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Chapter 99 - Uterine curettage

from Section 21 - Gynecologic Surgery

Published online by Cambridge University Press:  05 September 2013

By
Erica C. Dun  and
Carla P. Roberts
Edited by
Michael F. Lubin ,
Thomas F. Dodson  and
Neil H. Winawer
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Neil H. Winawer
Affiliation:
Emory University, Atlanta
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Summary

Uterine curettage is the second most frequently performed gynecologic procedure. The primary indications for uterine curettage are both diagnostic and therapeutic:

  1. Polymenorrhea: menstrual cycle interval less than 21 days.

  2. Oligomenorrhea: menstrual cycle interval more than 37 days.

  3. Menorrhagia: excessive or prolonged menstrual bleeding.

  4. Postmenopausal bleeding: uterine bleeding occurring more than 12 months after the last menstrual period in a menopausal woman.

  5. Breakthrough bleeding: intermenstrual bleeding in a menstrual cycle that is the result of exogenous hormones.

  6. Dysfunctional uterine bleeding: any abnormal uterine bleeding in the absence of pregnancy, neoplasm, infection, or uterine lesion.

  7. 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.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 657 - 658
Publisher: Cambridge University Press
Print publication year: 2013

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References

Antibiotic prophylaxis for gynecologic procedures. ACOG Practice Bulletin, No. 104, May 2009. Washington, DC: American College of Obstetricians and Gynecologists.
Butler, WJ, Carnovale, DE.Normal and abnormal uterine bleeding. In Jones, HW, Rock, JA, eds. Te Linde's Operative Gynecology. 10th edn. Philadelphia, PA: Lippincott, Williams & Wilkins; 2008, pp. 585–608.Google Scholar
Friedman, A, DeFazio, J, DeCherney, A.Severe obstetric complications after aggressive treatment of Asherman syndrome. Obstet Gynecol 1986; 67: 864–7.CrossRefGoogle ScholarPubMed
Hefler, L, Lemach, A, Seebacher, V et al. The intraoperative complication rate of nonobstetric dilation and curettage. Obstet Gynecol 2009; 113: 1268–71.CrossRefGoogle ScholarPubMed
Schorge, JO, Schaffer, JI, Pietz, J et al. Sharp dilatation and curettage. In Schorge, JO, Schaffer, JI, Halvorson, LM et al., eds. Williams Gynecology. New York, NY: McGraw-Hill Companies, Inc.; 2008, pp. 896–900.Google Scholar
Tuncalp, O, Gulmezoglu, AM, Souza, JP.Surgical procedures for evacuating incomplete miscarriage. Cochrane Database Syst Rev 2010; 8: CD001993.Google Scholar

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