COMING TO IMPORTANT DETAILS ABOUT CURETAGE;
It is the process of removing and evacuating the product of pregnancy (intact or impaired or anembryonic pregnancy) in the uterus. In addition, in patients with abnormal bleeding, curettages are performed to determine the cause of bleeding, that is, for diagnostic purposes. For example, if a woman entering menopause experiences bleeding for no reason, the inside of the uterus and sometimes even the inside of the canal will be examined by curettage. These types of procedures for histopathological examination are abbreviated as D/C (initials of Dilatation and Curettage).
Legally up to 10 weeks (This period is perceived as the end of 2 months among the public; because the public (sometimes it calculates the pregnancy from the date of intercourse) Curettage can be performed.
It should be applied by Gynecologists and Obstetricians and in sterile environments.
Since the last 30 years, 60cc vacuum injectors and plastic cannulas have been used in the world and in our country. (sticks) are used. We also apply the same method. Evacuation can be done with cannulas so thin that they almost do not even need a bougie. Around 8 weeks, dilation up to size 7 with bougies is sufficient.
TECHNICAL:
It is applied under local or general anesthesia.
Contrary to popular belief, it is not very difficult, but it is extremely careful. It is an action that needs to be done. Sharp-edged curettes are almost never used.
Daily work can be continued approximately 1 hour after curettage.
And I always call patients for a check-up after 1 or 2 weeks.
Meanwhile, despite the medications;
Persistent pain,
Excessive bleeding,
Foul-smelling discharge with or without blood and/or
38C If there is a fever (manifested by chills and chills) that goes above and beyond, I would like them to come for a check-up immediately.
COMLICATIONS:
Complications can happen to any doctor who performs curettage.
No doctor wants to harm his patient.
However, irresponsibility or carelessness are not things that can be forgiven.
Despite all your attention and precautions, you may encounter complications.
Especially 10 Around the week or for medical reasons such as anomaly, or in cases called missed abortion and molar pregnancy (popularly known as grape pregnancy), there may be blood at the time of evacuation. However, complications such as perforation and remaining fragments may be encountered.
IS THERE A ABORTION PILL OR NEEDLE?
Menstrual delay is not specific to pregnancy.
Hormonal and psychological factors are very important. Although some women are not pregnant, depending on many factors; There may be a menstrual delay. The woman may also think that she has pregnancy symptoms. The urine test may even give a false positive. In this case, pharmacists or journeymen give menstrual stimulants (we usually use gestagens) to the patient and say, "Oh, we made you have a miscarriage" when the menstruation occurs after the medicine is finished. Well, this was a more common situation in ancient times, but considering the education level of the people, it is still a situation encountered in the suburbs.
-In real pregnancies, Misoprostol (which is an anti-ulcer drug) stimulates uterine contractions and can cause miscarriage. However, with excessive contractions, the fatigued uterine muscle cannot recover at the end of the pregnancy, causing atony, which can lead to lethal bleeding. Therefore, it can be used in hospital conditions and to dilate the cervix.
-RU-486, which is used for abortion abroad, is not currently used in our country.
CAN CURETAGE CAUSE INFERTILITY?
No.
However, in the past, infertility could occur due to the adhesion of the uterine walls (Asherman syndrome) when using metal curettes and very deep scrapings of the uterus, but these were such exceptional cases that their occurrence was in the thousands.
WHEN WILL BLEEDING OCCUR AFTER CURETAGE?
I tell my patients that bleeding may occur between 1 week and 1.5 months, ovulation will begin 10-15 days after curettage and the risk of getting pregnant again will arise.
WHAT IS THE NON-STOPPING BLEEDING AFTER CURETAGE?
As a result, the important part of the pregnancy product is the small part of the structure called placenta and we call it chorion in the first 10 weeks. Its tight adhesion to the uterine wall or the failure of the plastic cannulas to withdraw will cause small pieces (the size of lentils or chickpeas) to remain on the uterine wall. Within 1-2 weeks after curettage, the uterus sometimes throws them out with contractions. At that time, the patient suffered from painful and intermittent bleeding. complains. He/she should be called for control immediately and checked with ultrasound. If there is, the situation should be explained to the patient honestly and the part we call rest should be removed with a cannula. Hiding it from the patient or neglecting it is an unforgivable situation.
PIECES LEFT IN CURETAGE:
It is one of the things that bothers doctors and patients the most.
The chorionic tissue between the child and the mother. The probability of small pieces of placenta remaining is around 2-3%.
No matter how careful you are; In the presence of factors such as intrauterine irregularity or the child's partner clinging tightly to the wall, pieces the size of lentils or chickpeas may remain. This happens to us from time to time. It is better to use plastic tips instead of sharp tools called curettes. The risk of excessive scraping of the uterine lining is eliminated, and situations such as puncturing the uterine wall with curettes are avoided.
In such a case, the body can usually expel the piece spontaneously with uterine contractions, otherwise we can remove the piece again with a small cannula.
It is necessary to give all this information to our patients before curettage.
Also important is not to abandon the patient.
ACCUULATION OF BLOOD CLOTS IN THE UTERINE AFTER CURETTE:
After curettage, blood clots may accumulate inside, especially in cases such as obstruction of the uterine canal. In these cases, also called post abortal syndrome, sometimes intrauterine blood can fill up to the cords, causing a very striking and severe picture.
When diagnosed with ultrasound, it is sufficient to drain the clot inside with a small cannula.
WHEN DO BETA HCG VALUES DECREASE AFTER CURETAGE?
The beta HCG value may be above 5 for up to 4 weeks.
CAN THERE BE PREGNANCY DELIVERY DURING CURETAGE?
Yes. Especially in very small pregnancies (especially in sacs that can only be detected by transvaginal ultrasonography), the pregnancy may not end with curettage. The patient calls you with complaints such as the nausea is not going away, there is no bleeding, or the pregnancy symptoms continue. Diagnosis is made by ultrasonography. Ultimately, the procedure is repeated.
WHAT ARE THE MINOR COMPLAINTS THAT MAY OCCUR AFTER CURETAGE?
Bleeding that lasts up to a week may occur.
Genital fungal infection may develop depending on the antibiotics we give.
Drugs can sometimes cause complaints about the gastrointestinal system (such as bloating, abdominal pain).
After curettage, blood may accumulate inside the uterus. It causes painful cramps. Dilation of the cervix with the thinnest cannula allows the blood to drain and the patient relaxes.
HOW MANY TIMES CAN CURETTE BE DONE?
Curettage should not be a birth control method. However, curettage does not have any risks other than the risks we have listed above.
CAN CURETAGE BE UNDERSTOOD BY OTHER GYNECOLOGISTS LATER?
No. However, the trace of the single-pronged forceps, called tenaculum, with which we hold the cervix in the first 48 hours, may give an idea.
SHOULD ANTI-D (PUBLICLY PUBLICLY AS BLOOD INCOMPATIBILITY INJECTION) BE DONE AFTER CURETAGE IN THOSE WHO HAVE BLOOD INCOMPATIBILITY?
If the embryo and therefore the blood circulation has not formed, there is no antigen to pass to the mother. Then there is no need for a needle. Anti D should be used in pregnancies that are large enough to have a heartbeat and in complete molar pregnancies.
AFTER CURETAGE, CAN A SPIRAL BE INSTALLED?
If the doctor is very sure, he may insert a spiral since there are no parts left.
Can Ovarian Cysts Occur DURING CURETTE?
A corpus luteum cyst may occur in the first weeks of pregnancy. The situation is explained to the patient. If the cyst persists during the check-up after curettage, it can be examined and oral contraceptives can be given.
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