Introduction,dilataion and curretage&suction curetage

2. Pre operative preparation and investigations:
Carful assessment of the patients
preoperatively , Allows preventive
measures to be taken to decrease
surgical risk and morbidity.

3. • To determine the risks & benefits ratio of the
operation.
• To assess whether the operation is urgent or
elective.

4. • Complete blood count CBC
• Blood preparations
• General urine examination GUE
• Blood suger
• Liver function test
• Renal function test
• Chest xray
• ECG

5. • Preoperative testing depend on the patient’s
symptoms, history and examination result.
• Serum potasium level should be meatured in
patients who are taking diuretics or undergoing
bowel preparation.

6. • Chest radiography is indicated in patient having
ahistory of cardiac &pulmonary diseases or recent
respiratory symptoms or malignancy.
• Instructions and informations for the patients: its
important to inform patients fully not only about
the operative procedures but also about specific
instructions for adequate preoperative
preparations.

7. o Indications ,risk, complications ,options about
surgical procedures & success rate.
o Pre operative fasting instructions.
o Preoperative bowel management
. Enema
laxatives

8.  Instructions about taking or avoiding medication
 Instructions about pre operative pain management
 Instructions about the need for mobility and passive
movement post operatively.
 Information about anesthetic induction and
recovery.
 Information about drains ,catheters& IV infusion

9. INDICATIONS:
1. abnormal uterine bleeding.
2. Post menopausal bleeding.
3. persistent vaginal discharge.
4. Retained products of conception.

10. 5. Pyometra , hydrometra &haematometra.
6. Investigations of infertility, pelvic pain
&dysmenorrhea.
7. Prior to vaginal hysterectomy.
8. When sampling of endometrium is not possible in
patients taken estrogen.

11.  Place the patient in lithotomy position.
 Scrub the vagina and vulva with providone_iodine .
 Examine the vagina bimanually to assess the pelvis
and the position and size of the uterus.
 Grasp the anterior lip of the cervix with tenaculum.
 sound the depth of the endometrial cavity.
 Dilate the cervix with hegar dilators.
 Perform hysteroscopy according to the patient’s condtion.
 Currete the endocervical canal and cavity.
 Search for the polyp by forceps.

16. A. Intraoperative complications:
• Perforation of the uterus.
• Laceration of the cervix.
• Inability to dilate cervical canal.

17. B. post operative complications:
• Infection.
• Peritonitis.
• Bleeding (malignancy &trophoblastic disease).
• Amenorrhea(asherman syndrome).

18. Indication:
• Termination of pregnancy.
• Evacuation of retained product of
conception.
• Evacuation of H mole.

19. • Position and anesthesia for the same as DNC.
• Start Iv infusion with 20 units of oxytocin.
• Gently dilate the cervix with hegar dilators.
• Insert the suction curette gently until it reaches the
fundus.(8-10mm suction curette is adequate for
most cases).
• Start suction and rotate the curette gently around
the endometrial cavity in an clock wise direction.
• Occasionally withdraw the tip of curette from the
cervix to allow products of conception to be
aspirated along suction tubing.

22. • Gently recurette the cavity with a sharp curette.
• Give methergine IM.
• Re aspirate the cavity with suction curette.
• Message of the uterus to diminish bleeding.