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ilation And Curettage ( &C)

Definition with Rationale The gradual enlargement of the cervical os and the curetting

(scraping) of endometrial or endocervical tissue for histologicstudy.

Hysteroscopy is the visual inspection of the interior of the

uterus through an endoscope. This procedure has not een found to ereliale in the diagnosis of tual pathologic conditions.

iscussion The procedure is usually performed to!

1 To

diagnosed cervical or uterine malignancy.

2 To control dysfunctional uterine leeding.

3 To complete an incomplete aortion.4 To aid in evaluating infertility.

5 To relieve dysmenorrheal.

"ractional D&C procedures can assist in differentiating etween

endocervical and endometrial lesions.

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#ositioning $ithotomy% arms may e etended on armoards.

#ac's rapes ynecologic pac'

*nstrumentation D&C tray

+upplies ,-uipment

#added stirrups

Telfa

#erineal pad

+uction

$uricant

#rocedure verview6 A weightened speculum is placed in the vaginal vault.

7 The cervi is grasped with a tenaculum.

8 A graduated sound is passed through the cervical canal into the

uterine cavity to determine its depth and angulation.

9 /sing Hegar or Han' dilators0 the surgeon egins to dilate thecervical opening0 increasing the si1e of each dilator.

10 A Telfa sponge is placed over the ill of the weighted speculum0

and the uterus is gently curetted0 allowing the tissue specimen tocollect on the Telfa sponge.

11 The small serrated curette is used to scrape the uterine walls

again or when the D&C is performed to remove retained placentaltissue0 while the large0 lunt curette and forceps are used to remove

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the tissue.

12 *f a fractional D&C is performed0 endocervical curettings are

otained efore the uterus is sounded0 to avoid ringing endometrialcells into the cervical os.

13 The weighted speculum is removed0 and the perineum is dressed with

a perineal pad.

#erioperative 2ursing Considerations14 +tirrups should e padded0 and a coccygeal support placed on the

tale to protect the lower sacral area.

15 Raise and lower the legs together and slowly to prevent

disturances caused y rapid alterations in venous return and orin3ury to the rotator hip 3oint.

16 *nstruments are set up on the lac' tale in order of usage0 a

scru person may not e necessary during the procedure.

*f a fractional D&C is performed0 multiple specimens may eotained. They should e placed in separate containers0 and laeledaccordingly.

ilatation and Curettage 4 #ost perative Care

Postoperative care involves the precautions that we need to follow aftera Dilatation and Curettage (D&C) procedure.

The precautions that need to followed after the surgery are!

+ome cramping or mild adominal discomfort is considered usual after aD&C0 consult the doctor if the pain is severe.

5edications should e ta'en as per the prescription of the doctor.

,nsure to ta'e the entire course of antiiotic.

Refrain from the use of internal tampons and seual intercourse foraout a wee' or as advised y your doctor.

/se sanitary nap'ins during this time period.

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*f there are any signs of infection such as fever0 pain or dischargeconsult the doctor immediately.

Read more:Dilatation and Curettage - Post Operative Care | Medindiahttp://www.medindia.net/surgicalprocedures/dilatation_curettage_postoperativecare.htm

i!""#$%dc&'l(

ilation (or dilatation) and curettage ( &C)is a gynaecologicalprocedure done y widening or opening the cervical canal and surgicalremoval of the uterine lining or uterine contents y scooping andscrapping (with the use of sharp curette) or suctioning (suctioncurettage) .

*t is a minor surgery done in amulatory or outpatient surgery clinics

or hospital. &Cis considered to e either a diagnostic or therapeuticprocedure depending on cases. *t can e diagnostic if it pertains todetermination for gynaecological prolems or malignancy (iopsy).therwise0 it may e therapeutic if it used to halt leeding fromendometrial hyperplasia0 endometrial polyps or myomas and sometimesecause of first trimester aortions.

A physician may refer a client for D&C if she complains of menorrhag a'nown as ecessive amount or duration of cyclic menstrual leeding0metrorrhag a0 termed as uterine leeding etween menstrual period andmost especially if she may eperience the so called postmenopausalleed ng. These manifestations could e a symptom for severalconditions which should not e ignored0 li'e polyps0 myoma (enignneoplasm of the uterus)0 or in some0 endometrial cancer . Thus0 this minorprocedure is often used in line with hysteroscopy in order for thephysician to view the uterus for presence of some anormal growths.

Dilation and curettageis performed with anesthesia. Depending on caseto case asis0 local0 spinal or general anaesthesias are used to allowthe client to e unaware of pain involved during the procedure.

The physician and the nurse oth have an important role for providinghealth teachings on the preparation prior to procedure and the thingsthat will happen during it. *t is est to provide comfort and support to

the client to relieve her fears aout D&C and its results. Thefollowing preparations are made prior to &C! Assessment of other medical conditions li'e cardiopulmonary

diseases0 pelvic infection and leeding tendencies.

The client will undergo various tests li'e urinalysis0 routine

lood analysis and other diagnostic tests to ma'e sure that theclient has no other illnesses that could hinder or complicate the

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procedure.

Days prior to D&C0 the client is advised not to ta'e any

unnecessary medications li'e aspirins0 or ta'e some alcohol.

+he is also advised not to ta'e food or fluids 6 to 7 hoursprior to procedureto avoid aspiration of gastrointestinal contentswhile under anesthesia.

An informed consent is properly otained to ensure that the client

understood and familiari1ed herself of the entire process and thethings she would epect from the procedure.

*t is performed in an operating room with strict maintenance of asepsis.The client is given the anesthesia and positioned with ac' lying andoth legs fleed (li'e the position for #ap smear). The client is thenprepped and draped properly. *f the client is under general anesthesia0her vitals are eing monitored y an anesthesiologist or an anesthesianurse. During the procedure0 the cervical canal is eing dilated0 ywhich aftermath is eing hold open y a speculum. Curettage ta'es place

y introducing a sharp curette to scrape or scoop the endometrial liningor uterine contents.

D&C would only last for more or less 89 to :9 minutesand after theprocedure the client may epect to eperience some discomforts li'ecramping sensations and light leeding which could last from half anhour to a day or days in some. &nalgesics li'e 2+A*Ds are usuallyadministered to relieve pain and the client is still eing monitored andplaced in a recovery room after it for an hour until she may ale tomove her lower etremities or until she is stale. +ince this procedureis done as an outpatient surgery0 the client may e allowed to go homethe net day if no untoward reactions occur. n the other hand0 if the

client e discharged0 she will e not allowed to drive within 8; hoursecause drowsiness may still ensue due to anesthetic effects.

espite eing a safe gynaecological method0 some complications maye encountered. *ntroduction or spread of infectionespecially for client with

pelvic infection which could e spread y the instruments used toother reproductive organs.

/terine perforationwhich could e detected y hemorrhage. This is

due sometimes to the use of the sharp curette.

*ntrauterine adhesionswhich could e referred to as

Asherman

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imaging procedures li'e ultrasound and hysteroscopy. The =H evenrecommends this method only if manual vacuum aspiration is unavailale.This procedure may e lin'ed to aortions ut let it e 'nown formanagement of aortion complications.

)ursing care plan may involve nursing prolems li'e fear0'nowledge deficit0 health see'ing ehavior0 volume fluid deficit andpain. *t is very helpful to educate0 too0 the client to watch out foranormal symptoms after the procedure0 li'e!

17 "ever

18 "oul smelling discharge from the vagina

19 ,cessive leeding which may e prolonged in duration

20 ,cessive and persistent pain which is not relieved y any pain

medications

References!>tasnice? >tanice title@B? lic'man0 . . (EEF). #hatom 2otes2ursing! 5aternal4 2eworn st ,dition. *nfo Access & Distriution #te$td. Gagins'i0 $. (8997). Dilation and Curettage. Retrieved last uly8:0 898 from www.medicinenet.com +toopler0 5. & Davis0 C. Dilation andCurettage (D&C). Retrieved last uly 890 898 fromhttp!www.emedicinehealth.com >tanice? >tasnice?

4 +ee more at! http!rnspea'.commaternal4child4nursingdilation4and4

curettagesthash.+h5I-d.dpuf

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