Curettage of the Cervical Canal and Uterine Cavity

Diagnostic curettage of the cervical canal and uterine cavity involves removing the surface layer of the mucosa that lines the cervical canal and the body of the uterus. This procedure is performed for the diagnosis and differentiation of gynecological diseases. The term "dilatation and curettage" (D&C) is also used.

It's called dilatation and curettage because the scraping of the uterine cavity and cervical canal is performed separately.

Curettage of the cervical canal and uterine cavity is classified as a diagnostic procedure, as the tissue samples removed are further examined under a microscope. During the procedure, only the upper layer of the endometrium is removed. Since this layer regenerates well, there are typically no negative consequences, provided that the procedure is performed:

• by a qualified physician;
• according to a strict protocol.

The main goal of curettage is to confirm or exclude malignant degeneration of uterine tissues. For example, a curettage of the uterine cavity may be offered in cases of endometrial hyperplasia. The manipulation is performed two to three days before the start of menstruation.

The treating physician informs the patient in advance about how the procedure will proceed, what its consequences may be, and discusses pregnancy after uterine curettage, among other aspects.

Indications for Curettage

Curettage itself traumatizes the endometrial lining. This means that bleeding and pain after curettage should be monitored, and the manipulation should be carried out strictly according to indications. Indications include:

• Disruptions in the ovarian-menstrual cycle, and the appearance of blood-stained discharge between two consecutive menstruations;
• Unusually heavy, prolonged, or painful menstruation;
• Blood-stained discharge after menopause;
• Suspicion of malignant metaplasia, in this context, curettage of the cervical canal and uterine body is of particular importance;
• Inability to conceive;
• Prior surgery related to uterine fibroids.

Curettage cannot always be performed. Additionally, complications may develop.

Contraindications to the Procedure Include:

• Acute infectious diseases;
• Inflammatory processes in female reproductive organs, particularly acute ones at their peak of development.

Possible Complications May Include:

• Perforation of the uterus (formation of a pathological opening);
• Tear (partial disruption of the integrity) of the cervix;
• Inflammation of uterine tissues;
• Hematometra – accumulation of blood-stained discharge in the uterine cavity. This is observed if the uterine contractions after curettage are normal, but the cervix spasms, blocking outflow;
• Destruction of the endometrium – results from overly vigorous curettage. In this case, the delicate growth layer is damaged—the endometrium loses the ability to regenerate, and it is not renewed.

Examination Before Performing D&C

Each patient should undergo a thorough examination before curettage. The results of this examination may determine how long one needs to stay in the hospital after uterine curettage. The most informative assessments include:

• Examination on a gynecological chair with a physician's conclusion;
• Complete blood count – especially important if anemia is already present;
• Coagulogram – analyzes blood clotting abilities and the potential for complications such as bleeding after uterine curettage;
• Electrocardiogram – helps to analyze cardiovascular activity since the curettage is performed under general anesthesia;
• Tests for various hepatitis;
• Wassermann reaction – detects syphilis;
• Blood test for HIV;
• Microscopic examination of a vaginal smear.

Preparation for Dilatation and Curettage of the Uterine Cavity

Before performing curettage of the uterine cavity and cervical canal, it is necessary to strictly adhere to a specific preparation protocol.

Two weeks before the procedure, it is necessary to:

• Stop taking medications unless they are prescribed by the doctor performing the curettage;
• Avoid all dietary supplements.

Two to three days before the dilatation and curettage, one should:

• Cease sexual intercourse;
• Avoid douching;
• Not use any intimate hygiene products - whether store-bought or homemade. Only wash with warm water;
• Stop using vaginal suppositories, tablet medications, or sprays.

On the last day, 8-12 hours before curettage, one should refrain from eating food and avoid drinking liquids in the morning of the procedure.

Curettage Procedure

Dilatation and curettage of the uterine cavity and cervical canal are performed in a hospital under intravenous anesthesia. The patient is positioned on a gynecological chair. A gynecological speculum is inserted into the vagina, and forceps are used to grasp the cervix. The depth of the uterine cavity is measured with a sound.

Curettage is performed with a curette, a surgical instrument resembling a small spoon with a sharp edge, which is used to scrape the upper layer of the mucous membrane, which is then placed in a special solution and sent to the laboratory. After the procedure, they wait for the patient to awaken from the medication-induced sleep, and if there are no complications, she is discharged home by the end of the day.

Blood-stained discharge after curettage of the uterine cavity may occur for several hours.

Discharge After Curettage and Other Consequences

A series of restrictions are put in place for the first two weeks after curettage — the patient should not:

• Engage in sexual intercourse;
• Use tampons in the vagina;
• Douche;
• Perform heavy physical labor; strenuous exercise at the gym is also contraindicated;
• Take baths, or visit saunas or steam rooms;
• Use medications based on acetylsalicylic acid.

The patient should promptly consult the physician who performed the curettage if:

• The discharge after the curettage begins to have a foul odor;
• Discharge from the vagina stops almost immediately after the curettage or there is significant bleeding;
• Body temperature reaches 38 degrees Celsius or higher;
• There are significant pains in the lower abdomen;
• Overall well-being worsens.