some complication has arisen.

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

Discharge after cleansing

• Brownish ones indicate blood clotting, that is, bleeding will soon stop;
• Profuse, bloody, accompanied by soreness and elevated temperature, with an unpleasant smell. 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 stops, and there are no complications.

Pain

After the general or local anesthesia, which is done when scraping the uterus, patients complain of significant pain. The sensations can last from a few hours to two or three days. To alleviate the patient's condition, the doctor prescribes painkillers.

Many women complain of pulling abdominal pain. This phenomenon occurs quite often. So that blood clots do not accumulate in the cavity of the organ and to eliminate pain, antispasmodics are prescribed (pr. no-shpa). Usually they are taken three times a day on a tablet.

sexual relations

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

Also, sexual intercourse can 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.