Curettage, when and how is done?

Curettage is a simple procedure which is usually performed after a miscarriage, but is also used in other cases. You will learn when is indicated, what is, and its possible complications.


Curettage is a technique used by gynecologists, which consists of scraping or coating mucosa called endometrial curettage of the interior walls of the uterus, in order to pull out.

What is curettage?

Curettage has two main purposes: catch the endometrial samples to analyze them or clear the inside of the uterus.
More specifically, we can say that curettage is conducted in the following situations:
· Diagnose acancerof uterus: endometrial cancer is not of the most common cancers in women, but still is not rare in mature women after reaching menopause. Curettage allows you to analyze the endometrium to see if there are signs of malignancy or not, but it does not treat the cancer if it is finally detected.
· Extract the contents of the uterus after aspontaneous abortion: Unfortunately, occasionally the embryo dies during the course of a pregnancy. If this is completely ejected is called complete abortion, but if it remains inside the uterus is called missed abortion. In these cases we have to extract the embryo and its annexes until there is an internal infection or other complications to give. Curettage is sufficient for pregnancies interrupted up to three months; then it may be necessary to use other more aggressive techniques.
· Treatment of abundant menstruations: cases of women whose menstrual periods are more abundant than usual. In this case curettage may be done to analyze the endometrium in search of abnormalities that explain this situation, but it can also be useful as a treatment in itself, since you can eliminate the cause (a myoma, for example).
· Treatment of irregular menstrual periods: i.e. the curettage can serve to treat the vaginal bleeding outside of the menstrual period. As well as the treatment of the abundant menstruations, curettage would serve to analyze the endometrium, and occasionally also would solve the cause of these bleeds. In addition, curettage handle stops bleeding to cauterize the vessels with heat.
· Perform therapeutic or induced abortions: one of the ways of terminating a pregnancy in the first quarter is the realization of a curettage that lets you extract the embryo along with the rest of the endometrium. This curettage is conducted either by the own pregnant will, because their health is in danger, or the future fetus is not going to be able to develop.
· Embedding of IUD: one of the complications of intrauterine devices (IUDS) is to eventually remain embedded in the inner walls of the uterus, being impossible to extract them directly. In these situations prior curettage is performed to remove the endometrium that retains the IUD.
· Treatment of fibroidsand theendometrial polyps: fibroids and polyps are abnormal growths of the endometrium or uterine muscle that develop into uterine cavity. Sometimes dan complications (miscarriages, sterility, abundant menstruations...) and must be removed using curettage.
· Analysis to prevent early endometrial cancer: is not recommended to perform this test to all women (unlike the mammogram, for example), but in certain situations to proceed to do it, because you can detect endometrial cancer when it is still easy to fix. The most characteristic situations occur after menopause and are: abnormal bleeding in women following hormonal treatment, irregular bleeding, and growth of the thickness of the endometrium detected by transvaginal ultrasound.

Curettage is performed

Curettage consists of two parts: the dilation and curettage.
Expansion consists of extending the entrance to the uterus to be able to get inside the instruments needed to perform curettage. To this end, the gynecologist introduces small metal cylinders through the neck of the uterus or cervix; These cylinders are becoming wider, so they enlarge the cervix slowly until it gets a proper size to introduce the instruments appropriate for curettage.
Curettage is to insert a rod with a handle that gynecologist can seize from outside, and which has at its end a small thin handle that allows you to scrape the surface of the uterine cavity, thus extracting the endometrium, removed gradually through the same cervix inside the uterus. Currently this handle has two improvements that formerly did not exist. Firstly, the Rod has built-in camera which, although it is not essential, allows to better direct the scraping by making it more effective and with fewer complications. Secondly, the handle has the ability to warm, so while you scrape the uterine surface it can clot injuries preventing bleeding.
Throughout this process, gynecologist in the cervix keeps a small instrument, called a Speculum, which keeps the open cervix. In general, the process takes only 15 minutes.

It takes some preparation prior to undergo a curettage?

Curettage can be performed in a hospital or in a clinic, and in addition the anesthesia can be local or general depending on the patient and their characteristics. In any case, the woman who is to be a curettage does not need special preparation.
Only would be needed routine surgery preparation, although it is not strictly a surgical operation. To do this the patient will need to:
· Perform a blood test prior to observe its general health status (rule out anemia, clotting disorders, etc).
· Undergo a gynaecological examination with a transvaginal ultrasound to check that the curettage can be performed without problems.
· Do not eat or drink eight hours earlier in the case that is going to perform curettage under general anesthesia.
· Do not take medicines the week before unless the doctor has told them. Even a single aspirin may interfere with blood clotting.

Care after curettage

After curettage women can return to perform their daily activities and joining the work as soon as you are, and can be on the same day even. It is normal that within 24 hours suffer colic pain abdominal, pelvic, or even located on the back, which can be alleviated by taking common painkillers. It is also normal to have some vaginal bleeding two weeks to curettage.
It must be especially careful with the women who practiced a curettage after an abortion, because the emotional impact can be too intense and may need psychological support.
Menstrual cycle returns to the establishment is normally between two and six weeks after the intervention, but despite having vaginal bleeding during the two weeks after the curettage, ovulation may occur before, and it is necessary to take it into account to use the contraceptive method that you want to.
Anyway, it is not recommended to have sex during the 10-14 days after curettage. Not use tampons, perform Vaginal Douches or bathing is recommended (only shower) during that period. You must avoid, in addition, carry out intense physical exercise.
There are symptoms that should alert women that something is not going well and that should go to the nearest medical centre as soon as possible after the curettage. The most important are fever, cramps, very intense cramping, foul-smelling vaginal discharge, the abundant bleeding with clots and dizziness.

Curettage: what are your risks?

Although curettage is a technique that is rarely enthralls, there are occasions in which Yes succession problems in the wake of this test. The most important are:
· Puncture of uterus: happens when the curettage Rod too strikes the uterine surface to perforate the uterus. It happened frequently in the past, when there was a camera allowing you to see the inside of the uterus, nowadays it is more rare. To fix this surgery should be performed in the operating room; in the worst case it would have to remove the uterus.
· Occlusion of the uterus by healing: referred to as Asherman syndrome. Once the curettage uterine surface must heal, but sometimes it happens that they contact each other and heal together. In this way the cavity of the uterus collapses and not allow that to develop a pregnancy, causing permanent infertility.
· Tearing of the cervix: although rare, it can happen that dilate neck uterine or subsequent handling to perform curettage, this tear by any of the edges. In this case you can solve the problem when sewing the tear if it is small; in case of too large it must be deeper surgery.
· Infection: during the curettage are various instruments that are inserted into the uterine cavity. In all cases these instruments have to be sterile to prevent the transfer of germs into the interior. However, it can happen that own Germs from the woman's vagina is transferred to the inside of the uterus and may be harmful for him. In such a case would develop an infection that would give fever, foul-smelling vaginal flows, etc. It is treated with antibiotic treatment intravenously if it is severe.
· Leave fabric on the inside of the uterus: when performing a curettage tissue of endometrium that has scraped the surface must be removed. When a part of this tissue remains in the uterus it can rot and serve as a focus of infection in the future. This is especially serious when a curettage is performed by an abortion.
· Hemorrhage: as in surgeries, one of the most common complications is bleeding from the wound, which in this case is formed on the uterine surface. It is rare to be serious, since no large arteries to that level of the uterus, but after or during the own curettage should watch that bleeds are not too abundant.
Article contributed for educational purposes
Health and Wellness

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