Immediately cleansing after caesarean section. Curettage of the uterine cavity after cesarean

Many women who have given birth to a child are faced with the need to clean the uterus. However, not all types of this procedure are painful. In addition, there are folk methods for cleaning the uterus after childbirth.

In what cases is it necessary to clean the uterus after childbirth?

The most important organ responsible for the successful course of pregnancy and the birth of a child is the uterus. It is on her that the greatest burden is placed during the course of these processes.

After childbirth, the uterus begins to clear itself of the membranes that surround the fetus throughout the pregnancy. This is called the birth of the afterbirth. The placenta, which includes the umbilical cord and the membrane of the fetus, must come out completely. If this does not happen, immediately after the birth process, the obstetrician-gynecologist can perform a manual cleaning of the uterus to get out the unexpired remains. Complete cleansing of the uterus occurs in 7-8 weeks and is a process similar to menstruation.

Before discharge from the hospital, each woman is checked with an ultrasound machine for the presence of blood clots in the uterus and, if they are found, a cleaning is prescribed. A woman should never give up on her.

Timely control of postpartum cleansing of the uterus is important and can prevent the development of complications:

all residues in the uterus can begin to decompose, creating favorable conditions for the development of bacteria;
the clot can adhere to the uterus, causing the development of endometriosis.

A uterine cleansing scheduled for a new mother is likely to delay discharge from the hospital by a few days. Carrying out the procedure in the next three days after childbirth makes it less painful, because the cervix has not yet had time to fully contract and it will not have to be expanded.

If at the maternity hospital the newly-made mother was not checked for the presence of clots in the uterus, then it is worth contacting the clinic at the place of residence or a paid clinic

If you were not checked for clots with an ultrasound machine at the maternity hospital, contact your local polyclinic or paid clinic to check your uterus.

How to clean the uterus after childbirth

Cleaning the uterus after childbirth is usually carried out according to the indications of ultrasound within 3-5 days after childbirth:

Before the procedure, the woman is given general or local anesthesia.
Then the patient's external genitalia and inner thigh are treated with iodine or another antiseptic, and the vagina and cervix with ethanol.
Using dilators of different sizes, the cervix is opened and the uterus itself is cleansed.

The whole operation lasts no more than 25 minutes. After the cleaning, a repeated ultrasound of the uterus is prescribed to control its complete cleansing.

Depending on the type of instruments used, cleaning the uterus is divided into several types:

vacuum cleaning;
manual (mechanical) cleaning;
washing (lavage).

Vacuum cleaning of the uterus

Vacuum cleaning - cleansing the uterus from blood clots or placenta residues using a special apparatus - a vacuum pump. This effective method avoids injury to the cervix and walls of the uterus.

The procedure is most often performed under local anesthesia, so that the woman does not experience pain. During the operation, the patient can feel only unpleasant feelings of curettage. Before cleaning, the obstetrician-gynecologist examines the woman's birth canal, then treats them with antiseptics. Further, with the help of special dilators, the cervix is gradually opened and the organ itself is cleansed.

The principle of operation of a vacuum pump is similar to that of an ordinary vacuum cleaner. With the help of this device, negative pressure is created in the uterus, which allows excess elements to come out.

The procedure lasts from twenty minutes to half an hour and is carried out only in a medical institution by experienced personnel.

Vacuum cleaning of the uterus is a gentle method of cleaning

Cleansing the uterus using a vacuum pump is the most painless method of cleaning for a woman who has just given birth.

Manual (mechanical) cleaning of the uterus

If a small number of blood clots are found in the uterus after childbirth, the doctor may try to get rid of them without surgery by pressing his hands on the patient's stomach. In other situations, manual (mechanical) cleaning of the uterus is prescribed.

The process of manual cleaning of the uterus is performed using a special obstetric instrument - a curette.

All preoperative measures for manual cleaning of the uterus are identical to those for vacuum cleaning. The very process of cleansing the organ is carried out using a special obstetric instrument - a curette. Sometimes an obstetric curette can be serrated. The procedure for manual cleaning of the uterus does not last long, usually no more than twenty minutes. During the operation, blood clots are scraped out, after which a new healthy mucous layer grows in the uterus.

Three days after giving birth in the maternity hospital, I had an ultrasound scan, which also revealed the presence of a small amount of blood clots. The obstetrician-gynecologist and part-time uzist began to clean the clots with my hand, the second pressing on my stomach. This manipulation did not last long - about 1–1.5 minutes. It was painful and uncomfortable. Immediately during the procedure, several clots came out. I was left in the hospital for one more day. The next day, the procedure was repeated, after which several blood clots came out again. Then I was again checked for ultrasound, they said that everything was fine, and they let me go home. I managed such a mini-cleansing in the maternity hospital, rejoicing that I did not have to undergo a full-fledged operation.

Video: how the uterus is cleaned by the doctor's hand

Lavage (washing) of the uterus

Lavage (washing) of the uterus is a procedure performed after childbirth to cleanse the body of the uterus from unexpired blood clots or particles of membranes.

A special thin tube is inserted into the uterine cavity, through which an antiseptic solution is injected:

Lavage of the uterus is carried out by two main methods:

self washing. A rubber tube is inserted into the genital tract, through which antiseptic preparations are poured into the uterine cavity. The contents of the uterus pour out spontaneously. For the best effect of the procedure, an ice pack may be applied to the abdomen;
aspiration method. A silicone tube is attached to the complex for intravenous injection, through which a disinfecting cold liquid is poured into the body of the uterus. Removal of blood clots and fluid is performed using an electric aspirator.

The washing itself goes through the main stages:

The patient's genitals are treated with an antiseptic.
A speculum is inserted into the vagina and the cervix is found.
In order to achieve the best washing effect, a tube is inserted as deeply as possible into the uterine cavity.
A cooled antiseptic solution is injected into the uterine cavity under a slight pressure to make a jet. Such washing lasts no more than 25 minutes.
The pressure of introducing the solution is reduced and the procedure is continued for another 100-120 minutes.

To achieve the maximum effect, it is necessary to carry out up to 4-5 washing sessions. It all depends on the degree of clogging of the uterus. With a small number of blood clots, one session may be enough.

For lavage, antiseptic preparations are used:

Novocain or Lidocaine is used as an anesthetic. In one washing session, about three liters of fluid is poured into the uterine cavity. The solution of antiseptics must be cooled to 5 ° C, which creates an additional effect of reducing sensitivity. After the procedure, to exclude the development of complications, patients are prescribed an antibiotic.

Consequences of cleaning the uterus

If the doctor has prescribed a cleaning of the uterus, then the procedure is mandatory, because complications will come not because of the cleaning, but because of the refusal to undergo it. After the operation, the endometrium (the inner lining of the body of the uterus) will gradually recover. The uterus will be covered with a new healthy layer of epithelium.

However, the consequences of cleaning the uterus cannot be completely ruled out. In some cases, there may be:

uterine bleeding. Such a phenomenon after cleaning occurs infrequently. It usually affects those women who previously had problems with blood clotting;
hematometers - retention of liquid blood or blood clots in the genitals. Such a pathology after cleaning is quite rare and occurs due to severe clamping or spasm of the muscles of the cervix or vagina. To avoid hematomas, obstetrician-gynecologists can prescribe Aspirin or No-shpu. These drugs help relieve muscle spasm, providing free cleansing of the female genital organ;
endometritis - inflammation of the inner layer of the uterus. It can occur due to the penetration of bacteria and microbes into the wounded surface of the uterus. To exclude the occurrence of endometritis, it is necessary to drink a course of antibiotics.

With proper and delicate cleaning, the risk of negative consequences after the procedure is reduced to zero. Therefore, do not be afraid of the operation and its consequences. Agree to the intervention of doctors.

Folk ways to clean the uterus after childbirth

You can speed up the recovery of the female genital organ with the help of herbs that help stabilize the hormonal background and contractions of the uterus. The action of such herbs stimulates muscle tone and improves immunity.

Drinks that help cleanse the uterus include:

nettle infusion. Nettle is very popular as a folk remedy because of its availability. To prepare the infusion, pour 5 tablespoons of dry nettle into 500 ml of boiling water and let it brew until cool. You can drink liquid half a glass up to 3-4 times a day. Nettle promotes uterine contractions, and also has an anti-inflammatory effect;
Nettle extract has an anti-inflammatory effect
infusion of young birch leaves. It must be prepared from young May birch leaves. The tool has an antiseptic effect, and also helps to increase the tone of the uterus. To prepare the infusion, pour 3 tablespoons of crushed leaves into 600 ml of boiling water and let it brew for about three hours. The chilled drink must be filtered and taken 200 ml 3 times a day. You can start using such a tool only two weeks after childbirth;
infusion from a shepherd's bag. It promotes uterine contractions after childbirth, stimulates blood circulation and has an invigorating effect. It is necessary to pour 30 grams of grass into 600 ml of boiling water and let it brew until cool. After the drink, strain and drink half a glass 3-4 times a day;
viburnum juice. For the preparation of the product, you must use only fresh berries. Juice should be drunk immediately after preparation, without leaving the next time. To increase the tone of the uterus, you need to drink 3-4 tablespoons of fresh viburnum juice per day.

In addition to herbs, the tone of the uterus and the removal of clots contribute to:

moderate physical activity;
frequent emptying of the bladder.

How to avoid cleaning the uterus after childbirth

When I was in the hospital, I was advised to go to the toilet frequently to urinate and to do reasonable exercise to stimulate the removal of clots. To activate uterine contraction, an oxytocin drip was placed. After discharge, he was prescribed to drink a course of pepper water extract (highlander pepper herb), which increases the tone of the uterus, stimulating its contractions. I took orally 30 drops 4 times a day 30 minutes before meals. The course of admission was 5-7 days.

The release of blood clots after childbirth is normal and even necessary. However, if there are few clots or, according to the results of an ultrasound scan, a woman has seen stagnation of blood clots, certain actions can be performed that contribute to the release of excess blood and help in some cases to avoid cleaning the uterus:

apply cold or ice to the stomach;
breastfeed your baby more often and longer. This contributes to the production of the hormone oxytocin, which leads to uterine contractions;
actively move, perform acceptable physical exercises that are allowed for new mothers;
lie on your stomach;
empty your bladder more often.

After a caesarean section, there may also be problems with the removal of blood clots from the uterus, since:

physical activity is contraindicated;
breast milk may come slowly.

Therefore, young mothers who have undergone CS are prescribed injections or oxytocin droppers even in the maternity hospital.

After pregnancy, bearing and giving birth, the mother's body should return to normal. A certain period of time is needed for the reproductive organs to be cleansed, the discharge to stop, blood clots and tissue remnants to come out. If this does not happen, rotting will begin in the uterine cavity, creating a favorable environment for the development of pathogenic flora.

Under certain conditions, there is a need for scraping. After childbirth, the uterus is cleaned if there are prerequisites: blood accumulates, particles of the child's place remain in the uterine cavity or on the walls of the organ, and blood clots do not come out. And after a caesarean section, this procedure is necessary, since the placenta has to be removed mechanically. Even microscopic parts of the placenta are perceived by the reproductive organ as foreign, and the body is set to remove them. Blockage of the vessel with a clot after a while can lead to severe bleeding.

Curettage after childbirth is performed by vacuum or mechanical means. With a sufficiently long birth, the mother's strength runs out, and the uterus does not contract sufficiently intensively so that the fetal membranes of the placenta are completely separated from it. Sometimes the fetal egg is too strongly attached to the walls of the organ, and the afterbirth has to be separated manually.

After the birth of a child, a woman in labor remains in the delivery room for another two hours, where her condition, the presence or absence of blood loss, and the dynamics of uterine contractions are assessed. After examination in the chair with the help of a gynecological mirror and ultrasound of the uterus, the doctors, having discovered a pathology, decide on cleaning.

Sometimes curettage is done on the same day, in other cases, the condition of the young mother is monitored and an ultrasound scan is performed on the 5th day after birth. According to its results, it is determined whether the process of reduction and purification is normal or cleaning is required.

The manipulation lasts about half an hour. A woman is given local or general anesthesia, the genitals are treated, the cervix is dilated, and the functional layer of the endometrium is scraped out with a curette. It is able to regenerate: after a certain time, a new intact mucosa is formed from its lower layers, and the uterus is again ready to “work”.

The technique for performing the procedure is the same as curettage for an unwanted pregnancy or curettage for diagnostic purposes.

During the operation, mechanical manual cleaning of the uterus from the functional layer of the endometrium, particles of membranes and blood clots is performed.

Cleansing of the woman in labor is controlled by doctors, the postoperative period is under close supervision. They monitor the pulse, body temperature, discharge, well-being, since curettage is a painful procedure, after which the uterus is an open wound. She needs antiseptic treatment and daily care. The preparations prescribed by the specialist will help to finally clean the birth canal.

Vacuum cleaning of the uterus

For this, a special device is used - a vacuum pump equipped with aspiration tips. Negative pressure is created in the cavity of the organ and the contents are brought out.

The vacuum method involves manual and machine scraping. The first is the most common and includes:

Treatment of the external genitalia.
Insertion of a speculum into the vagina.
Preparation of the cervix.
Insertion of a suction tube.
Removal of tissues by rotating the tube or diagnostic sampling of material for research.

Vacuum cleaning is shown:

if, after childbirth or caesarean section, the placenta or part of it remains in the genital organ;
as a result of spontaneous miscarriage with incomplete exit of embryonic residues;
after an abortion;
for the study of biocenosis;
with cystic drift;
severe uterine bleeding.

This method of curettage is more gentle than mechanical, since injuries to the uterus, cervical canal and endometrium can be minimized.

Purging after a caesarean section

If cleaning the uterus after childbirth is a frequent occurrence, then the doctor should prescribe curettage after a cesarean section with caution and taking into account the state of health of the woman in labor. The body after the operation recovers longer, the incision made violates the integrity of the muscle tissue, and the genital organ contracts worse. Only by the end of the second week after the birth of the baby, its size and shape are restored, and the stitches heal even longer.

Women who had to undergo a caesarean have more postpartum complications in the uterine cavity.

On the 3rd day after the procedure, an ultrasound is done, the integrity of the suture is studied. If there is intense pain, an unscheduled ultrasound examination is performed to assess the condition of the postoperative scar. Its swelling may indicate - inflammation in the mucous layer of the uterus.

According to the doctor's indications, curettage is carried out during the caesarean section itself, this helps to avoid complications. But sometimes parts of the placenta remain inside, which is a direct reason for cleaning.

In order for the pregnancy following a cesarean section to be successful, experts recommend refraining from conception for 3 years. During this time, the postoperative scar heals, and the uterus is again ready to bear the baby.

However, sometimes pregnancy occurs earlier, and you have to make a choice: keep the baby or decide to terminate the pregnancy. Women who have had an abortion after a caesarean note that this is a big health risk, as an unformed scar can be damaged.

It should be remembered that the consequences of abortion can be infertility, infection, bleeding, hormonal disorders.

Complications after cleansing

There are potential complications after every surgical intervention. Curettage of the uterus after childbirth is no exception. One of the side effects is when blood clots accumulate in the reproductive organ. With muscle spasm, the pharynx closes, they remain inside. To prevent the accumulation of blood in the uterine cavity, doctors prescribe No-shpu to relax the muscles.

During the cleaning process, the surgeon may pierce the wall of the uterus with a sharp instrument, which will lead to its perforation. As a rule, the problem is fixed on the same day.

Late complications that develop a few days after curettage can lead to infection and further unpleasant consequences. Poor disposal of placental remnants can provoke symptoms, which are characterized by high fever, pain in the lower body, discharge with an unpleasant odor.

The condition of the uterus after curettage does not differ from menstruation: normal discharge should be moderate, without an unpleasant odor, and last about a week. Then their intensity decreases, and the bleeding stops.

Recovery

Rehabilitation after curettage should be aimed at restoring the function of childbearing, uterine bleeding still occurs, but this is a common occurrence. Slight pain radiating to the lower back indicates that the organ has begun to contract. The discharge becomes brown, and after a while - white, mucous, that is, they return to normal.

It is necessary to refrain from sexual activity until the complete healing of the surface injured by curettage. Both partners are at risk of infection, and the woman will experience pain during sex. There may be heavy bleeding due to irritation of the vagina.

You should adhere to a healthy lifestyle, follow medical prescriptions. You can not take baths, douche, go to the bath and sauna, use tampons, lift weights.

Treatment

Therapy after curettage of the uterine cavity involves taking medications. They do not build up the endometrium, but prevent infection, improve a woman's well-being. Antispasmodics are prescribed with caution, as they contribute to uterine contraction, which is accompanied by severe pain, especially immediately after cleaning. In severe cases, No-shpa is indicated.

Antibiotics are prescribed necessarily: they help to avoid infection. The microflora of the vagina is restored with the help of antifungal agents in the form of tablets and suppositories. You can use herbal decoctions and infusions: shepherd's purse, nettle, hogweed, viburnum, lemon balm.

Hormonal drugs help restore balance in the body and prevent the recurrence of the disease.

In addition to these drugs, they take enzymes that prevent the formation of adhesions.

A prerequisite is an examination by a gynecologist and re-testing to avoid relapse. It is not worth planning a pregnancy in the next six months of treatment. should be with a condom and only after a control examination by a female doctor.

Childbirth occurs in three periods: contractions, the birth of the fetus and the birth of the placenta. The afterbirth is the placenta and fetal membranes in which the fetus is located. After the birth of the placenta in the uterus, its remnants should not remain, as well as blood clots attached to its walls or blocking the outflow of secretions, the cleansing should be complete. All these tissues will rot in the uterine cavity after childbirth, and creating a nutrient medium for numerous opportunistic and pathogenic microflora living on the surface of the body.

Blood clots remaining in the cavity can interfere with its cleansing after childbirth - the removal of lochia from its cavity - postpartum discharge. A blood clot can also clog a vessel in the wall, and then come off after a while, which will cause severe bleeding. Such bleeding can begin suddenly even a month after childbirth.

In order to prevent such consequences, they clean (scrape, curettage) the uterus after childbirth. If parts of the placenta and membranes remain in its cavity, curettage is carried out immediately after childbirth or within a day after them. If there are blood clots in the uterus that interfere with the cleansing of its cavity, curettage is carried out according to the indications, depending on the condition of the woman, but not later than the first week after childbirth. The presence of indications for curettage in modern clinics is confirmed by ultrasound (ultrasound).

The operation is simple, but painful, so it is performed under anesthesia. The doctor scrapes the uterine mucosa with a medical instrument (curette), removing its upper functional layer along with the remnants of the birth tissues. Sometimes vacuum cleaning is performed followed by ultrasound control.

Important! if the doctor considers it necessary to clean, the woman should not refuse it!

The main criteria for the success of the cleaning of the uterus

The success of the operation of scraping after childbirth is evidenced (it is worth remembering!):

the absence of a significant increase in the body temperature of the puerperal (the norm is up to 37.5˚);
no bleeding, moderate spotting for several days (sometimes up to a week) is considered normal, they gradually turn brown, and then brighten; discharge does not have an unpleasant odor;
soreness in the lower abdomen - it gradually decreases, but persists until the uterus is completely contracted;
the general condition of the woman is satisfactory, but slight dizziness may disturb; All these symptoms indicate that the cleansing is proceeding correctly.

It is important to pay attention to the following symptoms and report them to your doctor:

increased bleeding;
complete absence of secretions in the first days after cleansing with a simultaneous increase in pain; this indicates a violation of purification;
discharge acquire an unpleasant putrid odor - a sign of infection;
the temperature rises to 38˚ and above.

How is rehabilitation and recovery going?

For some time (4-6 days) after cleaning, the puerperal is in the hospital under the supervision of a doctor. He conducts a daily examination for the timely detection of possible complications. Medical treatment is prescribed:

drugs to reduce the uterus - this is the prevention of re-bleeding;
antibiotics - to prevent the development of infections.

If the rehabilitation period is normal, the woman is discharged 5-6 days after the cleaning, and further monitoring of her condition is carried out by the doctor of the antenatal clinic. Allocations after curettage (as well as after childbirth) last about 6 weeks, gradually brightening and decreasing in volume. Two months after the birth, there is a complete cleansing and recovery.

Complications and consequences after curettage of the uterus

As with any other surgery, complications are possible. Complications may be early or late. Early complications include:

bleeding in case of damage to the vessel located in the wall of the uterus; in this case, profuse bleeding can be from the genital tract, or it can manifest itself in the form of hemometers - accumulation of blood in the uterine cavity due to the closure of the exit from the cavity; for the prevention of hemometers, antispasmodics are prescribed - drugs that relieve spasm of smooth muscles;
perforation (violation of integrity) of the uterine wall with a sharp instrument - a small puncture can heal on its own, and a large one is sutured; unpleasant consequences, as a rule, do not happen.

These consequences are eliminated on the operating table or during a second operation during the first day. In modern clinics, there is every opportunity to cope with such consequences.

Hormonal disorders and failure of the menstrual cycle can be a consequence of too deep scraping of the walls, when not only the upper functional (restoring) layer of the endometrium is removed, but also the lower, basal, which cannot be restored. This complication can be treated with great difficulty and most often it becomes the cause of infertility.

Natural childbirth is a rather difficult and long physiological process that requires a lot of strength and patience from a woman. It can be conditionally divided into several stages: the onset of labor, the birth of a child and the birth of an afterbirth. The appearance of the shell in which the fetus developed is the completion of the birth processes: it depends on its integrity whether cleaning will be carried out after childbirth, or, in medical terms, postpartum curettage.

You should not be afraid and, moreover, refuse this procedure: first of all, specialists will definitely examine the condition of the uterus, and find out the validity of the curettage. In order to more accurately understand the meaning of such an action as cleaning after childbirth, a woman should have at least a general idea of \u200b\u200bthe reasons for the need for curettage, as well as the consequences of refusing it.

Scraping - cleaning help to the body

It must be said that the well-known expression: “Man is a social animal” finds confirmation in all manifestations of human life, from the moment of conception to death. The process of childbirth is no exception: in the wild, the birth of any animal is governed by the principles of natural selection, and only human children are born under the supervision of medical specialists. It is thanks to the institution of obstetrics that many women maintain their health, the possibility of re-conception, and sometimes their lives (not to mention the health and life of their child) - and therefore one should trust the professionalism of people who are called to protect the life and health of their patients. Believe me: without proper reason, cleaning the uterus after childbirth is not carried out - especially with such a level of medical diagnostics as it is today.

The fact is that the integrity of the placenta can be violated for some reason: the exfoliation of the amniotic membranes and placenta from the tissues of the uterus may be incomplete - particles of the baby placenta can remain on the walls of the uterus or in its cavity, causing many diseases.

Subinvolution of the uterus occurring after childbirth

First of all, the pieces of tissue (or blood clots) that linger in the uterus undergo decay, becoming an ideal breeding ground for bacteria and viruses - and this can already lead to necrosis of surrounding tissues and blood poisoning, not to mention inflammatory processes of varying severity.

In addition, even microscopic particles of the afterbirth, being in the uterine cavity, are perceived by the body as foreign - and therefore the body seeks to get rid of them, spending its (already depleted) protective resources. As a result, the recovery postpartum period is delayed, which increases the possibility of infection of the genital organs, and the return of a woman to her normal rhythm of life is postponed indefinitely.

In order to avoid such postpartum complications, vacuum or manual (scraping) cleaning is carried out after childbirth.

If you allow yourself a figurative comparison, then the work of a gynecologist, in this case, can be compared with the services of a cleaning company. Any hostess is able to maintain order in the house, but sometimes it is difficult to cope with the consequences of especially violent parties or visiting too “liberated” guests alone. Then professionals come to the aid of cleaning, who will quickly and efficiently restore perfect order and sterile cleanliness: there will be no trace of food leftovers, crumbs in the cracks, dirty shoe prints, which means that the threat of “invasion” of cockroaches and microorganisms harmful to health will disappear. .

The process of postpartum cleansing and its consequences

It should be noted that in the case of a caesarean section, curettage is carried out much more often, and in some clinics it is considered a mandatory procedure. This order is due to the fact that labor activity during cesarean section is smoothed out (or completely absent) - and therefore the natural separation of the placenta does not occur. Of course, in the uterine cavity, after removing the child from it, there are multiple remnants of the fetal membranes - and they pose a threat to the health of the woman.

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As for natural childbirth, the statement is popular in the obstetric environment: the average woman gives birth twice in one visit to the maternity hospital (and multiple pregnancy has nothing to do with it). In fact, the exit of the placenta is comparable to the birth of another child - the mechanism of the process is the same.

However, if the birth lasted a long enough time, then the woman may simply not have the strength for the final attempts - which means that the intensity of uterine contractions may not be enough to fully separate the fetal membranes of the placenta from the uterine tissue. Too strong attachment of the tissues of the fetal egg to the walls of the uterus can also complicate the situation. In both cases, the doctor taking delivery has to separate the placenta manually: the result of such an intervention may be pieces of fetal tissue, as well as blood clots remaining in the uterus.

To exclude the possibility of incomplete cleansing of the uterus from foreign residues, a woman is examined in a gynecological chair using mirrors, and an ultrasound of the uterus is also done - and if a pathology is detected, curettage or vacuum cleaning of its inner layer is prescribed.

A planned cleaning operation lasts about 20 minutes and is carried out using local or general anesthesia, in compliance with all surgical standards, including the rules of asepsis and antisepsis.

Specialists, with the help of obstetric devices, dilate the cervix, and then scrape out the functional layer of the uterine surface with a special curette. The peculiarity of this tissue (endometrium) is in the ability to regenerate: a new uterine mucosa is formed from the lower layers of the endometrium, which does not have the slightest damage - and the functionality of the uterus is restored.

Fast recovery guarantee

As a rule, cleaning after CS and ordinary childbirth practically does not differ in the method of implementation. The rehabilitation period in both cases is also almost the same - it lasts about 2 weeks (unless, of course, the birth canal was damaged in the case of orthodox childbirth). The first days after the cleaning, the woman should be under strict medical supervision - the doctor monitors the symptoms of the recovery process: body temperature, pulse rate, abdominal pain on palpation - according to these parameters, the specialist can draw the correct conclusion about the patient's condition and her readiness for discharge.

Solving the problem of how to go to the toilet for a woman after childbirth

Medicines prescribed during this period contribute to the speedy recovery and stop the development of inflammatory processes: as a rule, these are no-shpa and antibiotics. Naturally, for this time you should refrain from breastfeeding - and for this you will need to express milk.

An important role in the rehabilitation period after cleansing is played by the observance of certain restrictions: at this time it is recommended to refrain from vaginal sex, swimming in any water bodies (including taking baths), visiting baths and saunas - the risk of pathogens entering the uterus is too high. In addition, at this time, you should avoid lifting weights over 3 kg and limit the intensity of sports, as such actions can provoke bleeding.

Childbirth takes place in two stages - the birth of the child and the release of the placenta. If the child's place did not come out on its own, there are suspicions that parts of the placenta, fetal membranes remained in the uterus, so scraping or vacuum cleaning is indicated. This is a simple but rather painful procedure, as a result of which it is carried out after preliminary anesthesia immediately after childbirth, during the next day, the first or second postpartum months. Why you can not do without cleaning, and what complications are possible after it?

In what cases is cleaning necessary after childbirth?

It happens that during childbirth, the placenta comes out partially or completely remains in the uterus. In this case, the obstetrician immediately decides on manual curettage of the uterine cavity or performs vacuum aspiration in order to clean the muscular organ. Before discharge from the maternity hospital (for 3-5 days), young mothers undergo a control ultrasound.

The reasons why parts of the placenta remain in the uterus are the low activity of the walls and the bending of the muscular organ. When the examination shows the presence of blood clots and placental remnants, signs of an inflammatory process, a cleaning is also performed. The young mother remains in the hospital for another 1-2 days.

Failure to timely curettage will sooner or later lead to hospitalization. This is fraught with the following consequences:

uterine bleeding with a drop in hemoglobin levels, weakness, inability to care for the baby;
inflammation of the endometrium;
sepsis - a common infection of the blood, which leads to infection of the uterus.

The best time to cleanse is right after giving birth. However, it also happens that it is prescribed 6-8 weeks after natural delivery or caesarean section due to the appearance of spotting or bleeding.

Cleaning technique

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Cleaning the uterus after childbirth, while its pharynx is open, is the optimal period for intervention. In this case, manual cleaning is possible, which involves instrumental scraping under anesthesia. In some cases, vacuum aspiration is performed. After such a procedure, a young mother lingers in the hospital for 1-2 days.
If the obstetrician is sure that after the birth the baby's place came out completely, a heating pad with ice is placed on the stomach. Then every day in the clinic they give intramuscular injections of oxytocin. The substance provokes active uterine contractions, allowing the organ to quickly return to the prenatal state. In this case, the doctor feels the stomach every day and is interested in the volume of postpartum discharge. A control ultrasound before discharge shows whether curettage is necessary.

If, according to the results of the control ultrasound, cleaning after childbirth is necessary, the woman stays in the hospital for a couple of days. The algorithm for the procedure is no different from an abortion:
the use of general or local anesthesia;
treatment of the external genital organs with antiseptics;
mechanical expansion of the cervical canal;
gentle removal of clots and parts of the placenta from the uterine cavity using a sterile curette.

The uterus is cleaned for no more than 15-30 minutes; a young mother gradually recovers from modern anesthesia, without headaches and other side effects. To increase uterine contractility, injections of oxytocin or similar drugs are indicated. Bleeding should not be normal, only lochia. The volume of secretions will gradually decrease, over time they turn pale.
In a public maternity hospital, the cost of cleaning is covered by compulsory medical insurance. In a private hospital, you will have to pay from 7 to 20 thousand rubles for the procedure. (depending on the level of the institution, the anesthesia and drug treatment used in the recovery period).
Cleansing of the uterus can be replaced by washing, which begins the day after delivery. The course includes 3-5 procedures. The task is to remove the remaining clots and carry out an antiseptic treatment of the cavity of the muscular organ. Manipulation is carried out under local anesthesia after the cervix is exposed using mirrors. Lavage is carried out in two ways:
Aspiration. A silicone tube is connected to the intravenous infusion system, through which a washing solution (antiseptic, enzyme, antibiotic, anesthetic) is pumped into the cavity. Extraction of contents is carried out using an electric aspirator through an expanded channel.
By gravity. Instead of a silicone tube, a rubber catheter is used. The contents of the uterine cavity comes out by gravity.

The rehabilitation period and ways to speed up recovery
The recovery period after curettage is about 2 weeks and coincides with the rehabilitation period after delivery. The condition of a young mother is controlled by a doctor, his task is not to miss the onset of the inflammatory process.
During recovery, anti-inflammatory, painkillers, antispasmodics and other drugs are indicated. The doctor selects the type of medication, their dosage and course of administration individually. The weakened state of the patient after childbirth, the level of hemoglobin in the blood, and general well-being are taken into account. During the period of therapy, breastfeeding is temporarily stopped. Lactation is stimulated with breast massage and pumping. This will help to quickly establish feeding the baby after discharge from the hospital.

In order for the recovery process to be successful, the young mother should take into account the following recommendations:
do not visit the sauna, bath, do not take a bath for 3 months;
observe the rules of intimate hygiene;
avoid swimming in open water;
do not use tampons, only pads that need to be changed regularly;
exclude intimacy and physical activity for 1.5 months.

If cleaning is carried out correctly and in a timely manner, complications can not be afraid. The main thing is to follow the recommendations of the doctor and be sure to undergo a follow-up examination.
Possible complications after curettage
The main criteria for a successful curettage:
no inflammatory process. what is confirmed by the results of ultrasound;
normal body temperature, which does not rise above subfebrile values (37.5);
the general satisfactory condition of the young mother, slight dizziness and weakness are possible as a result of the interventions;
pulling mild pain in the lower abdomen, which gradually disappears;
the absence of scarlet spotting, normally lochia may be present - slight discharge, which eventually becomes paler and completely disappears in 6 weeks.

Complications and the need for additional medical intervention are indicated by:
severe uterine bleeding, in which sometimes it is necessary to make a decision about the extirpation of the uterus;
hematometer - the absence of lochia after cleaning (indicates a poor-quality operation and accumulation of secretions in the organ cavity);
decreased contractility of the uterus;
an unpleasant smell of secretions is a sign of tissue infection;
high body temperature, febrile condition.

The doctor performs curettage after cesarean section especially carefully, taking into account the fact that the integrity of the muscular organ is broken. For this reason, the uterus recovers more slowly, contracts worse. She returns to her previous state 2 weeks after birth, and the sutures heal a little longer.

Ultrasound on the 3rd day after surgery allows you to assess the condition of the muscular organ. Swelling of the postoperative scar may indicate endometritis, which is treated with medication. Despite the fact that doctors thoroughly clean the uterine cavity during a caesarean section, sometimes ultrasound shows the presence of clots. If particles of the placenta or proliferation of the endometrium are found, they are cleaned under anesthesia. The next pregnancy is recommended to plan after 3 years.
Poor-quality curettage can lead to health problems in the future. It negatively affects the further ability to bear children, leads to adhesive processes in the pelvic area. Subsequently, there may be difficulties with conceiving and bearing a baby, hormonal imbalances that lead to fibroids, cysts and other gynecological pathologies.
No one is immune from complications during manipulations. To reduce the risk of their occurrence allows the operation by an experienced doctor with the help of modern equipment. In this case, the endometrium will quickly recover, and a new pregnancy is possible in the next ovulatory cycle. During lactation, it is difficult to miss, and if the spouses do not plan children, it is better to take care of the means of protection.

Once, having read frightening stories of experienced mothers on the “Internet” forums about the special cleansing after childbirth, I myself came to a disappointing conclusion: the less you know, the better you sleep. However, then, after a little thought, I realized that such information received simply from the forum is catastrophically insufficient for my sound and restful sleep. It is quite natural that the cleansing necessary after childbirth is an unpleasant manipulation, and it also hurts that this is a kind of ending to the most important and tremulous moment in the life of any woman. And in fact, all those women who once experienced such a state are sometimes unable to restrain their emotions, which is precisely why their stories may well be regarded as "horror stories" called "only, not for the faint of heart." We will add at the same time: these stories are not for pregnant women.

But in order not to be afraid of such a postpartum cleansing at all and not even think about it (after all, the fact that you read this article does not mean at all that you will need one specifically), you need to try to get as much high-quality reliable and medical information about such a cleansing as possible, and not at all information "from the personal experience of an experienced and already frightened mother."

When may it be necessary to clean after childbirth?

Doctors jokingly say that every woman always gives birth twice (meaning for one visit to her maternity hospital): first a baby, and then the placenta itself (or placenta), in which the baby was all the long nine months of pregnancy. Many of the women do not even notice the birth of the placenta, because at this very time they are already actively examining their baby, who quietly buried his very small nose into the warm mother's chest. However, this is not always the case, and, of course, this is to our great regret. Sometimes it also happens that it has “grown” too tightly to the uterus and is born, as they say, “partially” or cannot come out at all. But in fact, in such cases, doctors should perform a manual separation of the placenta or placenta, which, among other things, should always be carried out after the cesarean section.

As a rule, immediately before discharge from the maternity hospital (and this is on the 2nd or 3rd day), each woman who has given birth is given a scheduled diagnostic ultrasound. This is necessary in order to timely assess the condition of the entire internal cavity of the uterus after childbirth. And if the doctor, during such a study, finds traces of the placenta or placenta in the uterine cavity, or maybe just blood clots, then such a woman in labor is prescribed postpartum cleansing.

How is postpartum cleansing done?

"Purge" in the modern "medical language" means banal as when performing an abortion. This procedure may well be familiar to all those women who have had an abortion at least once in their lives. As you understand, curettage from the mucous membrane of the uterus of a woman is a special operation in which a purely mechanical removal of a certain functional layer of the uterus is usually performed. And from the germ layers of the same endometrium, soon after such scraping, a completely new healthy mucous membrane will grow.

Most often, they try to carry out such cleaning only under general anesthesia and, of course, in a standard gynecological chair. Immediately before such an operation, all external genitalia must be treated with an ordinary alcohol solution of iodine, but only 5%, but the vagina, and the cervix, are treated with a 50% solution of ethyl alcohol. Further, with the help of previously introduced dilators of various diameters, they try to expand and remove all remnants of the so-called placental tissue directly into the cervical canal. Moreover, such removal is usually carried out using a special blunt curette, and sometimes with the help of an obstetric curette with special teeth. This operation usually takes no more than twenty minutes.

How should you behave immediately after cleaning?

We note right away that immediately after such a cleansing, a woman will necessarily have to be under the strict supervision of doctors who will monitor her body temperature, pulse rate, and, of course, the secretions that appear from the genitals. In addition, at least twice a day, a woman should treat her external genitalia with special antiseptic solutions.

Immediately after such an operation, it will not be possible to use ordinary vaginal tampons, douche, take a hot bath, visit saunas or baths, lift any weights, and even play sports, and this ban will last for two whole weeks. Vaginal sex will also be contraindicated at this time, and this is a ban, only due to the fact that the woman’s cervix itself will remain open all this time, and quite a lot of erosion will be observed directly on the mucous membrane of the walls of the uterus. And this, as you understand, can become truly favorable conditions for the acute development of any infections that your sexual partner can “bring” to you.

But for the prevention of inflammation, and other real complications possible after such a cleaning, a woman is prescribed antibiotics. It should be noted that the scraping procedure itself is quite painful, which is why even in the postoperative period a woman may experience some pain, and always of varying intensity. In this period, you may well be prescribed a drug such as no-shpa, this is only necessary in order to prevent the sudden development of hematometers (a condition when blood clots linger in the uterine cavity).

What complications can occur after cleaning?

Actually hematometra - this is just the same and there is the most common complication after not entirely successful curettage. This condition may well arise due to too much compression (or spasm) of the woman's cervix itself, which subsequently will cause such a delay in blood clots directly in the uterine cavity. And it is worth remembering that a too quick cessation of any bleeding after childbirth is the most important symptom of the occurrence of hematomas. But in order to be able to support your cervix in a completely relaxed position, doctors prescribe the usual No-shpa, as mentioned a little earlier.

We go further, another common complication of such postpartum cleansing is heavy uterine bleeding, but we hasten to reassure you, they are really extremely rare (and mostly only in those women who have some violations of normal blood clotting). In cases of penetration directly into the uterine cavity of any microbes after such a postpartum cleansing, such a dangerous disease may well arise as an infectious inflammation of the entire mucous membrane of the uterus itself.

It is worth noting that all of the above complications, of course, will require a strictly defined adequate and timely treatment from a woman, which, by the way, can only be prescribed by an experienced gynecologist treating you. And “ideally” it would be after such a cleansing for literally a few hours that there would be quite abundant spotting, which would be with blood clots, and that they would soon become less and less abundant. In addition, after such a curettage, for at least ten days, rather meager, as if smearing, bloody, possibly brown or even yellowish discharge from the vagina should be observed.

As we can see, the very procedure of cleaning after childbirth is not at all so scary, especially if you follow some fairly simple rules of your personal hygiene and strictly follow the instructions of your doctor. Therefore, it is definitely not worth worrying about this procedure! After all, it is quite possible that in your particular case, everything will do without it!

It is not difficult to guess how much anxiety and excitement expectant mothers experience during pregnancy and on the eve of childbirth. The stories of friends who have already gone through the maternity ward are sometimes like retelling a horror movie. And if cleaning the uterus after childbirth with a huge metal spoon is mentioned, then some have a desire for this pregnancy to miraculously resolve.

Sometimes one gets the impression that everyone without exception will have to go through this execution after giving birth. Is it so?

Childbirth is a physiological process

Knowledge of the physiology of childbirth, the sequence of their stages, greatly reduces the feeling of fear and anxiety before the upcoming visit to the maternity hospital. The X hour will come, and labor will begin, regardless of your emotions. Of course, they will flow much more comfortably if the fear of the unknown gives way to the expected situations.

Childbirth consists of three stages:

disclosure period. The period of opening the cervix is the longest - about 8-12 hours. Usually in primiparas it is somewhat longer than in multiparas. It starts with the first regular contraction and ends with the full opening of the cervix. The fetus at this time descends with its presenting part (and in 95% of births this is the head) to the pelvic floor. With the end of this period, the fetal bladder bursts, and light amniotic fluid pours out.
The period of expulsion of the fetus, or the pressing period. The muscles of the pelvic floor are rich in nerve endings, so irritation with their head causes attempts - involuntary contractions of the striated muscles of the body. The duration of attempts does not exceed 2 hours. From the moment they begin, the midwife will ask you to go to bed, and during the insertion of the head, she will offer you to go to the birth table in the delivery room. From now on, dressed in sterile clothes, she will be at your feet. Listen carefully to the commands of the midwife - it is she who is now managing the birth. It is she who is destined not only to be the first to see the birth of your baby, but also to provide him with some help in this complex process and protect your birth canal from tears that the baby can cause you. She will cut the umbilical cord, show your long-awaited baby, and put it on you for a closer acquaintance and the first attachment to the breast. The second period is over.
Follow-up period. The third stage of labor has begun. It seemed that everything was over, but it was during this period that complications could occur that would require the very cleaning of the uterus. The follow-up period lasts up to 30 minutes. The midwife takes care of your baby, performing the first toilet of a newborn, tells you his height and weight, puts bracelets on your hand and the baby. Not gold or silver - just pieces of oilcloth with the date, time of birth, gender, weight and height. Childbirth continues to lead the doctor. In the third period, through contractions, the placenta should separate from the wall of the uterus and the placenta (baby place) should stand out along with all the membranes. It is strictly forbidden to force this process by pressing on the uterus. The doctor stands nearby and watches for signs of separation of the placenta. Seeing them, he allocates the placenta by pulling on the umbilical cord. The birth is over.

Complications 3 periods

30 minutes have not yet passed, but profuse bloody discharge appeared from the uterus, indicating that the process of separation of the placenta is disturbed. There is only one way out - manual separation of the placenta is necessary. It is performed under inhalation or intravenous anesthesia by a doctor by inserting his hand into the uterine cavity. There is no need to be afraid of this - if the child has already passed, then the doctor's hand will pass all the more.

Manual separation of the placenta is also performed when 30 minutes have passed, and there are no signs of separation of the placenta. But all these 30 minutes the doctor should not touch the uterus, press on it in order to speed up the 3rd period. Just wait for the signs of separation, and then select the afterbirth by carefully pulling the umbilical cord.

The afterbirth is subject to careful examination to establish the integrity of the placental lobules and membranes.

In case of a placental defect or suspicion of it, the doctor is obliged to perform a manual examination of the uterine cavity. Torn fruit shells are not an indication for this operation.

Early postpartum period

Yes, the birth is over, but you have to make sure that there are no gaps, that is, you have to examine the birth canal in the mirrors. The cervix is carefully examined with the use of special tools, its tears are immediately sutured. Tears of the soft tissues of the vagina are also sutured with self-absorbable subsequently threads, silk sutures are applied to the skin tears, which are removed on the 5th day.

Within 2 hours after childbirth, the puerperal remains in the delivery room under supervision:

Monitoring of well-being, pulse rate, blood pressure and the state of the uterus is carried out.
She has an ice pack on her stomach to keep the uterus hypothermic and prevent uterine bleeding.

This period is dangerous with hypotonic bleeding, which may require surgery to enter the abdominal cavity and possibly even removal of the uterus.

Uterine cleansing

In the normal course of the postpartum period, in the first 5 days after childbirth, the uterus continues to contract, its involution occurs. This is accompanied by specific secretions - lochia.

If the lochia ceases to stand out, the uterus becomes swollen like a ball, painful and the temperature may rise, then this complication is called a lochiometer. It occurs due to a spasm of the muscles of the cervical canal, the suckers meet an obstacle for excretion to the outside and accumulate in the uterine cavity. Ultrasound confirms the diagnosis.

Lochometer - an indication that cleaning is needed after childbirth. There is no such term in medical practice. Doctors say - curettage of the uterine cavity.

How is cleaning done:

After childbirth, this operation is performed with a large blunt curette - a special perforated oval spoon.
Under intravenous anesthesia, after treatment of the genitals with an antiseptic solution, the neck is exposed in the mirrors. The vagina is also sanitized with an antiseptic.
The neck is fixed behind the front lip. If necessary, the cervical canal is expanded with special dilators, after which the lochia is removed with a curette.
After the operation, uterotonic drugs, antispasmodics, antibiotics are prescribed.

This procedure is short, about 15 minutes, but it can delay discharge from the hospital by 1-2 days.

The second situation, when cleaning is performed after childbirth, occurs with subinvolution of the uterus in the postpartum period. Often an obstacle to the normal contraction of the uterus after childbirth is the presence of placental remnants in its cavity. This can happen with an inattentive examination of the born placenta, for example, you may not notice the absence of the so-called additional lobe of the placenta. Being in the uterus, it not only prevents its involution, but also contributes to the development of the inflammatory process - postpartum endometritis.

A characteristic sign of retained parts of the placenta during vaginal examination is a patent cervical canal. An ultrasound will also confirm the presence of residues in the uterus.

In this case, postpartum cleaning will have one peculiarity: the cervical dilatation step will not be needed, it will be open enough to insert the curette and remove residuals. Everything else is exactly the same as with a lochiometer.

If after cleaning the uterus contracts normally, there are no signs of inflammation, then there are no obstacles to discharge from the hospital. Another vaginal exam, another ultrasound, and get ready to drive home with your baby in your arms.

After discharge

If you are among the “lucky women” who have undergone cleaning after childbirth (and as you can see, this procedure is not done for all puerperas, but only in the presence of the above complications), you will be required to strictly observe the rules of postpartum hygiene. They are:

Washing with warm clean water at least 2 times a day.
Change pads as needed.
No tampons or douches.
No saunas, hammams, baths, steam rooms and baths. Only showers are allowed.
Vaginal sex is prohibited.
Avoid drafts and hypothermia.
Postpone heavy physical activity and intense sports for at least 2 months.
Perform daily a set of gymnastic exercises for those who have given birth.
Pool, swimming in the river and the sea is also not for you.
Eat in a balanced way. Preference for protein foods, vegetables and fruits, restriction of fatty and simple carbohydrates.
Use vitamin and mineral complexes for nursing.

I would like to believe that you got rid of the habit of drinking alcohol and smoking at least six months before the planned pregnancy. If not, do it immediately.

Visit your OB/GYN doctor 5-6 weeks after giving birth to make sure there are no abnormalities. At the same time, discuss the issues of future contraception.

As a rule, even the cleaning of the uterine cavity, which has fallen on the difficult lot of a woman, does not greatly overshadow the memories of the wonderful days spent in the maternity hospital and associated with the arrival of a baby in this world. And many then want to go back there again and again. And there are no obstacles to this. Yes, even if you had a cleaning of the uterus after childbirth, but if you followed all the doctor's recommendations, then there should be no problems in the future.

Many women are terrified cleansing after childbirth is a necessary and final procedure.

Childbirth for the female body is always a complex and rather difficult process, taking away strength and threatening with all sorts of complications. It is the cleaning of the uterus that is a medical method that allows you to eliminate many postpartum complications, clean the uterine cavity from the placenta and preserve the health of a woman for many years.

How it is carried out and in what cases it is shown, how to behave after this gynecological procedure, and will be discussed further.

Gynecological cleaning

When do you need a uterine cleansing after childbirth?

Cleaning the uterus after childbirth is an activity to clean the uterine ducts. As gynecologists themselves note, a woman in her physiology gives birth twice in one visit to the maternity hospital. So the first time she gives birth to her baby, and the second time is the placenta, in which the fetus grew and developed for all 9 months.

It is the afterbirth, which did not leave the uterine cavity in a timely manner, which can cause many complications and the reason for such a gynecological procedure as cleaning the uterus after childbirth.

According to many women in labor, they practically do not notice the exit from the placenta, because at this very moment they already hold their baby in their arms and are carried away by the first minutes of communication with him. But as the practice of doctors shows, this does not always happen - in some cases, the placenta grew so strongly to the uterus and partially left the woman's body or did not leave at all.

In the gynecologist's office for surgery

In such cases, doctors prescribe a manual method for separating the placenta - cleaning after childbirth, helps to remove the placenta completely and is indicated both after natural childbirth and after cesarean section.

First of all, to determine whether this procedure is needed or not, a woman is checked with an ultrasound scan, and if the results show the remains of blood and placenta in the uterine cavity, then postpartum cleaning is prescribed after the birth of the uterine cavity.

How to clean after childbirth

Cleaning after childbirth - for many women it sounds intimidating, but the procedure itself is necessary and important. Suffice it to say that during a cesarean section, the uterine cavity is cleaned even more often than after a natural delivery process.

Due to the fact that particles of the fetal membrane remain in the uterine cavity after childbirth - they can decompose and rot, an inflammatory process develops, which is dangerous for a woman.

The procedure is similar to the birth of a baby and the mechanism in this case is almost the same. However, if labor itself is delayed and the woman does not have enough strength to push, the intensity of contraction of the walls of the uterus decreases accordingly. As a result, the placenta does not leave completely after childbirth, and doctors have to separate it manually. But as a result, pieces of the placenta can still remain on the walls of the uterine cavity.

Consequences of postpartum cleaning of the uterus

In order to fully eliminate the negative consequences and completely clean the uterine cavity, doctors practice postpartum cleaning. First of all, a woman is examined by a gynecologist on a gynecological chair, using gynecological mirrors.

As necessary, an ultrasound of the uterine cavity is performed and, when diagnosing a pathology, a vacuum type of cleaning of the inner layer of the uterus is performed.

The very same planned operation to clean the uterine cavity lasts about 15-20 minutes, when the doctor uses a local or general type of anesthesia, observing all the norms of surgical intervention, the rules and norms of asepsis, as well as antiseptics.

A gynecologist, using special tools, expands the uterus and after that, using a special curette, scrapes the placenta layer from the walls of the uterus. The functional layer of the uterus, the endometrium, will gradually recover, as will the subsequent reproductive function of the uterus itself.