Dilation and curretage Gyane and obs

1. dilatation and curettage
Presented by :
(ARNAV)219
(ARTI)220
(ASHA)221
(ASHISH)222

2. Dilatation a n d curettage
The operation consists of dilatation of the cervix and
evacuation of the products of conception from the
uterine cavity

3. Indications :

4. Diagnostic Indications :
Uterine polyps
Fibroid/ Myoma
Endometrial hyperplasia
Uterine cancer
Sample of endometrium is taken and send for
histopathological examination

5.  Elective termination of pregnancy
 Abortions – missed/incomplete/ inevitable
 Molar pregnancy
 Treat excessive bleeding after delivery by clearing out any placenta that remains
in the uterus.
 Remove cervical a n d uterine polyps (benign).
Therapeutic indications:

6. PRE - REQUISITE
INFORMED CONSENT
EMPTY BLADDER
PART PREPARATION – with savlon

7. Instruments used i n D&C
1. Uterine sound
2. Sims vaginal speculum
3. Ovum forceps
4. ANTERIOR vaginal wall retractor
5. Sponge holder
6. Vulsellum foreceps
7. Hegar’s dilator

9. Sims vaginal speculum

10. Hegar d i l a t o r

11. Uterine s o u n d
To check the uterocervical length

12. Sponge h o l d e r
CLEANING THE PART

13. OVUM FORCEPS

14. Sims uterine curette

15. Valsellum forcep

16. CONTRAINDICATIONS
DESIRED TO CONTINUE VIABLE INTRAUTERINE PREGNANCY
BLEEDIND DIATHESIS
PATIENT ON ANTICOAGULATION THERAPY

17. STEP:
(1) Oxytocin 20 units in 500 mL of normal saline IV is given
intraoperatively and continued after the operation for 30 minutes.
(2) The vagina and the cervix are swabbed with antiseptic (povidone-
iodine) solution.
(3) Vaginal examination is done to note the size of the uterus, position of
the uterus and state of dilatation of the cervix.
(4) Posterior vaginal speculum is introduced and is to be held by an
assistant. The anterior lip of the cervix is to be grasped by the Allis
forceps to steady the cervix.
(5) The cervix is dilated with the graduated metal dilators to facilitate
introduction of the ovum forceps.
(6) The products are removed by introducing the ovum forceps.

18. • The posterior vaginal speculum and the Allis forceps are
removed.
• The uterus is massaged bimanually and after being
satisfied that the uterus is empty (evidenced by a well
contracted uterus with minimal bleeding), the patient is
sent to her bed after placing a sterile vulval pad.
• Prophylactic antibiotics (doxycycline and metronidazole)
are prescribed.

20. COMLICATIONS :
Immediate:
• (1) Excessive hemorrhage—incomplete evacuation/
atonic uterus
• (2) injury - hematoma/ uterine perforation.
• (3) Shock
• (4) Perforation—injury to major blood vessels, bowel
or bladder.
• (5) Sepsis—endometritis, myometritis and pelvic
peritonitis.
• (6) Hematometra may cause pain

21. LATE COMPLICATIONS
• (1) Pelvic inflammation
• (2) infertility
• (3) cervical incompetence
• (4) uterine synechiae and in subsequent pregnancy
• (5) preterm labor
• (6) ectopic pregnancy.

22. Extensive scarring of the uterus may occur after over
aggressive scraping leading to Ashermans syndrome.
It’s major symptoms are light or absent
menstrual periods, infertility and recurrent
miscarriage.

23. Aftercare
A woman who has had a D&C performed in hospital
can usually go home the same day or the next day.
Many woman experience backache and mild cramps after
the procedure.
May pass small bloodclots for a day or so.
Vaginal staining or bleeding may continue for several
weeks
Patient should avoid sexual intercourse , douching and
tampon use for atleast 2 weeks.