The World of Pregnancy

Curettage: A Detailed Explanation of this Procedure

Have you ever been put in the situation of considering curettage? Even if you didn`t, you still need to know all the basics of this procedure as you never know what might happen in life.Curettage

What Is Curettage?

Curettage represents the surgical treatment of incomplete abortion or abortion on demand under 14 weeks of amenorrhea. The methods of evacuation of the uterine content involve of aspiration cannula or clean metal, which is has little usage at present due to the risk of perforation or the appearance of uterine synechiae. The preoperative clinical examination is mandatory and consists of vaginal tact which should identify the position of the uterus and cervix. Also, an ultrasound which will show the age of the pregnancy is essential.

Curettage is practiced under local or general anesthesia, the procedure being adapted under the patient`s necessities. It`s not recommended to perform curettage under 7 weeks of gestation. In case of a pregnancy stopped from evolving at 5 – 6 weeks, curettage isn`t also necessary, as the evacuation is made spontaneously and so a clinical and ultrasound monitoring being sufficient. After this procedure, the administration of an antibiotic (such as azithromycin or doxycycline) is beneficial in preventing the inflammatory pelvic disease. For the pelvic pain, the doctor may administrate you anti-inflammatory drugs such as NSAIDs or paracetamol.

Abortion is a blind method and has a rate of immediate complications of 1% – 8%, such as bleeding, uterine perforation, cervix laceration, perforation of near organs or even maternal death. Remote complications include endometritis, adnexal reactions or uterine synechiae.

How to Prepare for Curettage?

Generally, curettage is performed a few days before menstruation – this helps in reducing blood loss and a fast recovery of the uterus after the procedure is completed.

Since this is a surgical procedure, for your safety the doctor will prescribe you some tests: general blood analysis, coagulation (blood clotting analysis), bacteriological vaginal smears and tests for STDs.

You should stop taking any medication and other food supplements (including herbal supplements) with 2 weeks before such a procedure, except medication about which you talked with your doctor. Some drugs can modify blood clotting and can increase the risk of bleeding. If you take drugs due to a serious illness (for instance, hypertension, arrhythmia, epilepsy), don`t stop the treatment, but inform the doctor who will perform your curettage about the medication you take.

With 2 – 3 days before curettage:

  • Stop any sexual contacts;
  • Don`t perform any vaginal washes and stop using any personal hygiene products. For any washes of the sexual organs, use only warm water;
  • Discontinue any drugs under the form of vaginal suppositories, tablets or sprays, if their usage wasn`t discussed with your doctor before curettage.

With 8 – 12 hours before the procedure, stop eating or drinking water. This is necessary for conducting the anesthesia in safe conditions.

How Is the Procedure Performed?

The main purpose of curettage is removing the top layer of the endometrium, which is rejected from the woman`s organism during menstruation.

This procedure is performed in the operating room on the gynecological chair.

Dilation of the cervix and curettage can be very painful and unpleasant. Due to this cause, this kind of procedure is almost always performed under general anesthesia, but in some cases (for example, immediately after birth when the cervix is dilated) curettage can be performed without anesthesia. In most cases, there are used intravenous injections of special drugs during curettage, which in a matter of second induce a state of sleep and entirely remove pain and memories of what happened during the procedure.

Before cleaning, the doctor will insert valves into the vagina (or speculum), an instrument which stretches the uterine wall and makes the cervix visible.

Then, the doctor performs the dilation of the cervix – for this, the doctor will hold the cervix using a special instrument and introduce in the cervical canal a probe with a rounded end. For performing a sufficient dilation of the cervix, the doctor replaces the first probe with a new one that is larger in diameter.

Once the cervix is dilated sufficiently, the doctor might perform hysteroscopy (the examination of the cervix with a special video camera) or can pass directly to performing curettage.

The doctor uses a special instrument (curette) to perform this particular procedure, which resembles with a small spoon with a long handle. The doctor scrapes off the top layer of the endometrium with cautious motions of this instrument and collects the obtained tissues in a test tube, which then is sent to the laboratory for histological analysis.

Generally, the procedure of dilatation of the cervix and curettage can last up to 30 – 40 minutes.

Most often, not only the uterine cavity is scraped, but also the cervical canal. This type of procedure is known as tiered or fractionated curettage. Initially, the scraping of the cervical canal is performed, and then is followed by the actual curettage. The removed tissues are collected separately and will further be put to histological examination using separate samples.

Why Is Performed a Histological Examination after Curettage?

Histology (histological examination) is necessary for determining the structure of the obtained tissues after curettage. This is the most important part of the investigations, as it allows to distinguish normal tissues from cancerous ones or tissues with precancerous changes. The results of the histological examination are, generally, ready in 10 to 14 days. When receiving the results, you`ll need to meet with the doctor again or to contact him to discuss about these results.

What Is Diagnostic Curettage?

Diagnostic curettage is performed for determining the cause of some symptoms which indicate a disorder of the female genital functions. In particular, the doctor can prescribe curettage to determine the cause of some symptoms, such as:

  • Irregular menstrual cycle, bloody leaks between 2 menstruations;
  • Menstruations that are too long, too heavy or too painful;
  • Vaginal discharges after menopause;
  • Difficulties in conceiving another child or infertility;
  • Suspicion of uterine cancer.

In such situations, curettage is only performed to obtain samples from the uterine mucosa, as their subsequent histological examination can help in establishing the proper diagnosis.

What Is Therapeutic Curettage?

Curettage, as a primary or secondary treatment method, is utilized in cases of diseases, such as:

Uterine Fibroid (Myoma)

In some cases, uterine fibroids (also known as leiomyomas) manifest through severe bleeding which can only be stopped with special medications or removal of the tumor.

Curettage can be performed to prepare the patient through a surgical intervention or in combination with hysteroscopy to completely remove fibroids.

Uterine Polyps & Cervix

As fibroids, uterine polyps can cause severe uterine bleeding (during menstruation or between 2 menstruations)., Some polyps can degenerate in cancer. Curettage is performed to remove polyps (of the uterus or cervix), but the subsequent histological analysis helps in determining if a polyp shows a risk of cancer or not.

Endometrial Hyperplasia

As uterine polyps, hyperplasia significantly increases the risk of developing cervical cancer and, therefore, requires removal by curettage.

Endometriosis

In some situations, curettage is required in the treatment of endometriosis along with antibiotics.

Curettage after Birth

After childbirth, curettage might be necessary for removing the remnants of the placenta from the uterine cavity and blood clots, which prevents the walls of the uterus to contract and creates a threat of bleeding and infection. This procedure can be performed immediately after birth or a few days later. – Click this link!

Also, curettage is used for performing abortion or for removing the dead fetus or in course of incorrect development.

Pregnancy Stopped in Evolution

The conservation of the dead fetus in the uterus, in case of pregnancy stopped in evolution, shows a high risk for the woman`s health. Because of this, a pregnancy stopped in evolution should be eliminated by curettage immediately after it has been discovered.

Miscarriage

Because there are fragments of fetal tissue remaining after a miscarriage which cause severe bleeding or infections, in most cases is required curettage.

Ectopic Pregnancy

Curettage can be used only for removing an ectopic pregnancy from the cervix or for cleaning the uterus after.

Abortion

Currently, abortion is rarely performed by curettage. Now doctors used a so-called vacuum cleaning to stop a pregnancy, in which the uterine mucosa and the fetus that is in full development are “sucked” in a special syringe.

Recovery after Curettage

After the procedure, the uterine wall is contracting significantly, which helps stop the bleeding. – More info!

A full recovery after curettage produces almost as fast as after a normal menstruation.

In the first few hours after scraping, the vagina eliminates blood clots, and the woman may feel weakness and drowsiness (a consequence of the anesthesia).

A few hours or days after this procedure some of the below symptoms may appear.

Pains

When the action of the anesthesia stops and after scraping, most women feel pain in the abdomen and the lumbar area, similar to the pain from during menstruation. These pains can last from several hours to a few days, and rarely requires special treatment. For severe pain relief, you can administer a tablet of ibuprofen.

Vaginal Discharges

You may experience heavy bleeding and blood clots in the first few hours after curettage. This is something normal.

After a few hours, bleeding becomes less abundant. Light brown or yellow bleeding can last for up to 10 days after the procedure. Any rapid disappearance of vaginal discharges after curettage might be a sign of cervical spasm and uterine accumulation of blood clots.

What You Shouldn`t Do after this Procedure?

For 2 weeks after this kind of procedure is performed, it isn`t allowed to:

  • Have any sexual contacts;
  • Use vaginal tampons (you can only use regular absorbents);
  • Apply any vaginal washes;
  • Do baths, sauna or steam bath;
  • Do any hard physical activities or intense physical exercises;
  • Administer any medications based on acetylsalicylic (e.g. aspirin).

Menstruation

The first menstruation after this procedure can come with a slight delay – after 4 to 5 weeks or even more. Any delayed menstruation after curettage isn`t a reason of concern. – Read this!

If menstruation is delayed for more than 3 months, you should talk to your doctor.

Possible Complications after Curettage

There are various complications that may appear after this procedure:

Uterine bleeding – this occurs relatively rare and generally in women with blood clotting disorders. Unlike spotting, when is considered a normal phenomenon and may persist even for a few weeks after the procedure, uterine bleeding represents a serious threat for a woman`s life. The doctor may prescribe you a few injections of Oxytocin for preventing abundant uterine bleeding.

Contact your doctor immediately if you experience abundant vaginal bleeding from which you need to change 2 – 3 tampons at 2 – 3 hours.

Accumulation of blood clots in the uterine cavity (hematometra) – this occurs due to the cervix`s spasm which appears immediately after this procedure. This situation can be very dangerous due to a risk of infection. The doctor may prescribe you antispasmodics to prevent accumulation of blood clots in the uterine cavity, as they`ll help the cervix maintain in the relaxed state.

The first sign that there are blood clots accumulated in the uterus is the rapid disappearance of bleeding after the procedure, as well as severe abdominal pain. If you have similar symptoms, get in touch with a doctor as soon as possible.

Infection and inflammation of the uterine mucosa – It appears when bacteria enter the uterus. Currently, doctors prescribe antibiotics to prevent the uterus`s infection after this procedure.

The first sign of infection is fever, chills and abdominal pains. Again, if you experience these symptoms, talk to your doctor immediately.

Infertility – This procedure can rarely affect the woman`s ability of conceiving. However, you should contact your doctor immediately after the procedure if:

  • Your vaginal bleeding quickly vanished and you have developed pain in the abdomen;
  • You have a temperature of over 38 degrees Celsius;
  • You have severe abdominal pains, which don`t disappear after taking analgesics;
  • You experience heavy vaginal bleeding, which quickly fills your tampons and don`t stop for a few hours;
  • You experience a bloody or brown discharge with a bad odor;
  • Your medical condition is deteriorating rapidly, your experience dizziness, weakness or fainting.

Sexual Intercourse

As already mentioned above, you should abstain from any vaginal intercourse for at least 2 – 3 weeks after experiencing this procedure.

The necessity of abstaining any sexual contacts is determined by the fact that the cervix remains open after curettage, and on the uterine mucosa there`s a large erosion. These conditions can be favorable for the development of the infection, which can enter the uterus during sexual contact.

It`s possible that for a while to feel pain during sexual intercourse after becoming sexual active again. This is something normal after going through curettage. However, if you feel this pain persists for a few months or becomes more severe, contact your doctor immediately.

Conception, Pregnancy & Birth

Generally, a woman can become pregnant again within 2 or 3 weeks after this procedure. Generally speaking, a woman can still give birth after such an experience.

If you try to conceive a child after such a procedure and you fail for more than 6 – 9 months, ask your gynecologist for further examination. Online in rare cases, this kind of procedure can disrupt the woman`s ability of conceiving.

Planning a pregnancy after curettage depends on the reason for which this particular procedure was performed. If you want to conceive a baby, it`s best to first talk to a doctor. He is able to properly evaluate your situation and suggest how is best to plan your next pregnancy.

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