Diagnostic curettage is the most informative procedure. Method of separate diagnostic curettage in gynecology

Diagnostic curettage of the uterine cavity; many women know what this procedure is. This is what is popularly called cleansing the uterus. This procedure is performed for the purpose of diagnosis, as can be understood from the name, and treatment of certain gynecological diseases. Let's take a closer look at what indications diagnostic and therapeutic curettage of the uterine cavity has, how painful it is, and how the body recovers after it.

Hyperplasia and endometrial polyp

Hyperplasia, in short, is excessive growth of the uterine mucosa. Occurs in women of reproductive age mainly due to an excess of the hormone estrogen. An overabundance can occur when taking certain hormonal medications and as an independent phenomenon.

Endometrial hyperplasia can be diffuse or focal; this is when a polyp forms in the uterus. Symptoms of the disease are intermenstrual bleeding, heavy menstruation, often infertility. But although hyperplasia in young women very rarely turns into cancer, it needs to be treated. A diagnostic curettage of the uterine cavity is performed for endometrial hyperplasia. As a result, a pathologically overgrown endometrium and focal formations in the uterine cavity, if any, are removed. The material is sent for histological examination. If everything is normal, atypical cells not detected - oral contraceptives are prescribed. The duration of their appointment will depend on the patient’s personal wishes and reproductive plans. Tablets can be taken long time without any complications. If you plan to become pregnant, it is usually recommended to take it for three months, and then, while discontinuing the drug, to become pregnant. It is believed that it is easier to get pregnant this way, since ovulation will most likely occur when the drugs are stopped.

Oral contraceptives prevent hyperplasia and benign neoplasms ovaries.

Doctors pay special attention to patients who have already reached menopause, but for some reason the endometrium continues to grow. This may indicate an oncological process. Without curettage, it is impossible to make a diagnosis and decide on further treatment tactics.

Separate diagnostic curettage of the uterine cavity (RDW), the first word in the name of the procedure means that material is taken not only from the uterine cavity, but also cervical canal, first from it - this is a very useful procedure if it is performed to remove a polyp or submucous fibroid. Since these neoplasms can play the role of intrauterine contraceptives and do not allow the fertilized egg to penetrate the endometrium for further development.

By the way, a polyp can not only be hormonally determined, but also be a consequence of an incomplete miscarriage. In this case, according to histology, a diagnosis of “placental polyp” is made. Moreover, sometimes women do not even understand where it came from, this polyp, if there were no pregnancies, there were no delays. It happens that pregnancy is terminated almost immediately after implantation of the fertilized egg into the wall of the uterus. Therefore, there are no symptoms. But such a “gift” in the form of a polyp may remain.

Diagnosis of endometriosis (adenomyosis)

Endometriosis is a disease in which cells of the endometrium, the inner layer of the uterus, spread into the muscular layer of the uterus or beyond the main layer. reproductive organ. If endometrial cells are affected inner layer uterus, lesions form. IN in this case the disease is called adenomyosis. Women often experience uterine bleeding and pain during, before and after menstruation. Menstruation is always profuse. But the most important thing is that with widespread adenomyosis it is very difficult to get pregnant.

How is the diagnosis made? The doctor can guess it based on the symptoms. In general, adenomyosis is a very common pathology among women of different ages. If an ultrasound confirms its probable presence, plus endometrial pathology, then the woman may be offered an examination. Diagnostic curettage of the uterine cavity is indicated for such problems, but to determine the prevalence of adenomyosis, it would be better to perform this procedure under the control of hysteroscopy - with a visual examination of the uterine cavity using a special device.

Completely get rid of adenomyosis in reproductive age will not work. Its symptoms will disappear only with pregnancy. And they will disappear completely - with the onset of menopause or after removal of the uterus. But you can significantly improve your condition and increase your chances of pregnancy if you take the medications prescribed by your doctor. hormonal drugs according to special schemes. Some of them put a woman into artificial menopause, but this is part healing process. After this, the foci of adenomyosis become smaller, and pregnancy may occur.

Uterine fibroids

Diagnostic curettage of the uterine cavity for fibroids is performed in two cases:

if the tumor grows inside the uterus, that is, it is submucous, it can be removed through the vagina;
if there is a suspicion of endometrial pathology;
this procedure is performed before removal of uterine fibroids to ensure that there is no endometrial cancer.

But diagnostic curettage of the uterine cavity and cervical canal is useless if the doctor wants to make a diagnosis between fibroids and sarcoma, and the tumor itself is located in the muscular layer or even grows on the uterus, that is, it is subserous. Even if the histology is good, it is not a fact that it is not sarcoma. At the initial stages of development of a malignant tumor, its cells in the endometrium may be absent.

In general, to distinguish fibroids, benign tumor, from sarcoma, a very aggressive, malignant tumor, a difficult task even for an experienced physician. In most cases, the main difference is the very rapid growth of the tumor. When it grows literally a centimeter per month. For sarcoma, the entire uterus is removed, and often the appendages along with it. Uterine sarcoma is a rare finding in young women. It is most often diagnosed in women over 50 years of age.

Removal of uterine fibroids is carried out not only because rapid growth tumor and its significant size, but also if it interferes with conception. This happens with the submucosa, submucous myoma. Just to remove it, the woman undergoes a so-called hysteroresectoscopy and immediately diagnostic curettage.

Before the procedure

In the case of a planned intervention, a woman first undergoes blood and urine tests, a smear for flora, must undergo an ECG and visit a therapist with all the results. Such “difficulties” are necessary because during the procedure, most likely, they will do general anesthesia. And there are many contraindications for its implementation. The anesthesiologist must know everything about the health of his patient in order to give her the safest possible anesthesia.

At the same time, the results of smears are important. If they are bad, the procedure may be postponed. The only time the results of smears are not taken into account is during emergency cleaning. It is performed, for example, in case of heavy intermenstrual bleeding in order to stop it. But after the procedure, antibiotics are necessarily prescribed.

Possible complications and consequences

Immediately after the procedure, the woman will have to recover from anesthesia. This can last up to three hours. You should not get up on your feet earlier than two hours after scraping, as you will feel dizzy.

There may be nagging pain in the area of the uterus. You can remove them with any antispasmodic quite quickly.

Discharge after diagnostic curettage of the uterine cavity continues for several days. And sometimes they can be quite intense, especially if the procedure was more therapeutic, for example, if a woman had a polyp or fibroid removed. As with menstruation, at first the discharge will be bright red, gradually it will become less, its color will be brown, and finally it will end in a light spotting. Sometimes complications occur during diagnostic curettage of the uterine cavity in the form of heavy bleeding. Then the woman is prescribed a hemostatic drug: “Vikasol”, “Ditsinon”, “Tranexam”, etc.

And if you don't accept antibacterial drugs prescribed by a doctor, endometritis and inflammation of the uterus may occur, leading to the formation of adhesions and infertility. At the same time, the woman is also prescribed antifungal tablets for the purpose of prevention; they will protect against thrush, which will probably appear otherwise while taking antibiotics.

Another common complication- These are cervical injuries. They may arise due to mechanical damage as a result of careless use of instruments by a doctor. For example, if the bullet forceps, which are used to pull the cervix downwards before its instrumental dilatation, are torn off. As a result, a woman experiences isthmic-cervical insufficiency and miscarriages in late pregnancy.

Recovery process

Menstruation after diagnostic curettage begins at different times. They depend on what day of the cycle the intervention took place. Usually doctors prescribe the procedure for the last 1-2 days of the cycle so as not to disrupt the cycle. In this case, menstruation should be expected after about 30 days.

If you start taking oral contraceptives, then bleeding will begin within a week after taking the last, 21st tablet from the package. Starting to take contraceptives is 1-5 days after cleansing.

Sometimes there is a delay in menstruation - this may be the consequences of diagnostic curettage of the uterine cavity. If the procedure is performed too carefully, intrauterine synechiae and adhesions may form; this is the result of endometrial trauma. Symptoms - prolonged absence of menstruation or very scanty discharge. Surgical treatment - dissection of adhesions.

Pregnancy can be planned 3 months after the procedure. Typically, this is the period gynecologists advise their patients to wait.

Content

Many women, having learned from their doctor about the need for a procedure called separate diagnostic curettage or abbreviated RDV, want to know what it is. The term RDV means gynecological procedure, which is used both for diagnosing various pathologies the uterine cavity and cervical canal, and to eliminate unnecessary tumors.

If RDV is performed for diagnostic purposes, then the curettage procedure also includes sampling of the uterine epithelium. The extracted inner layer of the uterine cavity is used for various important analyzes. To carry out the RDV procedure, the patient is admitted to the gynecology department on an inpatient basis. RDV is quite often carried out as a diagnosis of the condition of the inner layer lining the uterine cavity.

The curettage procedure in gynecology is carried out using instruments under conditions of absolute sterility. First, the pharynx of the cervix opens, thereby becoming accessible internal cavity. Then a curette is used to scrape the mucous layer of the uterus from its different parts. If necessary, this procedure is also performed in the cervical canal.

After RDV, the material under study is sent to the laboratory to obtain the research result; the cells of the uterine cavity mucosa are treated with special dyes and then placed in the desired environment. Diagnostic curettage helps determine the condition of both the uterus and a woman’s ovaries.

Why is RDV carried out?

Diagnostics. Periodically, during an ultrasound scan of the pelvic organs, pathologies are detected. However, technical capabilities this method studies do not allow accurate visualization of the tumor. Thus, a series of studies are carried out over the course of menstrual cycle women. Sometimes pathological neoplasms disappear for some time. Otherwise, a more complex research method in gynecology is recommended, which will allow diagnosing various seals in the uterine cavity, as well as in the cervical canal. In the process of RDV, material is taken from the uterine cavity or cervical canal for research, which is then sent for a specific analysis. RFE is extremely necessary for timely diagnosis such oncological pathologies as cancer and sarcoma, which can affect the cervix and uterine cavity.
Treatment. Curettage is also performed to remove various tumors or lumps. With the help of therapeutic and diagnostic curettage of the uterine cavity, you can get rid of pathologies that are not amenable to conservative treatment.

Indications for LDV and RDV

Speaking about LDV (therapeutic diagnostic curettage) of the uterine cavity, it can be noted that this study is widely used in gynecology.

With unnatural thickening of the endometrium, which is called hyperplasia, curettage is diagnostic and therapeutic in nature. It seems possible to determine the cause of this pathology only during curettage. In addition, with the help of special tools, pathology is eliminated. Subsequently, the achieved result is consolidated by conservative treatment.
Urgent medical and diagnostic curettage is carried out in case of uterine bleeding, the cause of which is usually difficult to find. This procedure stops the flow of blood, thereby protecting the woman from anemia.
Endometritis is most often treated with medication. However, sometimes for accurate diagnosis In case of an inflammatory process in the uterine cavity, therapeutic and diagnostic curettage is performed.
It is known that RDV of the uterus and the cervical canal is mandatory procedure for various tumors, polyps and fibroids. This study is of particular value in gynecology when neoplasms are suspected of being malignant.
Therapeutic and diagnostic curettage is often performed in cases of frozen pregnancy, miscarriage, or complications after an abortion. In these cases, using curettage, the remnants of the fertilized egg are removed along with the endometrial layer.
When the opposite walls of the uterus grow together, which in gynecology is called synechiae, surgery using special gynecological devices.

How to prepare for the procedure

Before hospitalization, you must undergo an examination, including:

blood test for syphilis, HIV, hepatitis;
general analysis urine;
general blood test with formula;
general vaginal smear, as well as for STIs;
cardiogram;
fluorography;
coagulogram;
sometimes a physician's opinion is required.

Examination before surgical intervention necessary to exclude possible acute diseases, which are a direct contraindication to performing therapeutic-diagnostic and separate-diagnostic curettage.

Curettage cannot be carried out as planned during inflammatory processes at any location, as well as during exacerbation of chronic diseases.

It must be remembered that the operation is performed only on an empty stomach: abstinence from food and water is recommended for several hours. In some cases, a woman is also recommended to have a cleansing enema.

What is diagnostic curettage?

For the RDV procedure, the day of a woman’s menstrual cycle is important, since the most favorable time it is carried out a few days before the expected menstruation. The procedure takes, on average, half an hour. Depending on the volume of intervention, it is used local anesthesia or general anesthesia. First, the cervical canal of the cervix is scraped. Next, the internal cavity of the uterus is scraped out. It should be noted that, in this way, only the upper functional layer is removed, which grows again over time. After the manipulation, scrapings from the cervical canal and uterine cavity are placed in different containers and sent to the laboratory for diagnosis. For several days, the patient is under the supervision of a doctor; she is periodically examined in a gynecological chair and an ultrasound scan of the pelvic organs is performed.

How is rehabilitation going?

After the study, the woman remains in the hospital for some time and complies with the doctor’s instructions, including drug treatment. In the first days after curettage, sanguineous and bloody issues. Almost immediately, a woman can return to normal life with some restrictions: it is necessary to exclude sex life, excessive physical activity for a period of 2 weeks to a month.

Possible complications after RDV

It is necessary to realize that RDV is an intervention used in gynecology, which, like other surgical procedures, can lead to serious complications:

damage to the growth layer of the endometrium;
perforation of the uterine wall with the instruments used;
accumulation of blood in the uterus, which requires further treatment;
irregularities in the menstrual cycle;
infection and inflammation.

At serious complications after RDV, such as bleeding, there is a threat not only to the health, but also to the life of the patient. Practice shows that death from loss of blood can occur within half an hour after the development of bleeding.

Careful and thorough preoperative preparation, including execution necessary list research, helps reduce the risk of surgical and postoperative complications.

The research results obtained by the RDV method are extremely important for making the correct diagnosis and determining treatment tactics, especially for pathologies such as malignant tumors.

The procedure of separate diagnostic curettage is a rather unpleasant, but vitally important surgical procedure. Complications after it are extremely rare. RDV usually does not affect the patient’s health, but in any case you should not refuse to carry it out, since this study often saves a woman’s life.

Various methods are used to diagnose and treat pathological processes in the female reproductive system. instrumental methods. One of them is separate diagnostic curettage of the uterus and cervical canal. The article talks about what it is, how and when it is performed, and what complications there may be.

What is the procedure used for?

The endometrium - the layer of the uterus that lines the organ from the inside - has two layers. The upper one, facing directly into the organ cavity, is called functional. It changes during the menstrual cycle and is rejected during menstruation.

Many pathological processes develop precisely in this zone. The cervical canal is located inside the cervix, connecting the uterine cavity and the vagina. It is lined with epithelial cells that can degenerate into precancerous and malignant. To conduct a microscopic analysis and clarify the diagnosis, the doctor needs to obtain samples of the altered tissue.

Therapeutic and diagnostic curettage of the uterine cavity consists of expanding the lumen of the cervical canal and removing the upper layer of the endometrium using gynecological instruments. It is advisable to carry out this procedure under control - endoscopic examination of the uterus. Curettage refers to minor gynecological interventions.

Indications in obstetrics:

termination of pregnancy, including frozen pregnancy;
removal of parts of the embryo during spontaneous miscarriage (incomplete abortion);
removal of the remains of the placenta retained in the uterus after childbirth.

In gynecological practice, manipulation for diagnostic purposes is carried out if endometrial hyperplasia, cancer or uterine tuberculosis is suspected. As a therapeutic intervention, it is used for severe uterine bleeding, as well as for removal. In addition, manipulation may be necessary to remove an organ that has grown into the wall.

Symptoms that may require diagnostic curettage of the mucous membrane of the cervical canal and uterine cavity:

irregular menstrual cycle, bleeding from the vagina between periods;
spotting and;
infertility.

The intervention is not carried out when acute inflammation genitals, as there is a risk of infection entering the uterus. An exception is therapeutic curettage, for example, in acute cases that develop after childbirth due to retention of part of the placenta.

Contraindications

The operation is contraindicated for any acute illness accompanied by fever, with suspected perforation of the uterus and with. Its implementation is difficult with severe arthrosis of the hip or knee joints preventing the patient from taking correct position on the gynecological chair.

Curettage of the uterus for certain diseases

Endometrial hyperplasia

Diagnostic curettage of the uterine cavity for endometrial hyperplasia is prescribed to most patients. This diagnosis is difficult to confirm using other methods. Therefore, removal of the inner uterine layer can be carried out repeatedly. Preference should be given to curettage under hysteroscopy control. Otherwise, even an experienced doctor cannot always completely remove the altered mucous membrane.

Endometrial hyperplasia often occurs against the background hormonal disorders, therefore it occurs in both young girls and perimenopausal women. If necessary, the doctor prescribes curettage for patients of any age after the onset of puberty.

After the intervention, hormonal drugs are prescribed for recovery hormonal levels and normalization of the cycle.

Myoma

It is not an indication for curettage. However, with this disease, hysteroscopy is often performed to help examine submucosal myomatous nodes. If signs of endometrial hyperplasia are detected simultaneously with the fibroid, curettage is prescribed.

Cervical cancer

If cervical cancer is suspected, curettage of the cervical canal should be performed and taken. Such an examination helps to clarify the diagnosis and determine the spread of the tumor.

If the doctor suggests malignant process endometrium, he definitely prescribes separate curettage. This procedure helps to clarify the localization of the pathological process.

Uterine bleeding

Curettage during uterine bleeding is an emergency intervention aimed at saving the patient’s life. It runs without preliminary preparation. Once the endometrium is removed, blood loss stops. After microscopic examination Doctors determine the cause of the bleeding.

Pathological changes in the cervical canal

In case of pathology of the cervical canal, for example, with ( precancerous condition) diagnostic curettage should be performed after conization of the cervix, and not precede it. This procedure helps evaluate the effectiveness of removing pathologically changed cervical tissue.

Scraping after pregnancy

The procedure is performed if a woman has had a miscarriage, and after that the rest of the placenta is retained in the uterus. This condition is diagnosed using ultrasound. Curettage is performed to stop bleeding and prevent infection. Another option for cleansing the uterine cavity is the use of medications that cause contraction of the organ. The effectiveness of medications is slightly lower than surgery.

In case of miscarriage on early stage curettage may not be performed if there is no blood loss and other dangerous symptoms. The remaining fetal tissue will be removed on its own during the first menstruation.

How to prepare for surgery

The manipulation is carried out in a hospital, but all preliminary studies are carried out in a antenatal clinic.

Preparation for diagnostic curettage of the uterine cavity includes the following tests and consultations:

gynecological examination;
blood test to determine coagulation parameters;
diagnostic tests viral hepatitis B and C, HIV infection and syphilis;
electrocardiogram;
a smear to rule out infection in the vagina.

When prescribing a procedure, you must inform your doctor about the medications you are constantly taking. medicines. If they may affect blood clotting parameters, they may need to be stopped a few days before surgery.

Women with severe general diseases such as epilepsy, severe arrhythmias, infective endocarditis, diabetes with insulin dependence, it is recommended to visit a specialized specialist (neurologist, cardiologist, endocrinologist, etc.) to correct the therapy being taken.

During the last 2 days before the operation, you must abstain from sexual contact, douching, and do not use vaginal suppositories and creams. In the evening before the intervention, you can have a light dinner, and from midnight do not take food and, if possible, water. The perineal area must be shaved, take a bath or shower, and thoroughly wash the genitals. In most cases, an enema is not prescribed.

How is diagnostic curettage performed?

Planned curettage is prescribed before the onset of menstruation. IN in case of emergency it can be performed regardless of the day of the cycle. Before the procedure, sedative (hypnotic) medications may be used to calm the patient and ease anesthesia.

Diagnostic curettage of the walls of the cervical canal and uterus is carried out under intravenous anesthesia, during which the patient is immersed in a medicated sleep and does not feel anything. This anesthesia is controllable, that is, the anesthesiologist can change its duration if necessary. On average, the duration of anesthesia is about half an hour.

Spinal or epidural anesthesia is less commonly used. The doctor introduces medicinal substances in the fabric around spinal cord. As a result, the patient is conscious, but does not feel anything in the area below the lower back.

In some cases, for example, with intolerance necessary medications, paracervical anesthesia is used - the injection of painkillers into the tissue around the cervix. This allows for painless manipulation while the patient remains conscious.

Before the intervention, the woman must urinate. She is located in a gynecological chair. The doctor conducts a two-handed examination, clarifying the size and location of the uterus. The patient is then given an anesthetic drug.

After treatment of the perineal organs, vagina antiseptic the doctor exposes the cervix using speculum, fixes it with bullet forceps and inserts a dilator into the canal. A small diameter instrument is inserted first, then it is removed and the next largest one is used until the cervical canal is widened enough to allow the instruments to be inserted.

If endoscopic control is used, the hysteroscope is inserted into the uterus before and after completion of the main stage of curettage. First, with its help, the doctor examines the surface of the mucous membrane, and at the end of the operation, monitors the effectiveness of endometrial removal.

If separate (fractional) therapeutic and diagnostic curettage of the uterus is performed, then first, with an instrument similar to a spoon with a pointed edge (curette), the epithelium of the cervical canal is removed, collecting it in a separate container. The curette is then inserted into the uterus and the inner layer of the endometrium is carefully scraped away.

Diagnostic curettage of the uterine cavity for fibroids should be carried out especially carefully. The curette can damage the tuberous surface of the organ and cause bleeding from the myomatous node. Caution is needed when performing manipulation against the background of endometrial cancer or pregnancy.

After removing the mucous membrane, the cervix is treated with an antiseptic, and the vaginal specula are removed. The scrapings are sent to the laboratory for testing.

The patient is under observation for some time medical personnel. If there are no complications, the woman can be discharged home by the evening of the same day or the next day.

Postoperative period

Curettage is considered a simple operation; it does not require sutures and is accompanied by rapid recovery of the body. The woman can return to normal life the next day, but to prevent complications it is recommended to adhere to certain restrictions.

During the first 24 hours, the patient may experience drowsiness as a consequence of anesthesia. She should not drive or engage in other activities that require increased alertness for 24 hours.

Bloody discharge after diagnostic curettage normally continues for several hours, gradually stopping. Slight spotting brown or light leucorrhoea may persist for a week to 10 days. If they are absent, it appears simultaneously It's a dull pain lower abdomen, you need to see a gynecologist. This condition may be a sign of cervical spasm and stagnation of blood in the uterine cavity.

Minor discomfort Period-like pain may be normal for 2 days, but it will stop after taking a pain reliever (such as Ibuprofen).

Possible negative consequences:

If the intervention technique is incorrect, perforation of the uterine wall is possible;
adhesions inside the uterus;
damage (tear) of the neck;
exacerbation of the inflammatory process of the genital tract;
hematometra - retention in the uterine cavity of blood released after the procedure due to cervical spasm;
damage to the lower (germ) layer of the endometrium due to excessive strong influence on the uterine wall;
allergic reaction to anesthetic drugs.

After the intervention, antibiotics are prescribed to prevent infectious complications. The course of treatment lasts from 5 to 10 days; oral medications (tablets, capsules) are usually used.

For at least 10 days after the procedure, the woman is advised to abstain from sexual intercourse. During this period, it is necessary to use not tampons, but sanitary pads. Douching, visiting a bathhouse or sauna, or taking baths is prohibited (you can wash in the shower). Required to limit physical activity(especially heavy lifting) for at least 3 days, avoid constipation, and do not use medications containing acetylsalicylic acid(Aspirin) and other anti-inflammatory components. These medications may increase bleeding.

Dangerous signs requiring consultation with a gynecologist:

rapid sudden cessation of discharge and increasing pain in the lower abdomen;
fever;
severe abdominal pain that does not go away after taking painkillers;
nausea, bloating;
ongoing uterine bleeding;
discharge from the genital tract with an unpleasant odor;
deterioration of health, weakness, dizziness, fainting.

If a woman does not have any warning symptoms, she comes for a follow-up examination in 10-14 days. At the appointment, the doctor may conduct ultrasonography to assess the condition of the uterus. Treatment after the curettage procedure depends on the results of histological analysis.

If the intervention was carried out due to a miscarriage, the woman may experience unpleasant emotions - grief from the loss of pregnancy, a feeling of despair, and others. Therefore, her family members should pay more attention to their relative and support her. If the psychological consequences are severe, you may need the help of a doctor.

Removal of the endometrium during curettage resembles its rejection during menstruation. During the next cycle, the lining of the uterus is restored. With good regeneration of the upper layer of the endometrium, pregnancy can occur even in the current cycle after ovulation. In most patients reproductive function normalizes after the next menstruation.

IN last years the number of curettage operations performed has decreased. It is practically not used for the treatment of mild uterine bleeding using hormonal drugs for this purpose. In diagnostics, ultrasound, hysteroscopy, and pipel biopsy are becoming increasingly important. However, it is curettage that saves a woman’s life, for example, in case of bleeding as a result of an incomplete abortion.

Name of service	Price
Diagnostic curettage of the walls of the uterine cavity	4200	rub.
Initial appointment. OBSTETRIC-GYNECOLOGIST	2000	rub.
Repeated appointment. OBSTETRIC-GYNECOLOGIST	1500	rub.
Russian Far East	8300	rub.
RDV + hysteroscopy	14400	rub.
Hospital complex examination (RW, HIV, hepatitis C, hepatitis B, coagulogram)	from 2500	rub.
Intravenous anesthesia	8100	rub.

RDV is prescribed to women of different ages. Indications for it are determined by the doctor after examination in a gynecological chair and ultrasound of the pelvis. In addition, diagnostic curettage of the cervix and uterine cavity separately can also be a therapeutic procedure.

Indications:

myoma;
acyclic bleeding;
adhesions of the uterine cavity;
polyps;
endometriosis;
amenorrhea or other cycle disorders;
recurrent miscarriage;
remnants of the fertilized egg.

This gynecological manipulation is well tolerated by women. Performance is practically not reduced. Within a few hours after RDV of the uterus, the patient can leave the hospital.

Indications and contraindications for RDV of the uterus

Indications for RDV are determined by the doctor after examination in a gynecological chair and ultrasound of the pelvis. The procedure is recommended for patients of all ages. RDV of the uterus is prescribed:

with acyclic bleeding;
cycle disorders;
adhesive process in the uterine cavity;
polyps;
endometriosis;
fibroids;
habitual miscarriage;
suspected endometrial hyperplasia or cervical cancer.

Curettage should not be performed during acute infectious diseases(local and general). The procedure is also contraindicated in cases of severe cardiac, respiratory or renal failure.

Examination before diagnostic curettage

Before RDV of the uterus, a standard examination is performed:

clinical blood test;
coagulogram;
analysis for blood group and Rh factor;
analysis for hepatitis B and C, HIV and syphilis;
microflora smear;
cytology smear;

In contact with

Classmates

RDV (separate diagnostic curettage) is one of the types of biopsy in which the material for analysis is the superficial, functional layer of the uterine mucosa (endometrium). The word “separate” means that in addition to the uterus, the mucous membrane of the cervical canal is also scraped out, and the resulting contents are sent for analysis separately.

In some cases, RDV is used with therapeutic purpose- for example, for treatment malignant tumors in the early stages of the disease, removal of fibroids, polyps and cysts, stopping uterine bleeding.

Due to the invasiveness of RDV, in gynecology this method is used only for strict indications, and if it is impossible to make a diagnosis in another way.

Indications

bleeding from the uterus of unknown origin;
malignant neoplasms of the uterus or suspicion of them;
complications after abortion;
uterine fibroids;
endometrial hyperplasia and dysplasia;
multiple polyps of the mucous membrane;
suspicious changes in the cervix;
fusion of the walls of the uterus (synechia);
disruptions in the menstrual cycle.

Preparation for the procedure

The period of the menstrual cycle during which it is better to perform RDV of the uterus depends on its purpose: to remove fibroids, polyps, tumors would be better suited the first half of the MC, and for diagnostic sampling of the endometrium - the second, a few days before menstruation, when physiologically its rejection should occur.

Before the procedure, the doctor must direct the patient to undergo a series of tests and undergo some instrumental studies. Mandatory are:

general blood test with leukocyte formula, general urine analysis (screening examinations to identify hidden inflammatory processes);
coagulogram (to assess blood clotting);
Wasserman reaction (diagnosis of syphilis);
blood test for hepatitis B and C;
a smear from the vagina for flora and for cytological examination (for the diagnosis of STDs, vaginal dysbiosis, the presence of cellular atypia of the cervix);
ECG (again, a screening method, designed to assess the body’s ability to withstand the load in the form of invasive manipulation).

If it is possible to diagnose inflammatory processes, bleeding disorders or heart disease, the procedure is postponed until normalization general condition patients.

You must come to the operation on an empty stomach.

How does curettage occur?

RDV of the uterus is done in a hospital, strictly observing the rules of asepsis and antiseptics. The operation is performed on a table similar to a gynecological one. Anesthesia can be either general (intravenous anesthesia) or local (injection of anesthetic into the cervix). General anesthesia is usually preferred because thanks to it the entire procedure occurs without pain or discomfort for the patient.

The surgical field (vulva and cervix) is treated with betadine or an alcohol-based antiseptic.

First, a gynecological speculum is inserted into the vagina, then the doctor grabs it with special forceps (they are also called “bullet” forceps). upper lip cervix, and with another pair of forceps fixes lower lip- in this way, stability of the uterus is achieved during surgery.

Next, they find out the length of the uterus and the features of its position using probing, after which they begin to open the cervical canal with Hegar dilators. They are introduced very carefully, starting from the smallest diameter and gradually increasing the thickness. The insertion end of the dilator should only slightly enter the uterine cavity. After this, the actual scraping begins. A small curette is held so that its bend follows the position of the uterus, and the end reaches the stop. The functional ball of the endometrium is gradually slowly removed, this is done especially carefully in the corners of the uterus - here scraping is carried out with the smallest curette. The basal ball of the mucous membrane cannot be removed, as this may subsequently lead to disruption of implantation of the fertilized egg. Sometimes a hysteroscope is used to better monitor the progress of the procedure and prevent damage - special device, which makes it possible to fully examine the uterine cavity.

The resulting samples are collected in special containers, placed in a bottle with formaldehyde solution and sent for examination to a histology laboratory. The contents of the cervical canal and the contents of the uterus are sent and examined separately. Usually the entire procedure lasts about 20-30 minutes.

The first days after the Russian Far East

The woman must stay in the hospital for several more hours after the operation, during which time her condition is monitored by an anesthesiologist and an obstetrician-gynecologist. Sometimes with for preventive purposes the doctor may prescribe antibiotics, antispasmodics and restorative drugs in the postoperative period.
For several days after the procedure, slight spotting and bloody discharge may be observed from the vagina. A repeat visit to the hospital should be made within a week: during the examination, a transvaginal ultrasound is performed and the healing process of the uterine mucosa is assessed.
The results of the RDV can be obtained and discussed with the attending physician within ten days after the procedure.

Contraindications to RDV

As with any diagnostic procedure, there are a number of diseases and conditions of the body that are contraindications to RDV:

acute and subacute inflammatory processes of the vagina;
submucosal fibroids of the uterus;
gonorrheal endocervicitis;
endometritis;
diseases of the hepatobiliary, cardiovascular and excretory systems in the stage of decompensation.

Complications

Sometimes, after an incorrectly performed procedure, violation of the rules of asepsis and antisepsis, or the traumatic nature of the RDV, a number of complications can arise. This is also facilitated by the patient’s weakened immunity, the presence concomitant diseases or failure to follow medical recommendations in the period after discharge from the hospital.

Among the most common complications it is worth highlighting:

formation of uterine hematomas;
damage and tears to the walls of the uterus, up to perforation;
development inflammatory diseases uterine mucosa;
hematometra (accumulation of blood in the uterus);
excessive scraping of the mucous membrane and, as a result, its damage.

In order to avoid undesirable results, you need to trust the operation only to highly qualified specialists, and give preference to a combination of RDV with hysteroscopy. It is also worth remembering that complications after this manipulation are quite rare, since RDV is very often used in gynecological practice.