D scraping. Preparation for diagnostic curettage

Curettage of the uterine cavity (curettage) is what many women know about this procedure. It is performed for different purposes: to terminate an unwanted pregnancy, treat, diagnose gynecological and oncological diseases. When a curettage of the uterine cavity is done, the specific day of the cycle depends on the reason for which the doctors prescribed this minor surgical intervention. In the case of pregnancy, it is performed for 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 disturb it. Thus, the woman seems to start menstruating 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;
• suspected 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. 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 to which a woman exposes herself by refusing the procedure.

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

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

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

Pregnancy is possible in a shorter time. For example, if a woman is over 35 years old, and this procedure has eliminated her cause of infertility or miscarriage. But one way or another, while there is a discharge after scraping the uterine cavity, sexual activity is prohibited. That is, for about 14 days after cleaning, you need to refrain from intimacy, since it can become a provocateur of the onset of an infectious process.

One very important question remained 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, it is, but only if performed with little or no local anesthesia. Particularly painful is the opening of the cervix, although curettage of its cavity is also very unpleasant and palpable. 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, is unconscious. And after the procedure, he quickly recovers and in almost all cases he can go home on his own the same day.

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

Modern hysteroscopy opens up a lot of opportunities both from 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 an addition to classical methods of treatment, for example, curettage of the uterine cavity.

The latter option is increasingly used and is called "hysteroscopy with WFD". Hysteroscopy with RFE, what is it? The most effective diagnostic method or a universal way to treat almost all types of intrauterine pathologies? More on this later…

General concepts

Hysteroscopy with WFD (Separate Diagnostic Curettage) is an operative diagnostic method used to diagnose and surgically treat intrauterine pathologies. At the same time, hysteroscopy itself can be performed for exclusively diagnostic purposes (the so-called ""), which do not involve any surgical manipulations during the procedure and are performed under local anesthesia. But it can also include simultaneous (diagnosed) or delayed surgery.

In the latter case, the design of the hysteroscope provides an instrumental channel through which surgical instruments are inserted 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 carried out, followed by removal of the detected pathologies.

What is scraping?

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 rejected with the onset of menstruation. At the same time, the basal layer of the mucosa, which remains unchanged, with the beginning of a new cycle, begins the formation of new endometrial cells, the main purpose of which is to promote the fixation of a fertilized egg on the uterine wall.

Pathological abnormalities in the process of endometrial growth are the most common diseases encountered in gynecology. They include the following types of tissue growths that can be malignant:

• atypical endometrial hyperplasia;
• glandular hyperplasia;
• glandular cystic hyperplasia;
• endometrial polyps;
• endometrial dysplasia;
• endometriosis of the muscular layer of the uterus.

Important! The main purpose of scraping is to remove the upper layer of the endometrium (functional layer) with all the existing formations (polyps, thickenings and cysts).

The wording "separate diagnostic curettage" implies the removal of the mucous membrane of the cervical canal (cervix) and only then curettage of the uterine cavity. In this case, the removed mucosa (separately from the cervix and uterus) is sent for histological analysis in order to identify atypical cells (that is, cancerous).

Anatomical structure of the uterus

Indications

Indications for hystroscopy with WFD are the following pathological conditions:

• uterine bleeding;
• endometriosis of the muscular layer of the uterus;
• suspicion of endometrial hyperplasia;
• infertility;
• tumor processes of the ovaries;
• ovarian cysts;
• the need to monitor the effectiveness of the treatment (repeated curettage).

Depending on the goals of hysteroscopy with WFD, the timing may vary. The operation on the 5th-10th day of the menstrual cycle is performed in cases where it is necessary to examine the condition of the walls of the uterus for foreign formations. During this period, the endometrium has a slight thickness, which allows a good view of the uterine cavity and the mouth of the fallopian tubes.

Carrying out the operation 2-3 days before the onset of the next menstruation allows you to save the menstrual cycle and get a large amount of material for histological examination. With dysfunctional uterine bleeding, curettage is performed during bleeding in order to stop it, since the removal of the endometrium in the vast majority of cases leads to the cessation of bleeding until its next formation.

Training

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

Execution technique

Classical hysteroscopy with WFD is performed in a hospital under general anesthesia of the patient (anesthesia). The duration of the operation takes no more than 20 minutes, after which the patient is transferred to the ward, where she regains consciousness. The operation begins with the treatment of the external genitalia with an antiseptic solution and the introduction of an instrument into the vagina to help expose the cervix (gynecological speculum). Then, with the help of bullet forceps, the neck is fixed in a certain position, excluding its displacement in any direction, and it is scraped with the smallest curette.

After dilating the cervical canal with Hegar dilators up to 10 mm, a hysteroscope is inserted into the uterine cavity and the mouth of the cervical canal and the uterine cavity are examined. Then, using a larger curette, the entire uterine cavity is scraped, changing the curettes in accordance with the need to scrape out hard-to-reach places. At the end of the operation, the hysteroscope is reintroduced and the result is examined.

If the detected polyps or myomatous nodes could not be removed using a curette, for example, due to their deep location in the muscle layer, then their further excision is performed using a resectoscope or a laser under vision control.

Important! All removed fragments of the mucosa, polyps, etc. must be sent for histological examination to exclude the possibility of developing a malignant process.

Curette set for scraping

Alternative ways

Surgical removal of the endometrium using electrical destruction and laser ablation is no less effective. In the first case, endometrial resection is performed using a resectoscope, and in the second case, using a laser.

The initial stages of the procedure occur in the same way as with the classical method of curettage, however, the process of removing the hyperplastic endometrium itself is carried out using a loop electrode. Hard-to-reach areas in the area of ​​the mouths of the fallopian tubes and the bottom of the uterus are treated with a roller electrode.

Despite the high efficiency of endometrial removal, this method is not without drawbacks. The main disadvantage of using a resectoscope is the rigidity of the design used, which greatly complicates the removal of the endometrium from the side walls and bottom of the uterus and increases the risk of damage in these areas. It is also not uncommon for resectoscopy to damage large vessels, leading to bleeding.

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

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

Modern equipment for hysteroscopy allows doctors not to look directly into the eyepiece of the hysteroscope, all manipulations are visualized on the monitor

Effects

After the curettage at the control hysteroscopic examination, all evenly treated areas of the uterine cavity should be clearly visible. Immediately after the operation, pulling pains in the lower abdomen are considered normal, while their severity can be of a different nature. If the patient complains about the intensity of pain manifestations, then the use of painkillers in the form of tablets or intramuscular injections (Analgin, Baralgin) is allowed.

Within 3-4 days there should be slight bleeding, the absence of which may indicate the formation of a hematomere (accumulation of blood in the uterine cavity). A slight increase in temperature is also acceptable (no more than 37.2º).

As an anti-inflammatory prophylaxis, immediately after surgery, antibiotics and antimicrobials are prescribed:

• Ciprofloxacin;
• Azithromycin;
• Metronidazole.

In rare cases, spotting may occur for 2-3 weeks. Menstruation after hysteroscopy with WFD should be expected after the allotted time, considering the day of the operation as the first day of the cycle, that is, after 4 weeks. Within six months after the procedure, for further monitoring of the state of health, it is imperative to perform diagnostic hysteroscopy and ultrasound of the uterus and appendages.

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

Thus, the use of hysteroscopy with RDD, regardless of the technology used, is the most optimal way to treat endometrial hyperplastic processes that are resistant to hormone treatment and are combined with polyps, cysts, and submucosal fibroids. The method of laser ablation is extremely effective in the treatment of postmenopausal women, since during this period it is permissible to completely remove the endometrial layer in all parts of the uterus. Modern methods of anesthesia allow you to transfer the procedure as comfortably as possible.

Getting a referral for curettage becomes a cause of negative experiences for many women. The lack of knowledge about this procedure, about the features of its implementation, about the consequences and the possibility of obtaining the most informative result leads to an unreasonable fear of this surgical intervention.

The modern level of development of gynecology allows for curettage with minimal consequences for the patient's body.

What is curettage of the uterine cavity?

Scraping- this is the removal of the inner functional layer of the mucous membrane of the uterine cavity and cervical canal with a specially designed tool.

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 assigned to the WFD, or separate diagnostic curettage. It differs from conventional scraping in that sampling is done 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 massive surgical intervention to assess its volume.

Therapeutic scraping. What and how are treated with it?

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

First.

Polyps of the endometrium of the uterus and cervical canal. After removal of the entire layer of the mucous membrane, recurrence of polyps does not occur.

Second.

Cleaning when bleeding between or during periods. Removal of the endometrium prevents massive blood loss.

Third.

Curettage of the uterus in postmenopausal bleeding.

Fourth.

Adhesions or synechia in the cavity of the organ, preventing conception and the implementation of the menstrual function.

Fifth.

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

Diagnostic. What pathologies are revealed?

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

• Hyperplasia of the endometrium - thickening of the functional layer and the development of neoplasms against this background;
• Dysplasia of the mucous membrane of the cervix - the exclusion of a malignant process;
• Myoma;
• Polyps of the endometrium and cervical canal;
• endometriosis;
• Menstrual disorders.

Abortive

Artificial termination of pregnancy for up to 12 weeks is carried out by scraping 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 the fetal egg.

Other purposes of scraping

Another function of scraping is the removal of a dead fetus during a missed pregnancy. Thus, the uterus is sanitized from the source of inflammation and serious pathologies of the reproductive system.

In what cases can not scraping be done?

There are clearly marked contraindications to the manipulation:

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

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

An excessively low degree of purity of the vagina requires its sanitation using drugs with an active antimicrobial effect. Curettage can be carried out only after reaching 1-2 degrees of purity of the vagina.

An exception to these rules is the curettage after childbirth against the background of endometritis, which was caused by particles of the placenta remaining in the uterus.

Carrying out the procedure

Despite the fact that the procedure takes very little time, it requires careful preparation, high qualification of the 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:

• Determination of the presence or absence of sexual infections (hepatitis, HIV, syphilis, gonorrhea);
• Coagulogram;
• A smear to determine the purity of the vagina;
• General urinalysis and blood test.

The best time to carry out therapeutic and diagnostic 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 opening.

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 scraping;
• Do not smoke for 1-2 days before the introduction of anesthesia.

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

You can not use vaginal tablets, suppositories, have sex, 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 during this operation is performed in the form of intravenous administration of modern anesthesia. The dose is designed for 20-30 minutes of drug-induced sleep without hallucinations and discomfort.

There is a precisely defined sequence for conducting a 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 specially designed probe.

Third.

It dilates the cervical canal with metal rods of increasing thickness (Hegar dilators) until a small curette can be inserted into the cervix.

Fourth.

The gynecologist carries out curettage of 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 revise the walls of the organ.

Sixth.

With the help of a curette, the gynecologist scrapes the endometrium, collecting material for research.

Eighth.

The cervix is ​​released from the forceps, an antiseptic treatment of its external pharynx and vagina is carried out, ice is placed on the patient's stomach.

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

After the procedure

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

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

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

Do I need to use antibiotics, can I take painkillers, which ones?

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

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

How long are the allocations?

Patients are often interested in how much blood is flowing, 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 the patient had a cervical spasm after cleaning the uterus, and a hematometra (a large blood clot) formed inside the organ.

Usually this condition is accompanied by severe pain, fever and requires immediate medical attention. You can clarify the diagnosis with the help of ultrasound, which fixes 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, turns yellow, it can be concluded that purulent exudate has accumulated in the organ cavity. In this case, the woman needs urgent complex therapy for the inflammatory process.

When will the monthly cycle return?

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

If you stop contraception 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 scarce, accompanied by unpleasant symptoms, you should contact your doctor.

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

In this case, the menstrual cycle recovers much longer, and its inherent cyclicity is often disturbed. The formation of synechia (adhesions) that impede the implementation of menstrual function leads to the same complications.

When can you have sex?

It is better to postpone the 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 scraping, the cavity of this organ is a vast wound surface, extremely susceptible to infection.

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

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

In addition, a woman must strictly follow the appointments and instructions of a specialist, treat her body responsibly and carefully.

Curettage - cleansing the uterine cavity

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

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

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

Hysteroscopy of the uterus and conventional curettage

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

At the same time, traditional curettage is carried out "blindly", and this, in turn, increases the risk of violations and complications, for example, trauma to the genital organs. Hysteroscopy allows you to fully control the course of the procedure and its results.

Indications for carrying out

There is a therapeutic and diagnostic curettage of the uterine cavity. The main indications for carrying out are:

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

When do periods start after cleansing?

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

Too abundant or very meager discharge, too painful contraction of the uterus after the procedure, fever are reasons to visit a doctor. The 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 the following unpleasant phenomena can still occur:

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

Pathological bleeding

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

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

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

Discharge after cleansing

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

Pain

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

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

sexual relations

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

Also, sexual intercourse can be painful at first. If this continues for more than 2 months, it is necessary to undergo an examination by a gynecologist.

Pregnancy and childbirth after curettage of the uterine cavity

The body will be ready for conception very soon - in 2-3 weeks. As a rule, the procedure does not affect the course of the birth process.

Curettage is a therapeutic and diagnostic procedure in which the inner layer of endometrial cells is removed from the uterine cavity. The percentage of complications after curettage is low. But every woman should know how to prevent and what symptoms may indicate a complication that has begun after the procedure.

curettage

Cavity curettage (curettage) in gynecology is performed for diagnostic or therapeutic purposes. The procedure is performed on an outpatient basis, under anesthesia.

With an instrumental curettage procedure, the surface layer of the endometrium of the uterine cavity is removed, which is then examined to make a final diagnosis. Curettage is also used as an auxiliary method for the treatment of gynecological disorders.

As a diagnostic procedure, curettage is prescribed if a woman has prolonged severe bleeding from the uterine cavity. In this case, the doctor usually examines the organ with a hysteroscope, takes a scraping for histological examination, establishes a possible cause of the pathology: fibroids, polyps, malignant neoplasms.

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

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

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

In some cases, curettage of the uterine cavity is also indicated:

• To stop severe uterine bleeding.
• If, after drug treatment, polyps and hyperplasia do not disappear.
• For any bleeding after menopause.

Curettage is a minor gynecological operation, not a highly traumatic one. But after her, the woman must go through a recovery period, which includes several mandatory procedures.

Recovery period

After curettage, until the integrity of the vessels is fully restored, the uterine cavity will bleed. It is considered normal if spotting after scraping lasts from 3 to 10 days. To relieve pressure in the uterus, it is better for a woman to stay in bed for the first three to four days, exclude physical activity, and not sit for a long time.

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

Allocations

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

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

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

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

Supportive care

To relieve pain, prevent infection and possible complications is the task of the next, recovery stage.

In the recovery period, the doctor may prescribe the following drug therapy:

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

Metronidazole is most often prescribed as monotherapy, but in some cases it is used in combination with other antibiotics.

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

Salicylates after curettage should not be drunk.

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

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

What else can not be done:

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

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

Possible Complications

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

Bleeding from the uterus

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

What are the signs of bleeding that has developed?

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

This complication is classified as an emergency, and the woman needs emergency hospitalization.

Hematometer

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

A woman needs urgent hospitalization, drug therapy with antispasmodic drugs, repeated curettage.

Inflammation in the endometrium

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

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

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

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

conception, pregnancy

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

By this time, the hormonal background has stabilized, and a woman can become pregnant again. Curettage does not affect gestation and labor in a healthy woman.

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