DILATATION OF THE CERVIX AND CURETTAGE
Objective
Dilatation and curettage is a gynecological operation having two distinct components:
• To enlarge the cervical canal.
• Removal (by scraping) of endocervical or endometrial tissue for histologic study.
Position
Lithotomy.
Anesthesia
Local, Epidural, General.
Procedure
1. Empty bladder.
2. Clean vulva, vagina and perineum.
3. Drape the parts with sterile towels, leaving the vulva exposed.
4. Expose the cervix with Sims’ speculum and anterior vaginal wall rectractor.
5. Catch the anterior lip of cervix with Vulsellum forceps.
6. Clean the cervical canal with cotton swab wrapped round a playfairs probe.
7. Pass a uterine sound to determine the size and direction of the uterine cavity.
8. Pass the dilators, well lubricated, steadily and gently, and in the direction of the cervicouterine axis, till their tips go beyond the internal os.
a. Do not pull on the cervix but use the Vulsellum to fix and steady the cervix in its normal position.
b. The cervix should be dilated enough to admit the sharp curette easily.
9. Steadying the cervix with the Vulsellum forceps.
a. Pass the sharp curette in the axis of the cervico-uterine canal till its tip touches the fundus of the uterus.
b. With steady pressure scrape down.
c. In the long axis starting with the anterior uterine wall and working systematically around the uterine cavity until the whole surface is scraped away.
d. A typical grating sensation is felt by the curette when the endometrium has been satisfactorily removed.
e. Collect the endometrium into a bowl containing sterile saline or a citrate solution.
10. Gently massage the uterus between the two hands to remove all blood.
Instruments Required
D and C set.
Any questions be sent to drmmkapur@gmail.com
All older posts are stored in archives for access and review.
Visitors that follow may post contributions to the site,please write to address above.
To create consumer/provider engagement visit www.surginstuatlas.blogspot.com
