Diagnostic curettage of the uterine cavity - Causes, symptoms and treatment. MF.

The meaning of the operation consists in scraping( or scraping) the mucous membrane of the uterus, more precisely, its functional layer. Scraping can be diagnostic when the remote mucosa is subjected to a histological( or other) examination, and therapeutic, when the pathologically changed mucous membrane of the uterus or the remains of the fetal egg retained in its spongy layer are removed for therapeutic purposes.

Before the endometrial scraping operation, the bladder and rectum should be emptied.

Skin of the perineum and external genitalia before the operation is treated with 70% ethanol alcohol and 0.5-1% iodine alcohol solution. With very careful, precise and correct operation, this can not be done, especially for women with increased pain sensitivity.

To facilitate the expansion of the cervical canal rationally for 20-30 minutes before the operation begins to introduce the patient one of the antispasmodics. The injection can be done directly into the cervical tissue.

The vagina is opened with mirrors and the cervix is ​​fixed with forceps. It is best to grasp the front lip of the neck with forceps. Treating the mucous membrane of the vagina and cervix with 70% ethyl alcohol and 0.5% solution of iodine alcohol, proceed to anesthesia. To this end, as already indicated, 1-2% solution of lidocaine with adrenaline is injected into the cervix, the injection can be done in two or four points: on the sides, in front and in the back( figure on the left).After anesthesia, wait at least 10-15 minutes. For the purpose of anesthesia, a solution of lidocaine can be introduced into the peritoneal cellulose tissue.

After anesthesia, the uterine cavity is probed and the extension of the cervical canal is expanded by Gegar dilators, the diameter of the dilator of each subsequent number is increased by 0.5-1 mm. The maximum diameter of the expander No. 29 is 2.4 cm. Begin the expansion by small-diameter expanders, successively introducing expanders of an ever-larger diameter until an extender of the desired number is found. Introduce the instrument by the same rules as the uterine tube( figure on the right), its curvature should correspond to the bend of the uterus. For diagnostic curettage of the mucous membrane of the uterus, it is sufficient to widen the cervical canal with expander No. 7-8, if necessary, large dilators of larger diameter( No. 10-12), respectively, are used to use a large curette. Expansion of the cervical canal can be done with a special tip attached to the apparatus for vibrating massage.

Scraping is produced by curettes, which also come in different sizes. Before the introduction of the curette into the uterine cavity, one should compare its width with the width of the handle of the expander: if it is equal to or slightly less than the width of the handle, which is much better, the curette can be introduced into the uterus painlessly and will not injure the tissues. Gently pushing the curette to the bottom of the uterus, it is pressed with a sharp part to the anterior wall of the uterus and boldly, but carefully led to the inner throat and again gently returned to the bottom. Reverse movement of the curette from the bottom to the inner throat should be done on the mucous membrane, which has not yet been scraped off and is located next to the scraped wall of the uterus. So systematically, starting on the middle line, scrape the endometrium of the anterior wall of the uterus. After this, the curette is turned with the acute part backwards and systematically scraping the mucous membrane of the posterior wall of the uterus. Finish the operation by scraping the mucous membrane from the bottom and horns of the uterus. Only after this same curette, turned back, you should remove the scraped mucous membrane from the uterine cavity. During the whole operation, the curette should not be strongly compressed in the hand. When the curette is pressed hard against the wall of the uterus, the basal layer of the endometrium and even the muscular membrane of the uterus can be scraped off. During the operation, one should never at all costs achieve the audibility of the so-called "uterine crunch".The mucous membrane is scraped, if the uterine wall is smooth, there are no soft tissues on it, the movement of the curette along which resembles the motion on cotton wool.

Scraping is collected in a tray, and after the operation is transferred to gauze, washed with water from the blood, lowered into a bottle( for example, from penicillin) and poured 5-10% with formaldehyde solution or better with 96% ethanol. In this form, scraping is sent to the laboratory for histological examination, indicating the date of the operation, the patient's surname, her age, the day of the menstrual cycle, the clinical diagnosis and the place where the tissue is taken from.

Contraindications for the procedure are:

· common infectious diseases

· diseases of the heart, liver, kidneys in the decompensation stage

· Sexually Transmitted Diseases