Unfortunately, not every pregnancy, even the most long-awaited one, ends in the birth of a healthy baby. There are cases when a child dies in utero. This can happen to any woman, as there are many factors that lead to fetal failure. Fortunately, this happens in most cases.

In this article we will talk about such a method of treating a non-developing pregnancy as curettage of the uterine cavity.

information It is usually performed from 7 to 12 weeks of pregnancy. The method consists of removing the frozen fetus along with its membranes and cleaning the inner layer of the uterus.

Contraindications for surgery

There are contraindications for curettage, which can lead to serious complications. These include:

• Various diseases of the body in the acute stage (diseases of the cardiovascular system, blood and others). To perform the operation, it is necessary to especially carefully prepare the woman for anesthesia.
• Infectious processes of the female genital organs (colpitis, vaginitis, inflammation of the appendages), as there is a risk of spread of the inflammatory process. It is necessary to sanitize the genital tract locally (vaginal suppositories and tablets) and systemically (antimicrobial drugs).
• Acute bacterial and viral infections (pneumonia, influenza and others).

Preparing for curettage of the uterine cavity

additionally Before the procedure, general clinical examinations are performed (general blood and urine tests, blood group and Rh factor are determined, an electrocardiogram is taken, a smear from the cervix, urethra and posterior fornix, a test for syphilis, a biochemical blood test).

A woman needs to shave all the hair from her external genitalia and take a shower. The day before curettage, you should avoid eating heavy meals and eating foods that cause increased gas formation in the intestines. The operation is performed on an empty stomach, the last meal should be no later than 6 hours before. Otherwise, if it is necessary to urgently perform curettage during a frozen pregnancy, gastric lavage is performed.

Before curettage in case of a non-developing pregnancy, it is advisable to prepare the cervix, especially in nulliparous women. This is done to gradually expand it and reduce trauma. To prepare the cervix, kelp (algae sticks) is used. They are inserted into the cervical canal, where, under the influence of the secretion, the kelp swells and expands it. They must be administered the day before the procedure.

It is also mandatory to consult and examine an anesthesiologist who will administer anesthesia, and an obstetrician-gynecologist.

How is the operation performed?

important The operation is performed on a gynecological chair under general anesthesia (in the absence of contraindications to it) on an empty stomach.

Immediately before curettage, the woman is examined by a gynecologist to assess the size of the uterus, its location, and treats the external and internal genital organs with disinfectant solutions. After the anesthesia takes effect, the obstetrician-gynecologist begins to expand the cervical canal with special instruments (dilators). Next, using a curette (a gynecological instrument similar to a spoon with a hole inside), the cleaning itself is carried out. The contents of the uterus and the upper layer are removed. During the operation, substances that contract the uterus are injected. The procedure itself lasts about 15 minutes. The woman usually wakes up in the ward.

Recovery after surgery

Rehabilitation after a non-developing pregnancy and curettage of the uterine cavity is very important. It includes:

• Prescribing antibacterial drugs to prevent infectious complications.
• Taking hormonal contraception for at least 3 months. This will normalize hormonal levels and allow the reproductive system to rest.
• Sexual rest for a month after curettage to prevent infection on the unprotected wound surface of the endometrium.
• An examination by a gynecologist and an ultrasound examination are required to exclude any remaining membranes.
• A subsequent pregnancy can be planned no earlier than 6 months after cleansing.

Menstruation most often occurs within a month after cleansing during a frozen pregnancy, but it can begin after 2 weeks and after 6-8 weeks.

Possible complications

As with any, even the most harmless and easy operation, there is also a risk of complications. In the case of curettage, these include:

• Inflammatory processes. The uterine mucosa after curettage is similar to a wound surface. Therefore, any entry of a pathogen can lead to the development of inflammation of the endometrium (endometritis). Signs of endometritis are pain in the lower abdomen, increased body temperature, poor uterine contractions, incessant discharge from the genital tract, and an unpleasant smell of discharge.
• Bleeding. It can develop during curettage, immediately after it, or after some time. The cause may be poor contraction of the uterus, remnants of the fertilized egg and its membranes, and disorders in the blood coagulation system. Heavy bleeding can lead to anemia, so if there is heavy bleeding, you should consult a doctor.
• Perforation of the uterine wall. It is the most serious complication that may require abdominal surgery. Fortunately, this rarely happens. Most often, its cause is the presence of deformation of the uterine cavity, myomatous nodes, structural features (saddle uterus).
• Remnants of membranes. Curettage of the uterus is carried out as if blindly. An obstetrician-gynecologist, when performing cleaning, is guided by his feelings and experience. However, sometimes it is not possible to remove parts of the membranes in the most inaccessible places, especially if the woman has any anatomical features. Therefore, it is important to do an ultrasound check after curettage to ensure that there are no residues. Typically, the symptoms of this complication are incessant bleeding, the uterus remains slightly larger than normal size.
• Adhesive processes in the uterine cavity. Since curettage is the removal of the surface layer of the endometrium along with pregnancy, there is a possibility of damaging its basal layer if handled too roughly. In rare cases, for this reason they can develop in the uterine cavity. They can interfere with the implantation of pregnancy, which leads to infertility.

In this article we will talk about the well-known therapeutic and diagnostic gynecological procedure - curettage or cleansing of the uterus. We will tell you how to clean the uterus, what the indications for this procedure may be, whether there are complications after cleaning the uterus, and how to restore the uterus after cleaning.

Cleaning the uterine cavity

Curettage or cleaning of the uterus has been one of the most popular diagnostic methods in gynecology for decades. Curettage can be diagnostic - in order to obtain scrapings - materials for laboratory research, or therapeutic. Today, diagnostic treatment is rarely prescribed. It is increasingly being replaced by safer hysteroscopy, but therapeutic curettage is as popular today as in previous years.

Reasons for prescribing uterine cleansing may include:

• development of myomatous nodes;
• pathological processes in the endometrium;
• suspicion of malignant neoplasm;
• bleeding. In recent years, cleaning the uterus during bleeding is prescribed less and less, but a few years ago this method was quite popular;
• polyps;
• treatment of complications after childbirth or abortion;
• preparation for surgery to remove fibroids.

In essence, curettage is the removal of the upper, functional layer of the uterine mucosa.

If curettage of the uterus is carried out as planned and not emergency, the procedure is done before the onset of menstruation. This is done in order to minimize the negative impact of mechanical damage to the uterine mucosa, because menstruation is a process of rejection of the upper layer of the mucosa, and therefore a process similar to curettage.

To improve control over the operation, gynecologists use a hysteroscope, which is inserted into the uterine cavity during surgery.

Cleaning the uterus: consequences

The difficulty of carrying out this procedure lies not only in the need for careful and accurate implementation, because the slightest carelessness or roughness can damage the walls of the uterus and lead to undesirable consequences, in particular, perforation of the walls of the uterus. The point is that the uterine cavity is quite difficult to scrape out completely. Some areas remain practically inaccessible for manipulation, and yet it is in such areas that the development of various kinds of pathological processes is most often observed.

For several days after the procedure, the woman may experience slight bleeding (spotting). They can last up to 10 days. If there is no discharge, but abdominal pain is observed, you should immediately consult a doctor. Perhaps the cervix is ​​spasmodic and has formed there - blood has accumulated in the uterine cavity.

There is also the possibility of developing inflammation, myomatous nodes, the development of uterine adhesions, or exacerbation of chronic diseases.

If you notice an increase in temperature and pain after cleaning the uterus, consult your doctor.

What to do after cleaning the uterus?

As a preventive measure for cervical spasm, drotaverine (no-spa) is prescribed, 1 tablet 2-3 times a day. Also, after the operation, a course of antibiotics is prescribed (not too long). This is done to prevent inflammation of the uterine cavity.

The patient is also advised to rest; if possible, it is advisable to reduce physical activity to a minimum.

In general, curettage is a fairly safe procedure, the effectiveness of which has been proven over the years. But, as with any other medical procedure, the most important thing is to choose a highly qualified and careful specialist to carry it out.

Content

Cleaning or curettage of the uterine cavity is a minor surgical intervention. This operation is performed for a number of medical indications or for diagnostic purposes; in terms of complexity, it can be compared to a medical abortion.

Undoubtedly, the need to perform curettage of the uterine cavity can frighten every woman. However, modern methods of performing the procedure are completely painless and the likelihood of complications with them is minimal. If the outcome is favorable, the patient goes home on her own within a few hours. And regular monitoring with your gynecologist will prevent the development of any complications.

Indications

In order to understand in what cases uterine cleaning is prescribed, you should determine its type. There are two types of curettage – diagnostic and therapeutic.

Therapeutic cleansing is prescribed in the following situations:

• with surgical hemostasis (heavy and prolonged bleeding);
• when the remains of the placenta are detected in the uterus after childbirth;
• as a result of the accumulation and stagnation of blood clots in the uterine cavity;
• for endometrial hyperplasia and polyps, medical cleaning is often prescribed;
• abortion for medical reasons, for example, due to fetal pathology or frozen pregnancy;
• after a miscarriage;
• in case of detection of fetal remains as a result of a poorly performed abortion;
• with adhesions and various adhesions in the uterine cavity.

Diagnostic cleaning of the uterine cavity is carried out in the following cases:

• with difficulties in getting pregnant;
• female infertility;
• with too long and heavy menstruation;
• if there is a suspicion of malignant tumors in the uterine cavity;
• with irregular menstruation, constant spotting, intermenstrual bleeding;
• detection of changes in the endometrium on ultrasound also becomes an indication for diagnostic curettage;
• uterine fibroids.

There are two main goals carrying out curettage: obtaining the material necessary for research (diagnostic cleaning) or removing pathological formations (therapeutic cleaning).

How is it carried out?

After conducting all the necessary examinations and collecting tests, the gynecologist determines the need for the procedure.

The cleaning itself takes place mainly under general (less often local) anesthesia, and the patient does not experience any unpleasant or painful sensations.

At the beginning of the procedure, the specialist dilates the cervix as much as possible using gynecological instruments. After achieving the required dilation, using a spoon-shaped curette, the doctor scrapes out the uterine walls.

Tissues that have been excised from the uterine cavity are collected for further microscopic examination.

Alternative procedure

Despite the fact that it is the most effective method of combating many diseases and pathologies, the operation may carry a certain risk to a woman’s health. Therefore, today most doctors turn to this method only in extreme cases, preferring to replace it with alternative methods.

Undoubtedly, for such pathological conditions in gynecology as spontaneous abortion, curettage is the only acceptable method of treatment. And, for example, in case of bleeding, it is much safer and cheaper to perform an endometrial biopsy, instead of complex and expensive cleaning.

It is carried out directly in the gynecologist’s chair, the intervention to which the patient is exposed is minimal. Anesthesia is not required during the procedure, which will undoubtedly have a more positive effect on health.

If alternative methods are ineffective, gynecological cleansing of the uterus has to be performed.

It should be remembered that not a single method: alternative or curettage of the uterus, protects the patient from the possible occurrence of complications. If they occur, you should immediately consult a doctor.

Complications

After surgery, quite rarely, but it is possible that a number of complications may arise.

• Perforation (tear of the uterus). During surgery, medical instruments can damage the walls of the uterus. Especially large injuries require sutures.
• Hematometra. Accumulation of blood clots as a result of cervical spasms can lead to infection. This condition requires additional treatment.
• Inflammation of the uterine cavity. It is believed that this complication is caused by insufficient compliance with sanitary standards. The main symptom of inflammation is increased body temperature after the procedure. The condition is relieved by taking antibiotics.
• Damage to the endometrial layer. A rather dangerous complication that is difficult to treat. Often the endometrium damaged as a result of curettage cannot be restored.
• Cervical tears. The cause of the tear is often slipped gynecological forceps. Especially large tears are sutured, small ones heal on their own within a few weeks after surgery.
• Poor cleaning. The formations that needed removal were not completely scraped out or appeared again. This condition, unfortunately, requires repeated cleaning.

When choosing a specialist who will perform the operation, you should pay attention to his experience and qualifications. As a rule, proper and careful cleaning by a qualified professional avoids most complications.

Signs

If the following symptoms appear after a gynecological procedure, you should immediately consult a doctor. Signs of complications include:

• severe abdominal pain that is difficult to relieve with painkillers;
• nausea and dizziness;
• bleeding;
• weakness, fainting;
• unpleasant, putrid or excessive discharge.

For a quick recovery, as well as to prevent inflammation, antibiotics are prescribed after gynecological cleansing. To prevent uterine bleeding, a course of Oxytocin in the form of injections may be prescribed.

For two weeks after surgery, you should follow basic precautions: avoid heavy physical activity, use of tampons, douching, and sex.

In gynecology and obstetrics, a procedure is performed to cleanse the uterus. This operation is far from safe, since various consequences may occur after cleaning the uterus.

Reasons for cleaning the uterus

In obstetrics, curettage of the uterine mucosa, as well as its contents, is carried out in the following cases:

• Termination of pregnancy in the early stages (up to 12 weeks),
• Postpartum period (removal of the placenta remaining in the uterine cavity),
• After an unsuccessful late pregnancy termination,
• Polyps,
• Preparing for removal surgery,
• Suspicion of malignancy,
• Pathological processes in the endometrium,
• Incomplete miscarriage.

In gynecology, curettage is carried out for the diagnosis and treatment of various female diseases, for example, polyps on the cervix or in its cavity, uterine bleeding of various kinds.

The process of cleaning the uterus

To clean the uterus, the patient is seated. After this, the narcologist administers anesthesia intravenously. After the anesthesia takes effect, the gynecologist treats the inner thighs, anus and external genitalia with an antiseptic (alcohol or iodine). Next, a special instrument is inserted into the patient’s vagina – a spoon-shaped speculum, with the help of which the cervix is ​​exposed. It is hooked using forceps that have sharp teeth at the end. This procedure straightens the angle between the uterus and its cervix. This instrument also fixes the very mobile uterus.

Next, the cervix and vagina are treated with an antiseptic. And only after this the uterine cavity is carefully probed in order to measure its length. Next, using special metal sticks, the cervical canal is expanded. First, a small diameter instrument is used, which is gradually changed with increasing diameter until the diameter of the cervical canal reaches 9-10 centimeters. After this, curettage is performed using a curette - an instrument that resembles a loop.

The material that was collected during scraping into a tray is sent for research. Sometimes separate diagnostic curettage is performed, during which the cervical canal is first cleaned, and then the uterine cavity.

Consequences and complications of uterine cleansing

The most common consequences after cleansing the uterus include:

• Violation of the integrity of the uterine wall,
• Menstrual irregularities,
• Great loss of blood
• infection,
• The occurrence of inflammatory processes in the genital organs.

Also, after cleaning the uterus, a woman may experience spotting for ten days. If there is no discharge, but instead abdominal pain appears, you should immediately consult a specialist. These signs indicate the possibility of the formation of a hematometer - an accumulation of blood in the uterine cavity. There is also a risk of causing various inflammations by the process of cleaning the uterus, as well as the appearance of myomatous nodes, exacerbation of chronic diseases, and the development of uterine adhesions. If after cleaning the uterus the patient’s temperature rises, it is also necessary to consult a specialist.

Any operation to clean the uterus is dangerous due to various complications, even if it is performed at a professional level. Often, highly qualified professionals perform high-quality work on cleaning the uterus. That is why this operation does not have any such consequences.

It is also necessary to take into account the fact that curettage has a number of contraindications:

• Acute infectious diseases, both in the body and in the uterus itself,
• The period of exacerbation of chronic diseases,
• The presence of sexual diseases in acute or subacute form,
• If there is a suspicion of a violation of the integrity of the uterine wall.

Despite these contraindications, cleaning the uterus is allowed in emergency cases, for example, immediately after childbirth. After curettage, it is recommended to monitor body temperature, as well as vaginal discharge.

For preventive purposes, after cleaning the uterus, the patient is prescribed drotaverine (no-shpa) one tablet two to three times a day. The patient must undergo a short course of antibiotics, which is prescribed by doctors to prevent inflammation of the uterine cavity. The patient should be provided with rest, as well as a reduction in physical activity to a minimum.

Curettage is a fairly safe procedure if it is performed by a highly qualified specialist. Therefore, before performing it, it is necessary to choose an experienced doctor, on whose path many similar successful operations have already been performed.

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Probably, many women have found themselves in situations where, after conducting an examination and examination, the gynecologist says that it is necessary to perform curettage for one reason or another. Popularly, this procedure is often called cleansing the uterus, which quite accurately reflects its essence.

But not every doctor considers it necessary to explain to patients what exactly this operation is and how it is performed, and therefore many women begin to panic as soon as they see the appointment in the chart - curettage of the uterine cavity.

But in most cases, worries are simply not justified.

The female uterus is a pear-shaped muscular organ where the development of the unborn child occurs from a fertilized egg. The inner surface of the uterus has a protective layer in the form of a special mucous membrane, which is called the endometrium.

Every month, certain changes occur in the uterine cavity, which are cyclical in nature. At the beginning of each menstrual cycle, the uterine cavity begins to prepare for the reception of a fertilized egg and the further development of the baby; if this does not happen and pregnancy does not occur, at the end of the cycle the prepared layers are rejected and the woman begins menstruation.

Carrying out curettage involves removing the functional layer of the uterine mucosa, which is a protective shell, after which the damaged endometrium is quickly restored. When cleansing is carried out correctly, the growth layer of the endometrium is not affected and due to this, rapid recovery occurs.

Curettage of the uterine cavity can be carried out in two types:

1. Separate, when at the first stage the cervical canal is cleansed, after which the doctor begins to clean the uterus itself. The scraping obtained during the procedure is sent to the laboratory for histological examination in order to determine the disease or make a more accurate diagnosis. Today, separate curettage is carried out simultaneously with hysteroscopy, when a special optical device is placed into the uterine cavity, allowing full control of the cleaning process. This approach to the procedure allows you to make it safer and more convenient, as well as eliminate some possible consequences.
2. When carrying out cleaning in the usual way, the operation is carried out blindly, which often leads to complications, since the uterus can be injured, which is excluded when performing hysteroscopy.

As a rule, cleaning the uterus is prescribed 1-2 days before the start of menstruation, since in this case the restoration of the damaged endometrium occurs faster and easier.

Indications for surgery

Curettage is carried out exclusively as prescribed by a doctor for the purpose of diagnosing or eliminating certain diseases.

The indications in this case are:

• Endometrial disorders, changes in its structure detected by ultrasound. Curettage for endometrial hyperplasia and other disorders is usually carried out for diagnostic purposes. Endometrial hyperplasia is said to occur in cases where its thickness deviates significantly from the norm upward. In addition, ultrasound can detect various local formations. In these cases, cleaning the uterus is necessary to make an accurate diagnosis and remove the disorder.
• Polyps on the surface of the uterus. As a rule, during a normal operation, polyps removed along with the endometrial layer do not appear again.
• Menstrual irregularities.
• Long and very heavy menstruation.
• Intermenstrual bleeding.
• Not the onset of a planned pregnancy without obvious reasons.
• The presence of bleeding during menopause.
• Pathological processes of the cervix, especially in cases where the doctor suspects that they are malignant.
• Spontaneous. Curettage after a miscarriage is often a necessary measure, since this is the only way to remove all remnants of the placenta from the uterus if this does not happen naturally.
• Stopping the development of pregnancy. Unfortunately, not every pregnancy ends in childbirth. In some cases, under the influence of various factors, the development of the fetus stops and it dies. Curettage during a frozen pregnancy is necessary to remove the dead fetus and prevent inflammatory processes.
• Remains of the placenta or fertilized egg after natural birth.
• Cleaning the uterus after an abortion.
• The presence of intrauterine adhesions (synechias).

In addition, the procedure is performed before many planned operations, for example, before removal of fibroids in cases where the uterus itself will be preserved.

Complications after surgery

After curettage, some complications may occur, but they are rare. These include:

• Damage to the cervix, its tear. Sometimes this consequence is observed after curettage and the cause of its appearance in most cases is the dislodgement of bullet forceps. If the tear is small, no measures are taken; such damage heals on its own. A large tear will require one or more stitches.
• Hematometra. After surgery, spasm of the cervix often occurs, which can lead to infection and the onset of an inflammatory process.
• Perforation of the uterus. Sometimes during the procedure, due to the carelessness of the doctor or the inappropriate behavior of the patient (under local anesthesia), the uterus can be pierced by the instruments used. Larger injuries will require additional surgery to close the perforation.
• Inflammation of the uterine cavity. The cause of inflammatory processes is usually various violations of antiseptic requirements, as well as non-prescription of antibiotics to a woman after surgery. The onset of the inflammatory process is indicated by the appearance of a high temperature after childbirth or curettage.
• Causing damage to the growth layer of the endometrium during cleaning. This consequence is very difficult to eliminate and is difficult to treat. Often it is this kind of damage that causes further problems with pregnancy, since the damaged endometrium cannot recover.
• Improper conduct of the procedure, when the reason for the operation, for example, some pathological formation in the uterine cavity, was not completely removed or was partially removed. In such a situation, the woman will need to have the operation repeated.

To avoid complications, you must trust the operation only to a qualified doctor who will do everything not only correctly, but also carefully.

Recovery after curettage

For several days after the operation, spotting may be observed. Their duration may vary and on average ranges from 3 to 9–10 days.

If there is no discharge, but pain appears in the abdomen, this may indicate that due to spasm of the cervix, hematometra has formed. In this case, you must immediately consult a doctor. The presence of spasm can be confirmed using ultrasound.

To avoid the appearance of hematomas after surgery in the first days after it, you can take No-shpa or its Russian analogue, 1 tablet 2 or 3 times a day.

After the operation, the doctor must prescribe antibiotics, which is necessary to prevent the occurrence of possible inflammatory processes. You should not neglect this appointment after cleaning the uterus.

10 days after the scraping, you need to visit a doctor to get the results of a histological examination of the scraping and discuss their details with your doctor.

It is important to remember that pregnancy after a normally performed procedure can occur within 2-3 weeks, so you should not mistakenly assume that curettage will be a temporary means of contraception.

In this case, complications usually do not occur during childbirth. If the planned pregnancy does not occur within 6–9 months after such an operation, you need to consult a doctor and undergo an examination.

Impaired ability to conceive after cleansing the uterus appears in rare cases, but such cases have been noted in medical practice.

The recovery period usually lasts about 14–15 days and during this time some restrictions should be observed, for example:

• You should abstain from sexual intercourse.
• Douching is not allowed.
• Vaginal tampons should not be used to absorb discharge.
• You cannot administer suppositories without a doctor’s prescription.
• You should refrain from any physical activity, especially heavy lifting and bending work.
• It is important to maintain personal hygiene.
• Hypothermia should be avoided.
• You should avoid visiting baths, saunas, solariums, swimming pools and gyms for 3-4 weeks after cleaning.
• During this period, you should not take baths, especially hot ones, or swim in the sea or other body of water.

Compliance with all instructions during the recovery period allows you to avoid complications. But you should not be afraid of such an operation, since modern equipment and the qualifications of many doctors make it possible to obtain excellent results from such a procedure without harm to health.

Just a few decades ago, curettage often led to problems with conception or complications during childbirth in the future. Today, such operations often help eliminate problems of female infertility and allow a woman to experience the joy of motherhood.

Useful video about the scraping procedure

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