The complexity of the structural structure of the organs of the female genital area implies the same variety of diagnoses, the frequency of which in our century is by no means decreasing. Rather, on the contrary, statistics record an increase in cases of precancerous and neoplastic diseases pelvic organs. Many of them debut in premenopause or menopause and are accompanied by incessant bleeding, which reliably indicates the existing pathology. However, in order to timely determine the malignant (or benign) nature of the process and begin adequate treatment, accurate diagnosis is necessary. In order to stop the bleeding and find out its cause, by examining the biopsy material under a microscope, therapeutic and diagnostic curettage of the uterine cavity or curettage is performed, which the women themselves simply call “cleansing”.

What is diagnostic curettage?

Diagnostic curettage is intended to establish an accurate diagnosis, the name itself speaks of this and is carried out in order to extract biopsy material from the uterine cavity. Any doctor's doubts about a serious pathology should be dispelled or confirmed by a scraping of the mucous membrane, carefully examined by a morphologist. Often, to determine the location of the pathological focus, separate diagnostic curettage (RDV) is used, which involves the sampling of the functional layer of the endometrium and epithelium. cervical canal separately. Of course, first they take a scraping of the cervical canal, and then move into the uterine cavity.

The procedure is carried out in a hospital in compliance with all the rules of asepsis and antisepsis. WFD can be performed under general anesthesia or with local anesthesia, which involves injection of pain medications directly into the cervix, which needs to be dilated for the introduction of instruments.

A special curette serves as a tool for extracting tissue, so you can often find another name for curettage - curettage of the uterine cavity and / or curettage of the cervical canal, when they mean scraping of the endocervix.

Diagnostic curettage is planned when ultrasound and cytological analysis indicate the presence of pathological changes unexplained genesis, and emergency.

Diagnostic curettage is best done under the control of a hysteroscope, which allows you to take material from a specific location, in addition, with hysteroscopy, the WFD is less traumatic.

Separate diagnostic and therapeutic curettage

Separate diagnostic curettage is prescribed by a doctor if a certain pathology is suspected. Based on the patient's complaints, the doctor conducts an initial examination, including cytological diagnostics and ultrasound.

A swab taken from the cervix and cervical canal, as well as aspiration biopsy can reveal:

• atypical cells;
• hyperplasia of the endometrium in the aspirate from the uterine cavity;
• indirect signs of a polyp;
• the presence of a tumor, however, to differentiate a malignant neoplasm, and even more so to determine the degree of tumor invasion, cytological analysis does not allow. This is available only for histological examination, where a tissue section with all layers is to be studied.

ultrasound ( ultrasound diagnostics), carried out initially, determines the thickness of the endometrium and allows you to suspect a malignant process, which will be the basis for a second ultrasound before menstruation and after (at the end of the cycle). If there were only assumptions, then the fears will go away along with menstruation, otherwise, diagnostic curettage will be prescribed. Separate or only the uterine cavity is up to the doctor, but usually they are used together in order to more accurately understand the condition of both the cervix and the uterine cavity itself.

The WFD often has a dual purpose, as it is both medical procedure. Such curettage, as a rule, is used for prolonged bleeding that occurs against the background of endometrial hyperplasia, which, after curettage with adequate treatment, often goes away forever.

The therapeutic purpose of the RFE also takes place in cases of removal of a polyp from the cervical canal or uterine cavity, which, in without fail sent for histological examination in order to exclude its malignancy.

A histological examination is carried out by a pathologist, for which the laboratory assistant prepares a series of preparations on glass slides intended for microscopic viewing. An accurate diagnosis can be obtained in 10 days, and then you can visit the gynecologist again, who will decide on the treatment tactics, depending on the diagnosis.

It is obvious that this procedure is therapeutic and diagnostic, but if it may not be therapeutic, then it is always diagnostic, and women should know that it cannot be ignored, because the importance and therapeutic effect of scraping can hardly be overestimated.

Indications

Often hearing scary word"curettage", women panic and are very afraid of the upcoming procedure, and some even try to refuse, referring to the fact that the RFE can damage the inner layer of the uterine cavity or cervical canal, which will lead to irreversible consequences.

Scraping should not be feared. The uterus after scraping will be “like new”, because it is only removed surface layer- functional, which already goes away every month along with menstruation. The menstrual cycle begins with the growth of a new endometrium due to the basal (growth) layer, which is not subject to curettage. Taking it off is considered rude medical error which, fortunately, is very rare.

Still often, women are tormented by the question, if the endometrium is removed during scraping, then when it forms again, how to build it up after the procedure.

There is no need to worry about this either. Preserved basal layer plus well-appointed hormonal treatment, quickly restore the endometrium in childbearing age. In the case when curettage was performed for endometrial hyperplasia, and dufaston was prescribed after the procedure, the functional layer will grow longer. Should I remind you that in premenopause and menopause, the endometrium undergoes significant changes, so the surface layer loses its relevance and ceases to function as unnecessary. In any case, these and other nuances of treatment after curettage will be explained by the attending physician.

The above factors indicate that if there are indications for curettage of the uterus and / or cervical canal, the RFE must be carried out without fail, and the indications for it are as follows:

As they say, choose the lesser of two evils, so if we are talking about life-threatening circumstances, then it is hardly necessary to think about how to build up the endometrium after scraping. The main thing is to find the reason inappropriate behavior endometrium and eliminate it.

What tests should be done before the procedure?

On admission to the hospital on an emergency basis (usually this is bleeding with clear signs anemia), as a rule, acute surgical pathology. In view of the urgency of the upcoming operation, when there is not much time for a comprehensive examination of the patient, a consultation with a surgeon and a therapist is prescribed. General anesthesia is carried out in the presence of an anesthesiologist.

Analyzes in the event of emergency curettage, of course, will be the most necessary, which can be performed urgently and at the same time assess the condition of the woman as much as possible:

• general analysis of blood and urine;
• blood sugar and prothrombin index;
• blood clotting and duration of bleeding;
• blood group according to the AB0 and Rhesus systems.

In the case of planned curettage of the uterine cavity, the range of tests expands:

• fluorography;
• complete blood count (detailed) and urine;
• coagulogram;
• blood type AB0 and Rh-affiliation;
• biochemical blood test (glucose, total protein, bilirubin, liver enzymes, urea);
• markers of hepatitis B and C;
• smear on flora and cytology;
• ultrasound examination of the pelvic organs.

It is important to take the examination before diagnostic curettage seriously, because contraindications may appear, which may require adjustments in terms of planned activities.

Contraindications

Acute inflammatory processes, especially those caused by genital infections, must first be cured, and only then go for therapeutic and diagnostic curettage of the uterine cavity, otherwise the consequences can be the most unpredictable. Before the RFE, it is also very important to assess the condition of the whole body of a woman, because some chronic diseases make it difficult to use and manage general anesthesia. Thus, when prescribing curettage, one should keep in mind the factors that impede the operation:

• acute inflammatory processes of the cavity and cervix;
• exacerbation of viral and bacterial infections;
• inflammatory diseases caused by HPV, chlamydia, trichomonas, gonococcus, genital herpes;
• respiratory diseases and of cardio-vascular system in the stage of decompensation:
• blood clotting disorders;
• diabetes.

It is important before the upcoming operation, in order to avoid extraordinary situations, to involve related specialists for a collegial decision on the issue of anesthetic management of the RFE.

Recovery and possible complications

After the operation, the patient receives antibacterial and restorative therapy, which she continues at home, where she goes at least the next day.

A week after the WFD, a planned gynecological examination with obligatory ultrasound of the pelvic organs. By that time, the uterus, if it was enlarged, should shrink after scraping, then the bloody issues accompanying the postoperative period. Restoration of the endometrium begins, as a rule, immediately after the curettage or in accordance with the prescribed treatment, which the gynecologist will prescribe after receiving the results histological examination.

There is no unequivocal answer to the numerous questions of women preparing for the WFD or those who survived it, when menstruation should come after curettage. Maybe in a month, maybe in three or - never, if there is a menopause. It depends on many factors and is strictly individual.

After scraping during the recovery period, it is possible yellow discharge from the genital tract, and the long-awaited periods may be excessively abundant and cause concern, which is completely justified, because they suggest the presence of a pathology associated with surgical intervention.

Like any operation, RDD can give undesirable consequences and complications that may arise during the intervention - perforation of the uterus, or have a remote character. Perforation of the endocervix, in general, does not threaten, due to the dense structure of the wall, therefore, the consequences of curettage of the cervical canal, as a rule, are limited to an acute inflammatory process, while in the uterus possible complications much more:

• tears of the cervix;
• inflammation of the lining of the uterine cavity (endometritis);
• hematomas and accumulation of blood in the uterine cavity - hematometra;
• adhesive process - synechia.

To prevent complications after diagnostic curettage, direct all efforts to prevention. inflammatory diseases female genital organs through the use antibacterial drugs, vitamins and an antioxidant complex, strictly observe the regime of work and rest and for a while forget about intimate life. Sex after curettage is contraindicated for at least two weeks.

Prices for diagnostic curettage

Emergency therapeutic and diagnostic curettage is performed according to vital indications, so it can be done free of charge. But with a planned WFD, a woman determines for herself where and how much to pay.

First of all, the price will depend on the region (of course, everything is more expensive in Moscow and the Russian Far East is no exception), the level of the clinic and the qualifications of the doctor.

In addition, the cost depends on the anesthesia used during the operation, which ranges from 1200-1500 (local) to 5500-6000 (total up to 3 hours) and up to 8000-9000 (more than 3 hours).

The scraping procedure itself without the use of a hysteroscope costs about 6,000 rubles, and under the control of hysteroscopy, approximately 11,000 rubles.

Some medical centers offer services where the cost of anesthesia and hysteroscopy is immediately included in the price of diagnostic curettage, which will cost 16,000-17,000 rubles. Well, as people say: “my money is my comfort”, because health is more important than financial costs.

I would like to think that after reading this article, women will not be afraid and sometimes avoid extremely necessary procedure called diagnostic curettage. WFD in some cases can eradicate the problem in its very bud (endometrial hyperplasia or removal of a polyp), and also help to identify malignant neoplasms. It is known that success in the fight against cancer depends on early diagnosis. BUT early diagnosis- This is a separate diagnostic curettage.

Scraping (cleansing) Most women in their lives are faced with a situation where a gynecologist after an examination prescribes curettage. Women often refer to this operation as "cleansing". Not all patients are told in an accessible form what this operation is, and this ignorance breeds unreasonable experiences.

Let's figure it out.

What is scraped (a bit of anatomy)?

scraping occurs

What is scraped (a bit of anatomy)?

The uterus is muscular organ similar in shape to a "pear", in which there is a cavity that communicates with external environment through the cervix, which is located in the vagina. The uterine cavity is the place where the fetus develops during pregnancy. The uterine cavity is lined with a mucous membrane (endometrium). The endometrium differs from other mucous membranes (for example, in oral cavity or in the stomach) by the fact that it is able to attach a fertilized egg to itself and give rise to the development of pregnancy.

During the entire menstrual cycle, the mucous membrane of the uterine cavity (endometrium) thickens, various changes occur in it, and if pregnancy does not occur, it is rejected in the form of menstruation and in next cycle starts growing again.

In scraping time- it is the mucous membrane of the uterus that is removed - the endometrium, but not the entire mucous membrane is removed, but only superficial (functional layer). After curettage, a germ layer of the endometrium remains in the uterine cavity, from which a new mucous membrane will grow.

For example, every autumn a rose bush is cut to the root and in the spring a new rose bush grows from this root. Actually scraping is like normal menstruation, only performed by the tool. Why this is done - read below.

During this operation scraping is also performed cervical canal(the place where the entrance to the uterus is located). With this, the scraping procedure usually begins - the mucous membrane lining this channel is also scraped off to the germ layer. The resulting scraping is sent for research separately.

Name deciphering.

Scraping- this is the main action during the manipulation, but the manipulation itself can have various titles.

WFD- separate diagnostic (sometimes an addition is used: diagnostic and treatment) curettage of the uterine cavity. The essence of this name: will be fulfilled

separate(first curettage of the cervical canal, then the uterine cavity)

scientific research, which will allow to put accurate diagnosis, “treated” - since in the process of curettage, the formation (polyp, hyperplasia) for which it was prescribed is usually removed.

scraping- process description.

WFD+ GS– separate diagnostic curettage under control hysteroscopy- This is a modern modification of scraping. Conventional scraping is performed virtually blindly. When using hysteroscopy (“hystero” - the uterus; scopia - “look”) - the doctor inserts a device into the uterine cavity, with which he examines all the walls of the uterine cavity, the presence of pathological formations is detected, after that he makes a curettage and at the end checks his work. Hysteroscopy allows you to assess how well the curettage is performed, and whether there are any pathological formations left.

Why are scrapings carried out - testimonies?

Scraping carried out for two purposes: get material(scraping of the mucous membrane) for histological examination - this allows you to put final diagnosis; the second goal is remove pathological formation in the uterine cavity or cervical canal.

Diagnostic purpose:

if a woman has an ultrasound scan mucosal changes- Ultrasound does not always allow an accurate diagnosis, most often we see signs indicating the presence of a pathological process. Sometimes ultrasound is performed several times (before menstruation and after). This is necessary in order to be sure that the pathological formation actually exists, and is not just a variant of the structure of the mucous membrane only in this cycle (artifact). If the formation that was found remains after menstruation (that is, rejection of the mucous membrane) - then this is a true pathological formation, it has not been rejected along with the endometrium, curettage should be performed.

If a woman has profuse, prolonged menstruation with clots, intermenstrual bleeding, long time pregnancy and other, rarer conditions do not occur, and according to ultrasound and other research methods, it is not possible to establish the cause

about uterine fibroids, in which the uterus will be preserved.

Therapeutic goal:

polyps mucous membrane (polypoid growths of the mucous membrane of the uterus) - there is no other type of treatment, they do not disappear with medication or on their own (there will be a separate article on the site)

rong>Synechia

- fusion of the walls of the uterine cavity - is performed using a hysteroscope and special manipulators. Fusions are dissected under visual control

What is the preparation for scraping?

If curettage is not carried out according to emergency indications(as, for example, with uterine bleeding), and in a planned manner, the operation is performed before menstruation, a few days before it starts. This is necessary so that the scraping process itself is practically coincided with the physiological period of rejection of the uterine mucosa(endometrium).

If scraping is carried out in the middle of a cycle or at the beginning - this can lead to prolonged bleeding in the postoperative period. This is due to the fact that the uterine mucosa grows synchronously with the growth of follicles in the ovaries - if the uterine cavity mucosa is removed significantly ahead of time the onset of menstruation, the hormonal background created by the ovaries "come into conflict" with the absence of a mucous membrane and will not allow it to fully grow. This condition is normalized only after synchronization between the ovaries and the mucous membrane again occurs.

It would be logical to suggest scraping during menstruation so that the natural rejection of the mucous membrane coincides with the instrumental one. However, they do not do this, because the resulting scraping will not be informative, as the torn mucosa has undergone necrotic changes.

Before curettage, the patient must pass the following tests(main set):

General blood analysis

you are invited to a small operating room, where you sit on a table with legs, like a gynecological chair. The anesthetist will ask you about any medical conditions you have had and allergic reactions on the medications(prepare for these questions in advance). late, that is, the whole operation, I may dream of pleasant hallucinations - now they are no longer used, although the anesthesiologist's skill in conducting anesthesia is of great importance) to expose the cervix. With special forceps (“bullets” at the ends of this instrument there is a clove) it catches the cervix and fixes it. This is necessary so that the uterus is immobile during the procedure - without fixation, it is easily displaced, as it is suspended on ligaments. ia of the cervix. Expanders are a set of iron sticks of various thicknesses (ascending from thinnest to thickest). These sticks are alternately inserted into the cervical canal - which leads to a gradual expansion of the canal to a size that freely passes the curette - the instrument used for curettage. It is a tool that looks like a spoon with a long handle, one edge of which is sharpened. The sharp edge is scraped. Scraping obtained from the cervical canal is placed in a separate jar. is given after the expansion of the cervical canal, a hysteroscope (a thin tube with a camera at the end) is inserted into the uterine cavity. The uterine cavity, all walls are examined. After this, the uterine mucosa is scraped. If a woman had a curette in the process of curettage. After the curettage is over, the hysteroscope is reintroduced and the result is checked. If something is left, the curette is reintroduced and scraped out until everything is achieved. rong> special instruments are introduced into the uterine cavity and these formations are removed under visual control. ng> forceps are removed from the cervix, the cervix and vagina are treated with an antiseptic solution, ice is placed on the stomach so that under the influence of cold the uterus shrinks and the small blood vessels of the uterine cavity stop bleeding. The patient is transferred to the ward, where she wakes up. Day hospital, and the hospital - discharge is carried out the next day). and discomfort for woman

It takes about 15-20 minutes, on the same day a woman can go home.

Complications of curettage

Generally scraping in the careful hands of a doctor enough safe operation and is rarely accompanied by complications, although they do occur.

Complications of curettage:

Perforation of the uterus- You can perforate the uterus with any of the instruments used, but most often it is perforated with a probe or dilators. Two reasons: the cervix is ​​very difficult to expand and excessive pressure on the dilator or probe causes it to pierce the uterus; another reason - the uterus itself can be greatly changed, which makes its walls very loose - because of this, sometimes the slightest pressure on the wall is enough to pierce it. Treatment: small perforations are tightened by themselves (observation and complex medical measures), other perforations are sutured - the operation is performed.

“flabby” and bullet forceps do not hold well on them - at the moment of tension, the forceps fly off and tear the cervix.

Inflammation of the uterus- this happens if curettage was performed against the background of inflammation, the requirements of septic and antiseptics were violated, and a prophylactic course of antibiotics was not prescribed. Treatment: antibiotic therapy. Hematometer- accumulation of blood in the uterine cavity. If, after curettage, a spasm of the cervix occurs, blood, which normally should flow from the uterine cavity for several days, accumulates in it and can become infected and cause pain. Treatment: drug therapy, bougienage of the cervical canal (removal of spasm) Mucosal injury(excessive scraping) - if the scraping is done very strongly and aggressively, the germ layer of the mucous membrane can be damaged, which will lead to the fact that the new mucous membrane will no longer grow. A very bad complication - practically untreatable.
In general, all these Complications can be avoided if this operation is performed carefully and correctly.. The complications of curettage include situations when, after this operation, all the pathological formation (polyp, for example) or part of it remains in place. More often this happens when curettage is not accompanied by hysteroscopy, that is, it is impossible to evaluate the result at the end of the operation. In this case, curettage is repeated, since it is impossible to leave a pathological formation in the uterine cavity.

After scraping within a few days (from 3 to 10) you may have spotting spotting. If the spotting stopped immediately and abdominal pain appeared, this is not very good, since there is a high probability that spasm of the cervical canal, and formed hematometer. Need to immediately contact your doctor and tell him about it. He will invite you for an ultrasound and if the spasm is confirmed, they will quickly help you.

As hematometer prevention in the first days after scraping, you can take 1 tablet 2-3 times a day.

In the postoperative period, you must appoint small course of antibiotics- it is necessary for prevention inflammatory complications.

Histological examination results are usually ready 10 days after surgery, do not forget to pick them up and discuss with your doctor.

AT imprisonment I would like to point out that scraping is one of the most frequent and most necessary small operations in gynecology. in the treatment and diagnosis of some gynecological diseases can't do without it. This operation is now being rescheduled. very comfortable and perhaps it can be called one of the the most comfortable interventions, which are in gynecology, since you do not experience pain and discomfort. Of course, if you are in careful gynecologist and anesthesiologist ...

Video. scraping

AT gynecological practice diseases of the uterine cavity are widespread, in which it is necessary to perform certain instrumental interventions (therapeutic or diagnostic). Among them is endometrial hyperplasia, which often requires manipulation such as curettage. And for women who are faced with a similar condition, it is extremely important to know what the procedure is, how it is carried out and whether any consequences are possible after it.

The essence of the procedure

Curettage of the endometrium or curettage of the uterine cavity is a fairly common manipulation in gynecology. It refers to invasive interventions performed with intervention in the structure of the genital organs. The essence of the operation is that the doctor, using certain tools, removes the upper (functional) layer of the mucous membrane without affecting the underlying tissues. Then the endometrium is restored on its own in the next menstrual cycle.

Indications

Curettage or "cleansing" of the uterine cavity is performed to identify various diseases as well as their elimination. Therefore, there are two types of procedures: diagnostic and therapeutic. This classification is based on the causes and indications for manipulation. If we talk about the first option, then it is applicable if a woman has the following signs:

1. Irregular periods.
2. Intermenstrual bleeding (metrorrhagia).
3. Abundant and prolonged menstruation (menorrhagia).
4. Pain during menstruation (algomenorrhea).
5. Uterine bleeding in menopause.
6. Difficulty conceiving a child (infertility).
7. Suspicion of a malignant pathology (cancer of the body of the uterus).

Very often in women there is an overgrowth of the mucous membrane of a benign nature: diffuse or focal. Therefore, diagnostic curettage of the uterine cavity with endometrial hyperplasia is a widespread procedure. It is necessary for many women awaiting confirmation of the pathology. And in medicinal purposes gynecological "cleaning" is performed not only with hyperplasia, but also in the following cases:

• Submucosal (submucosal) fibroids.
• Polyps of the cervix and body of the uterus.
• Endometritis.
• pathological childbirth.
• Non-developing and ectopic pregnancy.
• Spontaneous abortion (incomplete).

And with the help of the scraping procedure, these conditions can be quite successfully treated. Meanwhile, the manipulation in question is also one of the methods of artificial termination of pregnancy. And despite the fact that in recent times more and more other methods are used (vacuum aspiration and medical abortion), its relevance has not been completely lost.

Not only endometrial hyperplasia, but also other conditions, both gynecological and obstetric, are considered indications for performing curettage.

Contraindications

In addition to indications for curettage, it is important to take into account the conditions that limit the procedure. These include acute infectious and inflammatory diseases in the vagina and cervix, in order to pathological process did not spread higher - to the uterus. But this does not apply to cases where curettage must be done due to endometritis and against the background of a delay in the evacuation of the placenta during childbirth.

Training

In order for curettage with endometrial hyperplasia to go smoothly, it is necessary to prepare well for it. Firstly, the procedure is performed in the second phase of the cycle - this allows you to reduce the severity of bleeding. Secondly, a qualitative examination of the woman is required, which includes:

• General blood and urine tests.
• Blood biochemistry (coagulogram, antibodies to infections, hormones).
• Vaginal smear (microscopy).
• Bakposev secretions.

This is necessary to take into account the likely concomitant pathology, which can become an obstacle to curettage or complicate the course postoperative period. And thirdly, there are several conditions that a woman must comply with before manipulation. These include the following:

• Stop using medicines(Tell your doctor if you are taking medication.)
• Refrain from sexual intercourse.
• Refuse to use funds for intimate hygiene, douching, vaginal suppositories and tablets (if not agreed with the doctor).

The first condition should be fulfilled 2 weeks before scraping, and the rest - within a few days before it. In addition, immediately before the operation, the patient should exclude food and liquid intake (during the last 12 hours), having come to the doctor on an empty stomach. This is necessary for the successful implementation of anesthesia.

Performing a procedure

The main question of concern to patients concerns how the endometrium is scraped. This procedure is performed in a hospital - in a small gynecological operating room. Since it is quite painful, before the manipulation, the woman must be introduced into short-term anesthesia by intravenous administration anesthetics. Exceptions are cases when the cervix is ​​already dilated - after childbirth or spontaneous abortion. Then general anesthesia is not required.

The first stage of the procedure is the opening of the cervical canal. This is done with a special metal tool (Hegar dilators). They have a different diameter, which allows you to gradually achieve the required opening. The next step is the direct scraping of the mucous membrane with a surgical spoon (curette). But another method can be used - suction with a vacuum aspirator. Just before inserting the instrument, it is necessary to probe the uterine cavity, setting its length and location (it happens, for example, to bend the body back).

All manipulations can be performed blindly, but hysteroscopy-guided surgery is considered the best alternative. This allows you to see everything that is happening and determine exactly which areas require scraping. In parallel, a biopsy can also be performed - taking material from a tumor or other formation. In addition, endometrial hyperplasia may require separate scraping: first, the uterine cavity is cleaned, and then the cervical canal. It is necessary for more accurate diagnosis, because the neck is also affected by proliferative processes. In this case, the obtained material is placed in different containers for further histological examination.

Curettage is performed in several stages and recently only under histological control.

Effects

Since curettage is accompanied by the removal of the surface layer of the endometrium, it takes a certain time to restore it. And it passes pretty quickly - almost the same as after normal menstruation. But given the surgical damage to the mucous membrane, a woman may still be disturbed by unsharp pains in the lower abdomen and discharge. First, blood clots come out of the uterus, then a bloody, sanious fluid, and finally, everything returns to normal (after 7–10 days). If a woman is worried severe pain, then you can take a non-steroidal anti-inflammatory drug (ibuprofen, ketoprofen). Other treatment after curettage is not welcome.

Menstruation comes a little later - after 4 weeks or more. But if the delay is more than 3 months, then you should consult a doctor. A visit to the gynecologist is also necessary in case of prolonged discharge, with intense pain and noticing an increase in body temperature. Then we can talk about complications:

• Uterine bleeding.
• Inflammatory process (endometritis).
• Accumulation of blood in the uterus (hematometra).

AT early period after the operation, as well as during it, iatrogenic damage to the organ is likely - perforation with a curette, probe or dilator. This can occur due to inept and rough manipulation without hysteroscopic control. And over time, adhesions or scars often form in the uterine cavity, which prevent the implantation of the embryo, thereby leading to infertility.

After the successful completion of scraping, a woman should still take care of her own body for some time, giving her the opportunity to recover. Therefore, doctors recommend adhering to the following restrictions for 2 weeks:

• Refrain from sexual contact.
• Stop using tampons and douches.
• Exclude thermal treatments(visiting a bath or sauna) and taking a bath.
• Protect yourself from intense physical activity.
• Do not take blood thinners (aspirin, heparin).

Another issue that worries women is pregnancy after scraping. But it cannot be answered unambiguously. It all depends on the reason for the procedure. A slight hyperplasia of the endometrium without pronounced changes in the ovaries is not an obstacle to the conception of a child. This can happen as early as the next ovulation.

To avoid adverse consequences after curettage, you should trust only experienced doctors and follow all recommendations regarding the recovery period.

Alternative Methods

With pathology of the endometrium, treatment consists not only in curettage of the uterine cavity. There are other methods, primarily conservative correction. They aim to restore normal hormonal background and suppression of proliferative processes. Therefore, the treatment of endometrial hyperplasia without curettage may include taking certain medications. The structure of therapy primarily includes such drugs:

1. Progestins and gestagens (Microlut, Provera).
2. Estrogen-gestagenic (Mersilon, Jess, Divina).
3. Antiestrogens (Fareston, Novofen).
4. Gonadotropin inhibitors (Danol, Nemestran).
5. Analogues of gonadorelins (Decapeptyl, Buserelin).

They can be used both in isolation and administered after curettage. In the latter case, the effect is much greater. In addition, other groups of drugs can be used, such as immunomodulators and antioxidants.

Thus, curettage of the uterine cavity is a necessary manipulation for the diagnosis and treatment of many diseases, including hyperplastic processes endometrium. This is a relatively simple procedure, but it requires high-quality and careful performance, good preparation, taking into account indications and restrictions, as well as adherence to a certain regimen in recovery period. This will avoid adverse effects and ensure success in treatment.

Content

Curettage (curettage) is gynecological surgery, during which the doctor, using special tools, removes the mucous membrane - the functional upper layer of the uterine cavity. The procedure is carried out for both diagnostic and therapeutic purposes.

The appointment of diagnostic curettage of the uterine cavity is justified if it is necessary to take material for a histological examination. Traditional curettage of the cavity is practiced in order to remove the altered endometrium, pathological neoplasms, as well as when extracting gestational sac(abortion).

Consequences of curettage

Since curettage of the uterus is a traumatic operation, it may have certain adverse effects. Conventionally, they can be divided into postoperative and long-term complications.

Intense bleeding

Curettage of the endometrium can have quite serious consequences. Since the uterine mucosa is permeated with many blood vessels, then when removing the endometrium, the risk of bleeding is not excluded. The reason is inaccurate work with a curette, which provoked deep damage to the walls of the organ.

Tissue debris can also cause bleeding. This is a serious condition requiring medical intervention. Either repeated curettage of the uterine cavity, or the use of hemostatics (hemostatic drugs) is prescribed.

Perforation (breakthrough) of the walls of the uterus

Violation of the integrity of the walls of the uterus can be obtained using any of the medical instruments involved. The causes of perforation are increased friability of the walls, insufficient expansion of the cervical canal.

Perforation of the uterus is life threatening condition. In case of late delivery medical care peritonitis develops and internal bleeding. An operation is prescribed, during which sutures are applied to the area of ​​​​the gap. AT severe cases remove the uterus.

Cervical injury

With the existing stenosis (pathological narrowing) of the cervix, the risk of irreversible damage is high. It's pretty serious consequence negatively affecting the possibility of bearing a child.

Neck tear is not ruled out. The cause of the damage is the disengagement of the bullet forceps used to facilitate the opening of the cervical canal.

A prerequisite for injury is the flabbiness of the tissues, so the tool slips during tension. It is this sudden movement that causes the neck to tear. Minor injuries heal on their own without prescription drug therapy, but significant damage requires suturing.

Formation of adhesions

Curettage of the uterine cavity may have long-term effects. One of the most common is the formation of synechia (adhesions).

When the uterine cavity is scraped, the entire upper layer of the endometrium is removed, which severely injures the organ and provokes the development inflammatory process. It is with curettage that the risk of adhesive disease in the future is especially high.

If a woman does not follow the recommendations of doctors regarding the postoperative period, then the development of Asherman's syndrome is not excluded - a rather serious consequence of curettage of the endometrium. The condition is characterized by the formation of numerous synechiae and cicatricial changes that can lead to deformation of the uterus.

The adhesions formed after curettage of the endometrium are characterized as follows.

• The place of localization is the internal cavity of the uterus.
• Synechia look like thin bridges connecting opposite walls of the organ.
• Spikes after curettage can also form outside the organ. Violation of the integrity of the uterus, the spread of inflammation from the uterine cavity to the fallopian tubes, peritoneum and ovaries can cause the formation of connective tissue cords that envelop all internal genital organs. Such a violation of the integrity of the walls and inflammation can lead to pelvic peritonitis, significant inflammation and bleeding. With the development of such consequences of curettage, adhesive disease can affect any pelvic organs.
• Adhesions can be an obstacle to fertilization and gestation. Sometimes after scraping, the endometrium is replaced connective tissue, which reduces its "useful" area. In the future, a woman may have difficulty fixing a fertilized egg. An increased risk of developing ectopic pregnancy, premature detachment of the chorion and other pathologies.

Cycle disorders

Excessively heavy or scanty monthly bleeding and intermenstrual daubing after the performed curettage against the background of a general deterioration in the condition require a consultation with a gynecologist.

Hematometer

This condition is typically characterized by an accumulation of blood inside the uterus after the procedure is completed. It causes excessive spasm of the cervix, which makes it difficult to evacuate its contents. To relieve spasm and restore the process of outflow of blood, drugs are prescribed.

What is the danger of hematometers? The blood lingering in the uterine cavity becomes a substance favorable for the reproduction of pathological microorganisms.

The main and most dangerous consequences hematometers become:

• endometritis;
• metroendometritis;
• pyometra (purulent endometritis);
• pyosalpinx;
• pelvioperitonitis.

The development of such conditions can cause infertility, as well as lead to the removal of the appendages and the uterus itself. The formation of sepsis is not excluded.

For carrying a hematometra pregnancy without complications in the form of inflammatory processes, is not an obstacle.

Germ layer trauma

Injury to the germ layer of the endometrium during curettage is one of the most serious consequences of the procedure. Excessive movements of the curette, as well as non-compliance with the rules for performing scraping, can cause injury. The danger of injury lies in the development of infertility and menstrual irregularities.

The mucous membrane of the uterus at the site of damage to the growth layer of the endometrium no longer grows. In the future, because of this, difficulties may arise with the attachment of a fertilized egg.

endometritis

The disease is an inflammation of the inner layer of the uterus.

Infection and the formation of an inflammatory process in the organ cavity, as a consequence of curettage, develops in three cases.

• After performing the procedure to remove the endometrium against the background of existing inflammation.
• If physicians do not comply with the rules of asepsis and antisepsis. Infection of the endometrium as a result of medical negligence is not excluded - poorly sterilized instruments, dirty gloves and other reasons.
• Irrational antibiotic therapy after manipulation.

Signs of inflammation of the endometrium are discharge of a dirty yellow color, accompanied by bad smell, detachable type of meat slops. It is possible that the temperature rises to high numbers and soreness in the lower abdomen.

In this case, a treatment regimen is applied aimed at stopping the inflammatory process and preventing chronic infection.

Complications after anesthesia

Complications can develop in the form of the body's response to the administration of painkillers and narcotic drugs. But the risk of such problems is minimal, because before the start of the operation, the anesthesiologist conducts a conversation with the patient. The specialist selects anesthetics based on the information received from the woman.

Diagnostic curettage

Separate diagnostic curettage (RDV) of the uterine cavity takes place in two stages:

• curettage of the cervical canal of the cervix;
• scraping of the uterine mucosa.

Diagnostic curettage of the uterine cavity also has adverse effects. Complications with RFE will be the same as with traditional curettage of the endometrium.

But to the already considered consequences of scraping, it is worth adding an incomplete extraction pathological education, which became the reason for cleaning the uterine cavity and removing the endometrium.

The reason for this complication is the implementation of curettage of the uterine cavity without visualization (hysteroscopy). In this case, curettage is performed again.

To avoid severe consequences after scraping the endometrium of the uterine cavity, compliance with all medical recommendations will help. Antibiotics are prescribed to prevent inflammation.

Curettage of the uterine cavity (curettage) is what many women know about this procedure. It is performed for different purposes: to terminate an unwanted pregnancy, treatment, diagnosis of gynecological and oncological diseases. When a curettage of the uterine cavity is done, the specific day of the cycle depends on the reason why the doctors prescribed this small surgical intervention. In the case of pregnancy, it is performed for a period of more than 7 and less than 12 weeks. If the goal is to stop intermenstrual bleeding - regardless of the day of the cycle. They try to prescribe diagnostic curettage of the uterine cavity for the last 1-2 days of the menstrual cycle so as not to disturb it. Thus, the woman seems to start menstruating a little earlier.

Some indications for curettage of the uterine cavity:

• fibroids with suspected atypia and (or) before its removal;
• endometrial hyperplasia;
• frozen pregnancy, first trimester;
• unwanted pregnancy up to 12 weeks;
• endometrial polyp;
• suspected endometrial cancer.

Curettage of the uterine cavity during bleeding is usually performed if a woman is diagnosed with endometrial hyperplasia on ultrasound. Thus, the procedure also has diagnostic value. If the doctor suspects hormonal cause uterine bleeding - he may prescribe hormonal preparations or hemostatic. That is, curettage of the endometrium of the uterine cavity is not a priority procedure, since it has not only positive aspects, but also negative ones. So, during it, the doctor may accidentally injure the uterus or cervix, which during pregnancy can result in a threat of miscarriage. There is still a high probability of an inflammatory process developing in the uterus, especially if the woman did not take antibiotics after the procedure. These are the consequences of curettage of the uterine cavity, but if it is performed strictly according to indications, then the risk of complications is much lower than the risk to which a woman exposes herself by refusing the procedure.

With a polyp, therapeutic curettage of the uterine cavity helps not only to avoid further uterine bleeding arising from his presence, but also to conceive a child. A polyp in the uterus acts as an intrauterine contraceptive. After its removal, women get pregnant.

But instrumental abortion, on the contrary, leads to infertility. Not only is the uterus injured, but also hormonal disbalance happening. Because of him, a woman is disturbed menstrual cycle, amenorrhea occurs, ovulation disappears. Therefore, women who do not have children, doctors gently try to dissuade them from terminating their pregnancy. There are many public organizations dealing with this issue.

Pregnancy after curettage of the uterine cavity is recommended to plan at least 3 months later. It is believed that by this time the endometrium should "recover". At the time of this recovery, oral contraceptives are prescribed to normalize the hormonal background. By the way, cancel hormonal contraceptives and pregnancy comes easier. This property of drugs has long been known and widely used by doctors.

Possible pregnancy in more short time. For example, if a woman is over 35 and this procedure eliminated her cause of infertility or miscarriage. But one way or another, while there is a discharge after curettage of the uterine cavity, sex life prohibited. That is, for about 14 days after cleaning, you need to refrain from intimacy, since it can become a provocateur of the onset of an infectious process.

One remained undiscovered important question- how painful is curettage of the uterine cavity and cervical canal. You can often hear from experienced women that this is an extremely painful procedure. Yes, it is, but only if performed with a weak, local anesthesia or without it at all. Particularly painful is the opening of the cervix, although curettage of its cavity is also very unpleasant and palpable. Fortunately, now in most hospitals, general intravenous anesthesia is performed free of charge or for a fee. The woman sees absolutely nothing, does not feel, is unconscious. And after the procedure, he quickly recovers and in almost all cases he can go home on his own the same day.