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from Section 21 - Gynecologic Surgery
Published online by Cambridge University Press: 05 September 2013
Uterine curettage is the second most frequently performed gynecologic procedure. The primary indications for uterine curettage are both diagnostic and therapeutic:
Polymenorrhea: menstrual cycle interval less than 21 days.
Oligomenorrhea: menstrual cycle interval more than 37 days.
Menorrhagia: excessive or prolonged menstrual bleeding.
Postmenopausal bleeding: uterine bleeding occurring more than 12 months after the last menstrual period in a menopausal woman.
Breakthrough bleeding: intermenstrual bleeding in a menstrual cycle that is the result of exogenous hormones.
Dysfunctional uterine bleeding: any abnormal uterine bleeding in the absence of pregnancy, neoplasm, infection, or uterine lesion.
Other: spontaneous abortion, incomplete abortion, inevitable abortion, fetal demise in utero, septic abortion, termination of pregnancy, dilation and evacuation of gestational trophoblastic neoplasms.
The operation involves dilating the cervix and removing uterine contents and endometrial tissue. The patient is placed on the table in the lithotomy position. The perineum and vagina are cleaned with a povidone-iodine (Betadine) solution. A straight Jacobs (double-tooth) clamp or single-tooth tenaculum is used to grasp and stabilize the cervix. A bimanual exam is performed to confirm the size and position of the uterus and a uterine sound is carefully passed to confirm the length of the uterine cavity and the angulation between the cervical canal and the uterine cavity. Sounding the uterus is contraindicated in the presence of a pregnancy because the increased risk of perforating the soft myometrium. Dilators are subsequently passed through the cervix to achieve the desired cervical canal diameter. After dilation, ureteral stone forceps can be introduced into the uterine cavity to remove endometrial polyps. Curettage is performed with a small serrated curette which can be used to systematically scrape the uterine cavity until a uterine “cry” (vibrations felt as the curette is gently dragged across denuded endometrium) is appreciated. When curettage is performed for the removal of placental tissue, a large, blunt, smooth curette is used to lessen the possibility of perforation and endometrial sclerosis.
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