DILATION & CURETTAGE (D&C)

DILATION & CURETTAGE (D&C)

Dilation and curettage is a surgical abortion procedure performed during the first 12 to 15 weeks gestation.

Indication

·       Curatine

·       Diagnostic

·       As preliminary to other operations

Diagnostic

·       Sterility

·       To determine whether the cycle is ovulatory

·       Dysfunctional uterine bleeding

·       Secondary haemorrhage and amenorrhoea

·       Carcinoma

·       Uterine polyps

·       Postnatal bleeding

Curatine

·       Dysfunctional uterine bleeding

·       Endometrial thickness reduced

·       Habitual abortion and relative infertility

·       Post obstetrical bleeding

·       To correct or arrest bleeding

·       Spasmodic dysmenorrhoea

As preliminary to the other operations

·       For any plastic operation of the cervix

·       Vacuum aspiration for MTP

·       As preliminary to an intra activity radium insertion

Articles

·       Vulsellam forceps

·       Posterior vaginal speculum

·       Uterine sound

·       Dilator

·       Curette

Procedure

Ø  Patient is asked to empty the bladder before being put to the table in lithotomy position.

Ø  The operation field should be cleaned with antiseptic solution and sterile drapes are put on.

Ø  Vaginal examination is done to confirm the size and position of the uterus.

Ø  Anterior tip of cervix is caught by the vulsellum and the cervix is cleaned again with antiseptic solution.

Ø  Gentle traction is applied to the vulsellum to pull on the cervix as the uterine sound is inserted to find out the length and direction of uterine cavity.

Ø  Dilatation of the cervix is done with cervical dilators. The tip of the dilator is dipped in savlon. The cervix is sufficient to admit a sharp endometrial curette.

Ø  Curette is then introduced and the endometrium is scraped. The cervix is swabbed with sterile swab.

Ø  Specimen is collected in a vial containing 10% formaline solution and sent to the lab.

Ø  Dilation and curettage is similar to suction aspiration but with the introduction into the cervix of a curette. A curette is a long, lopped shaped knife that scrapes the lining, placenta and fetus away from the uterus. A cannula may be inserted for a final suctioning. This procedure usually lasts 10 minutes with a possible stay of up to 5 hours.

Side effects and/or complications

The side effects and possible complications of dilation and curettage are the same as suction aspiration as noted above with the exception that there is a slight increased chance for perforation of the uterus.

Additionally, dilation and curettage or D&C may be necessary after a vacuum aspiration. In this procedure, a separate curette (a spoon-shaped instrument) may be used to help remove any remaining tissue that may be lining the uterus. A vacuum aspiration abortion procedure (by itself or followed by a dilation and curettage) can be performed in one visit and is an option for women until 14 weeks have passed since their last menstrual period. It is nearly 100% effective.

Nurses Responsibility

Preparation

Ø  The patient is instructed to refrain from eating and drinking for at least eight hours before the procedure, if general anaesthesia will be used.

Ø  Prepare the patient when the doctor order blood and/ or urine tests to scan for certain abnormalities.

Ø  Sedatives may be given before the procedure begins as doctors orders because opening the cervix can be painful.

After Care 

Ø  The nurse usually looks for any abnormalities and sends home from the hospital on the same day or the next day.

Ø  The nurse observes women experiencing backache and mild cramps after the procedure, and pass small blood clots for a day or so. Vaginal staining or bleeding may continue for several weeks.

Ø  Nurse educates the women that they can resume normal activities almost immediately and should avoid sexual intercourse, douching and tampon use for at least two weeks to prevent infection while the cervix is closing and to allow the endometrium to heal completely.

Ø  As the procedure is infectious, the woman is educated to report immediately to her doctor, who can treat the infection with antibiotics, if a woman experiences any of the following symptoms.

·       Fever

·       Heavy bleeding

·       Severe cramps

Foul-smelling vaginal discharge