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