D curettage. Preparation for diagnostic curettage

Curettage of the uterine cavity (curettage) many women know what this procedure is. It is performed for different purposes: to terminate an unwanted pregnancy, treatment, diagnosis of gynecological and oncological diseases. When curettage of the uterine cavity is performed, the specific day of the cycle depends on the reason why doctors prescribed this minor surgical intervention. In the case of pregnancy, it is performed at a period of more than 7 and less than 12 weeks. If the goal is to stop intermenstrual bleeding, regardless of the day of the cycle. They try to prescribe diagnostic curettage of the uterine cavity for the last 1-2 days of the menstrual cycle, so as not to disrupt it. Thus, it is as if the woman begins her menstruation a little earlier.

Some indications for curettage of the uterine cavity:

• fibroids with suspected atypia and (or) before its removal;
• endometrial hyperplasia;
• frozen pregnancy, first trimester;
• unwanted pregnancy up to 12 weeks;
• endometrial polyp;
• suspicion of endometrial cancer.

Curettage of the uterine cavity during bleeding is usually performed if a woman is diagnosed with endometrial hyperplasia on ultrasound. Thus, the procedure also has diagnostic value. If the doctor suspects a hormonal cause of uterine bleeding, he may prescribe hormonal drugs or hemostatic drugs. That is, curettage of the endometrium of the uterine cavity is not a priority procedure, since it has not only positive aspects, but also negative ones. So, during it, the doctor may accidentally injure the uterus or cervix, which during pregnancy can result in a threat of miscarriage. There is still a high probability of an inflammatory process developing in the uterus, especially if the woman did not take antibiotics after the procedure. These are the consequences of curettage of the uterine cavity, but if it is performed strictly according to indications, then the risk of complications is much lower than the risk that a woman exposes herself to by refusing the procedure.

In case of a polyp, therapeutic curettage of the uterine cavity helps not only in the future to avoid uterine bleeding that occurs due to its presence, but also to conceive a child. The polyp in the uterus acts as an intrauterine contraceptive. After its removal, women are able to get pregnant.

But instrumental abortion, on the contrary, leads to infertility. Not only is the uterus injured, but hormonal disruption also occurs. Because of it, a woman’s menstrual cycle is disrupted, amenorrhea occurs, and ovulation disappears. Therefore, doctors gently try to dissuade women who do not have children from terminating their pregnancy. There are many public organizations working on this issue.

It is recommended to plan pregnancy after curettage of the uterine cavity at least 3 months later. It is believed that by this time the endometrium should “recover.” During this recovery, oral contraceptives are prescribed to normalize hormonal levels. By the way, stopping hormonal contraceptives and pregnancy occurs easier. This property of drugs has long been known and widely used by doctors.

Pregnancy is possible in a shorter period of time. For example, if a woman is over 35 years old, and this procedure eliminated the cause of infertility or miscarriage. But one way or another, while there is discharge after curettage of the uterine cavity, sex life is prohibited. That is, for about 14 days after cleansing, you need to refrain from sex, as it can provoke an infectious process.

One very important question remains unsolved - how painful is curettage of the uterine cavity and cervical canal. You can often hear from experienced women that this is an extremely painful procedure. Yes, this is true, but only if it is performed with weak, local anesthesia or without it at all. The opening of the cervix is ​​especially painful, although curettage of its cavity is also very unpleasant and noticeable. Fortunately, now in most hospitals general intravenous anesthesia is performed free of charge or for a fee. The woman sees absolutely nothing, does not feel anything, and is unconscious. And after the procedure he quickly comes to his senses and in almost all cases can go home on his own the same day.

When treating gynecological diseases, quite often there is a need to establish a diagnosis using minor surgery. The detection of most pathologies of the female reproductive system when using non-invasive diagnostic methods 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, it is possible to find out exactly the nature of the changes occurring only with the help of operational diagnostics.

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

The latter option is increasingly used and is called “hysteroscopy with RDV”. Hysteroscopy with RDV, what is it? The most effective diagnostic method or a universal method of treating almost all types of intrauterine pathologies? More on this later...

General concepts

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

In the latter case, the design of the hysteroscope provides an instrumental channel through which surgical instruments are introduced into the uterine cavity, allowing the following manipulations to be performed:

• 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 of which is lined with a mucous layer - the endometrium. A characteristic feature of the endometrium is its ability to grow in accordance with the phases of the menstrual cycle and be shed 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 endometrial hyperplasia;
• 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 to identify atypical cells (that is, cancerous).

Anatomical structure of the 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 of the 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. In case of 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

The RDV includes the following actions. The first is taking a set of tests, including blood for sexually transmitted diseases, blood for AIDS, determination of the rate of blood clotting, a general blood test and a general urine test. 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 treating the external genitalia with an antiseptic solution and inserting an instrument into the vagina to help 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 larger curette, the entire uterine cavity is scraped out, changing curettes according to the need to scrape hard-to-reach areas. 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 developing a malignant process.

Set of curettes for curettage

Alternative methods

No less effective is surgical removal of the 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 of the laser beam during the procedure 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 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, nagging pain in the lower abdomen is considered normal, although its severity can 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) is allowed.

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 anti-inflammatory prophylaxis, antibiotics and antimicrobial drugs are prescribed immediately after surgery:

• 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 technology used, is the most optimal way to treat endometrial hyperplastic processes that are resistant to hormonal treatment and combined with polyps, cysts and submucous fibroids. The laser ablation method is extremely effective in the treatment of postmenopausal women, since during this period complete removal of the endometrial layer in all parts of the uterus is permissible. Modern methods of anesthesia make the procedure as comfortable as possible.

Receiving a referral for curettage becomes a cause of negative experiences for many women. Lack of knowledge about this procedure, the peculiarities of its implementation, the consequences and the possibility of obtaining the most informative results lead to an unreasonable fear of this surgical intervention.

The current level of development of gynecology allows curettage to be performed with minimal consequences for the patient’s body.

What is uterine cavity curettage?

Scraping– this is the removal of the internal functional layer of the mucous membrane of the uterine cavity and the cervical canal with a specially designed instrument.

The manipulation is considered a minor surgical intervention and is carried out in compliance with all standards adopted for these procedures. The material obtained as a result of the procedure is sent for histological examination and determination of the causes of possible pathology.

In most cases, the patient is prescribed RDV, or separate diagnostic curettage. It differs from conventional curettage in that sampling is performed separately:

• From the cervical canal;
• From the uterine cavity.

This technique in many cases contributes to a more accurate diagnosis.

In what cases is it necessary?

Curettage is prescribed for both therapeutic and diagnostic purposes. It can be prescribed before a major surgical intervention to assess its volume.

Therapeutic curettage. What and how is it treated?

Using this manipulation, the following pathologies of the reproductive system are eliminated:

First.

Endometrial polyps of the uterus and cervical canal. After removing the entire layer of the mucous membrane, recurrence of polyps does not occur.

Second.

Cleaning when bleeding between or during periods. Removing the endometrium helps prevent massive blood loss.

Third.

Curettage of the uterus for postmenopausal bleeding.

Fourth.

Adhesions or synechiae in the organ cavity, preventing conception and menstrual function.

Fifth.

Infertility of unknown etiology against the background of the relative health of the patient.

Diagnostic. What pathologies are detected?

Curettage of the cervical canal and uterine cavity is prescribed to clarify the following diagnoses:

• Endometrial hyperplasia - thickening of the functional layer and the development of neoplasms against this background;
• Dysplasia of the cervical mucosa – exclusion of a malignant process;
• Myoma;
• Endometrial and cervical canal polyps;
• Endometriosis;
• Menstrual irregularities.

Abortive

Artificial termination of pregnancy for up to 12 weeks is carried out by curettage of the functional layer. Abortion is nothing more than curettage of the uterine cavity.

After a spontaneous miscarriage, the procedure is performed to remove particles of the placenta and fertilized egg.

Other purposes of curettage

Another function of curettage is to remove a dead fetus during a frozen pregnancy. Thus, the uterus is sanitized from the source of inflammation and serious pathologies of the reproductive system.

In what cases should curettage not be done?

There are clearly defined contraindications to the manipulation:

• Diseases of the gastrointestinal tract, respiratory and cardiovascular systems;
• Inflammatory diseases of the reproductive system;
• 3-4 degree of vaginal cleanliness.

These contraindications are due to the fact that curettage against the background of pathologies of the vagina and other pelvic organs will certainly lead to the spread of the inflammatory process.

An excessively low degree of vaginal cleanliness requires its sanitation using drugs with an active antimicrobial effect. Curettage can be carried out only after achieving 1-2 degrees of vaginal cleanliness.

An exception to these rules is performing curettage after childbirth due to endometritis, which is caused by placental particles remaining in the uterus.

Carrying out the procedure

Despite the fact that the procedure takes very little time, it requires careful preparation, highly qualified operating gynecologist, and compliance with certain standards.

How to prepare?

Before going for curettage to extract the contents of the uterine cavity, a woman must undergo a standard examination. It includes the following diagnostic procedures:

• Determining the presence or absence of sexually transmitted infections (hepatitis, HIV, syphilis, gonorrhea);
• Coagulogram;
• A smear to determine the cleanliness of the vagina;
• General urine test and blood test.

The best time to carry out diagnostic and therapeutic curettage of the endometrium from the uterine cavity is the end of the menstrual cycle, since at this time the cervix, due to its softening, is most prepared for forced dilatation.

On the appointed day, the patient must come to the gynecological hospital. Since the operation is most often performed under general anesthesia, the woman must comply with the following requirements:

• Do not eat less than 8 hours before the intervention;
• Do not drink 3-4 hours before curettage;
• Do not smoke 1-2 days before the introduction of anesthesia.

These rules are determined by the prevention of accidental ingestion of food particles from the gastrointestinal tract during aspiration of the patient, therefore the stomach must be completely empty during the intervention.

You cannot use vaginal tablets, suppositories, have sexual intercourse, or do douching 1-2 days before the intervention. A mandatory hygienic requirement is the absolute absence of hair on the external genitalia.

How is it carried out?

Most often, anesthesia for this operation is performed in the form of intravenous administration of modern anesthesia. The dose is designed for 20-30 minutes of medicated sleep without hallucinations and discomfort.

There is a precisely defined sequence for conducting separate diagnostic curettage:

First.

The operating gynecologist inserts a speculum into the vagina and fixes the cervix with bullet forceps.

Second.

The doctor measures the internal size of the uterine cavity with a probe specially designed for this purpose.

Third.

He dilates the cervical canal with metal rods of increasing thickness (Hegar dilators) until it is possible to insert a small curette into the cervix.

Fourth.

The gynecologist scrapes the mucous membrane of the cervical canal, collecting the material in a separate container.

Fifth.

If necessary, the doctor inserts a hysteroscope tube into the uterine cavity, using it to inspect the walls of the organ.

Sixth.

Using a curette, the gynecologist performs curettage of the endometrium, collecting material for research.

Eighth.

The cervix is ​​released from the forceps, the external os and vagina are antiseptically treated, and ice is placed on the patient’s abdomen.

At the end of the manipulation, the woman is transferred to the ward of the gynecological hospital. The material obtained as a result of curettage is sent for histological examination.

After the procedure

A successfully performed diagnostic intervention does not guarantee the absence of complications, since successful rehabilitation depends on the individual characteristics of the woman’s body.

To completely eliminate extensive bleeding after surgical curettage of the uterine cavity, the patient should remain in the hospital for several hours. If necessary, women stay in the hospital for 1-2 days.

In the first hours after surgery, the patient may feel severe pain. These manifestations do not last longer than 2-4 hours, turning into mild nagging pain that persists for 7-10 days.

Do I need to use antibiotics, can I take painkillers, what kind?

To prevent the development of inflammatory processes, antibiotics are prescribed to each patient after curettage. In addition, women with a low pain threshold should take painkillers to relieve acute pain.

For these purposes, antispasmodics are used ( No-shpa or Drotaverine), analgesics ( Indomethacin, Ibuprofen), antidepressants.

How long does the discharge last?

Patients are often interested in how much bleeding there is and whether there may be other discharge after cleaning the uterus. The average duration of bloody spotting is 3-9 days.

In gynecological practice, there are cases when it is not necessary to talk about how much blood is flowing, because after cleaning the uterus, the patient experienced a cervical spasm, and a hematometra (large blood clot) formed inside the organ.

This condition is usually accompanied by severe pain, fever and requires immediate medical attention. The diagnosis can be clarified using an ultrasound that detects the spasm. When the uterus does not contract, Oxytocin is most often used, which stimulates its contractility, as well as antispasmodics and analgesics.

If the discharge that appears after cleaning the uterus has an unpleasant odor, a liquid consistency, and turns yellow, we can conclude that purulent exudate has accumulated in the cavity of the organ. In this case, the woman needs urgent complex therapy for the inflammatory process.

When will the monthly cycle be restored?

Normally, the first menstruation after curettage occurs within 4-6 weeks. During this period, the uterine mucosa is regenerated, the endometrium is restored, and therefore menstrual function is restored.

If contraception is abandoned at the end of this period, a woman is able to become pregnant even before the cycle is restored. When planning a pregnancy, it is better to carry out the conception procedure after 3 full menstrual cycles.

If the first menstrual flow after diagnostic curettage of the uterine cavity is abundant or, conversely, too scanty, accompanied by unpleasant symptoms, you need to contact your doctor.

One of the serious consequences of the procedure is damage to the growth layer of the endometrium due to excessive efforts applied to curettage.

In this case, the menstrual cycle takes much longer to recover, and its inherent cyclicity is often disrupted. The same complications result from the formation of synechiae (adhesions) that interfere with menstrual function.

When can you have sex?

It is better to postpone restoration of intimate relationships after this procedure for 2 weeks. The restriction is associated with an increased risk of pathogenic microorganisms entering the uterus, leading to the development of an inflammatory process.

After curettage, the cavity of this organ represents an extensive wound surface, extremely susceptible to infection.

It is quite possible that even after this period, sexual intercourse may be accompanied by pain or discomfort. These unpleasant phenomena usually last a short time and pass quickly.

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—the unborn child—grows and develops. 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 a 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 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 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 very little discharge, too painful contraction of the uterus after the procedure, elevated temperature are reasons to visit a doctor. A regular cycle is restored after 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. The symptom of this complication is most often high fever;
• 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 fever, 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 general or local anesthesia, which is done during uterine curettage, stops working, 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.

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.

As a 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 determines the possible cause of the pathology: fibroids, polyps, malignant neoplasms.

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

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 is a minor gynecological operation and is not highly traumatic. But after it, the woman must undergo a recovery period, which includes several mandatory procedures.

Recovery period

After curettage, until the integrity of the vessels is completely restored, the uterine cavity will bleed. It is considered normal if spotting after curettage lasts 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 stay in bed, avoid physical activity, and 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 relieve 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

Relieving pain, preventing infection and possible complications is the task of the next, recovery stage.

During the 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. A course of antibacterial drugs Antibiotics after curettage are indicated for prophylactic 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, a large pad gets 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 considered an emergency, 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. The normal brown color of the discharge disappears and takes on 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, drug therapy with antispasmodic drugs, and 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.

For treatment, a course of antibacterial therapy is prescribed. What drugs are indicated: Metronidazole as a monocomponent, or in combination with Ampicillin, Doxycycline, Cefazolin, Clindamycin. In severe cases of the disease, Metronidazole is prescribed with intravenous Metrogyl.

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, the hormonal levels have stabilized, and the woman can become pregnant again. Curettage does not affect pregnancy and labor in a healthy woman.

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.