Gynecological instruments for scraping. Curettage - a necessary procedure or an anachronism

Cleaning the uterus (curettage or curettage) is at least a very common surgical intervention. Information preparation before this manipulation will allow the patient to calm down, make sure that it is necessary and learn about all the nuances of the intervention. A woman should not be afraid of curettage, since in modern gynecology this procedure is painless, and its complications are extremely rare.

If the patient is scheduled for cleaning, there is nothing surprising in this. When scraping, you can identify various diseases of the uterus, remove the pathological process, or stop the bleeding that exhausts the woman. Scraping is of two types:

• diagnostic;
• medical.

The main function of the uterus is to bear a fetus. The inner layer of the uterus is called the endometrium and is a protective mucous membrane. Every month, cyclical changes occur in the uterus of women of reproductive age. At the same time, the endometrium grows, preparing for the possible fertilization of the egg and its fixation. If pregnancy does not occur, then endometrial cells are rejected, accompanied by menstruation.

Cleansing the uterus for the body looks like artificially induced menstruation. To do this, using medical instruments or a vacuum system, the uppermost uterine layer is removed.

With properly performed scraping, only the functional uterine layer is removed, which is quickly restored. The basal uterine layer is not affected.

After cleaning, a layer of the endometrium (germ) remains in the uterus, which quickly grows and recovers. Recovery after cleansing occurs at the usual time for the monthly cycle.

The tissues obtained by scraping are sent for research.

What is the purpose of scraping

Usually, uterine curettage is performed for the following reasons:

• for histological examination and clarification of the proposed diagnosis;
• to remove pathologies in the cavity or cervix.

In what cases does cleaning happen for a diagnostic purpose, and in which it is done for treatment?

Diagnostic curettage is performed when:

• formations on the cervix;
• prolonged periods with clots, or bleeding outside the cycle;
• infertility of unknown cause;
• before operations in the uterine cavity;
• suspicion of oncological processes;
• after changes in the mucosa, confirmed by ultrasound and not disappeared after menstruation.

Curettage for therapeutic purposes can be performed in situations:

• polyps on the uterine mucosa that do not disappear after drug treatment;
• hyperplasia (excessive growth of the endometrium) of the endometrium (the only treatment);
• uterine bleeding (for various reasons, including those that are not clear);
• incomplete abortion;
• inflammation after an abortion or after spontaneous miscarriages;
• dissections with adhesions of the uterine walls;
• treatment of endometritis.

Contraindications

For any surgical intervention, there are general contraindications in the form of infectious diseases with high fever, acute inflammation, severe general ailments.

Curettage is also not performed for certain gynecological diseases or conditions:

• normal pregnancy;
• malformations or infectious processes of the uterus;
• deforming tumors;
• less than 6 months after termination of pregnancy.

The doctor always decides about the possibility of scraping a woman.

Types of scraping

Two main types of scraping are commonly used:

• Separate. With this method, the cervical canal is first scraped, and then the uterus itself. It makes it easier to make a correct diagnosis and is often combined with hysteroscopy, when an optical device is inserted into the uterus. This method makes the procedure safe and reduces the risk of complications.
• The usual way of scraping with surgical instruments. Such manipulation is performed blindly and can damage the uterus.
• Vacuum cleaning. This is a gentle method that minimizes injuries during intervention. It is used as a method of diagnosis, treatment or during an abortion.

When to clean

It is undesirable to clean in parallel with the onset of menstruation due to the low information content of such research results.

It is also undesirable to clean the uterus at the beginning or middle of the cycle due to the friability of its mucosa and the risk of bleeding.

When cleaning at the beginning of the cycle or in its middle, there is a high probability of hormonal failure in the woman's body. After all, the growth of the uterine mucosa occurs in parallel with the growth of ovarian follicles. If at this moment the uterine mucosa is suddenly removed, then the work of the ovaries is disrupted - a contradiction occurs between the uterine and ovarian cycles.

How to prepare for scraping

Cleaning of the uterus can be performed according to emergency indications (for example, with uterine bleeding). In this case, there is simply no time to prepare for this intervention.

If scraping is carried out according to plan, then preparation for it is mandatory.

Before scraping, a woman is usually prescribed tests:

• general analysis of blood and urine;
• coagulograms (assessment of blood clotting);
• for hepatitis, HIV and syphilis;
• vaginal smear.

For scraping, a woman comes on an empty stomach, shaving her hair in the crotch. The patient is advised to limit the amount of liquid and take along pads, slippers, a disposable diaper, clean cotton items (T-shirt, socks, bathrobe).

What awaits a woman when scraping

Of course, it is important for a woman to know in advance what she should prepare for and what awaits her in the process of cleaning the uterus. Consider in general how scraping is performed.

1. A woman enters the operating room and sits on a table that looks like a gynecological chair.
2. The anesthesiologist clarifies the patient's possible allergic reactions and previous diseases.
3. A woman is injected intravenously with drugs for anesthesia with a short-term effect. After that, she falls asleep and wakes up already in the ward. The patient does not have to endure any pain. In addition, modern drugs are not accompanied by hallucinations or severe recovery from anesthesia.

What kind of manipulations is the patient exposed to during cleaning?

1. Before the operation, a gynecological speculum is inserted into the woman to expose the cervix.
2. The gynecologist fixes the cervix with special forceps "bullets" to ensure its immobility at the time of the intervention.
3. With the help of a probe, the specialist enters the uterus. Cervical dilators are then used until the cervix begins to skip the curette (curettage instrument). In this case, the tissues after scraping are placed in a special container.
4. When using a hysteroscope (a device with a camera at the end), all uterine walls are examined. Then scraping is done. After the procedure, the hysteroscope is reintroduced to check the result. It is thanks to the hysteroscope that various pathological inclusions in the uterus (myomatous nodes, polyps, etc.) are removed. Usually, curettage lasts no more than 15-20 minutes.
5. After the operation, the vagina and cervix are treated with antiseptics. Ice is placed on the woman's stomach to prevent bleeding.

The woman is transferred to the ward, where she stays for several hours. After that (or the next day), the woman is often allowed to go home.

Possible Complications

Complications after cleansing are rare. To do this, curettage must be carried out in a medical institution by a qualified specialist.

However, cleaning is an operation and can have complications. Rare, but possible complications during curettage may be:

• exacerbations of gynecological inflammation;
• adhesions in the tissues of the uterus;
• puncture of the uterus with surgical instruments;
• neck tear;
• mucosal damage;
• leaving in the cavity of polyps, adhesions or nodes that were planned to be removed;
• hematometers (collections of blood in the uterus)

With careful manipulation, complications can almost always be avoided. Minor tissue damage after cleaning heal themselves. Only massive damage to the cervix or uterus requires surgical intervention. When inflammation or hematometers appear, drug treatment is used.

A serious complication of cleaning is too much removal of the mucosa. This condition often leads to infertility due to the inability to fix the ovum.

Vacuum cleaning of the uterus

The use of vacuum minimizes complications during interventions in the uterine cavity.

In addition to the diagnosis and treatment of gynecological diseases (hematometer, bleeding), vacuum curettage is very often performed when:

• termination of pregnancy;
• incomplete abortion;
• removal of parts of the fetal egg or placenta;
• frozen pregnancy.

Scraping with a vacuum method is carried out with special tips and a vacuum pump. At the same time, due to the negative pressure in the uterus, pathological tissues are brought out of the uterus.

The vacuum method is a safer and more gentle way of scraping. At the same time, the risk of hormonal disruptions and damage to the uterus or its cervix is ​​minimal.

Vacuum complications are extremely rare, but they do happen. In addition to the usual complications of cleaning, a complication after vacuum curettage is an air embolism.

Behavior of a woman after scraping

After scraping, a woman usually has spotting discharge for several days, associated with hormonal changes in the body. Usually, menstruation begins after a month and may be slightly different from normal (be shorter, leaner, etc.)

Pain in the abdomen is natural after cleansing, and you should not be afraid of this. Usually, painkillers are recommended for pain in the lower abdomen.

• Avoid hypothermia and physical exertion.
• Avoid high temperatures (steam rooms, baths, saunas).
• Observe the hygiene of the genitals.
• Give up sex for a month.

Doctors advise planning a pregnancy after cleaning no earlier than six months after an examination by a gynecologist.

Pregnancy immediately after curettage may result in miscarriage of the fetus or its intrauterine death.

In modern hospital conditions, a woman absolutely should not be afraid of cleaning. Thanks to this useful method, many gynecological pathologies can be identified and cured. Complications during the curettage procedure are extremely rare, and the intervention itself is painless for the patient.

Curettage of the uterine cavity is understood as a surgical procedure in which the upper layer of the uterine lining is removed. The operation is carried out with special instruments or vacuum. Often, in order to cleanse, you must first expand the uterine cavity with an instrumental or medication method.

Currently, gynecological cleaning is done both for diagnostic and therapeutic purposes. Since general anesthesia is used for the procedure, sometimes hysteroscopy is performed along with it, during which the uterine cavity is examined and, if necessary, curettage of its other sections is performed.

Many women are interested in the cases in which curettage is performed, how long it lasts and how the recovery period goes. Let's consider these questions in more detail.

Types of scraping and indications for its implementation

There are two types of curettage: diagnostic and therapeutic. Diagnostic cleaning of the uterus is done if some diseases of the reproductive system are suspected. It is prescribed in the presence of the following symptoms:

With this type of curettage, only samples of the uterine lining are taken, which are then sent to the laboratory for histological examination. Such an analysis helps the doctor to make the correct diagnosis for the patient.

Therapeutic curettage of the uterine cavity is carried out in the presence of certain diseases. They belong to:

Features of preparation, anesthesia

Cleansing is often done 4-5 days before your period. This avoids large blood losses and shortens the recovery period.

Since curettage is a surgical intervention, some tests must be passed before it is carried out. These include a complete blood count, clotting time, vaginal swab, HIV, hepatitis, and syphilis.

Preparation for the operation includes some other activities. 14-15 days before the procedure, you need to stop taking any medications. If it is impossible to completely refuse, you should consult a doctor who will evaluate all the risks from using a particular drug. After all, there are drugs that can reduce blood clotting, increasing the likelihood of bleeding during surgery.

Preparation for scraping the day before it includes:

• refusal of sexual intercourse;
• conducting intimate hygiene without the use of special means;
• complete refusal of drugs;
• refusal to eat 12 hours before surgery;
• conducting an enema;
• consultation of an anesthesiologist and a doctor who will carry out curettage of the uterus.

How long the operation will last depends on the size of the pathological area. Often, its duration does not exceed 20 minutes. The surgery is done under general anesthesia.

Anesthesia is carried out only by an anesthesiologist. With increased excitability of the patient, several hours before surgery, sedatives are administered intravenously.

Since the operation does not last long, and there is practically no chance of getting the contents of the stomach into the respiratory tract, anesthesia is done while maintaining natural breathing. The patient breathes on his own. She is wearing an oxygen mask. Such anesthesia is called intravenous.

Intravenous anesthesia has a strong sedative effect, causing sound sleep and relieving pain. In Russia, general anesthesia is performed using ketamine, sodium thiopental, and propofol. Ketamine is used less and less because it is an old drug that can cause hallucinations. Such anesthesia will cause significant discomfort to the patient. The best choice for today is anesthesia with propofol. The drug has a mild effect, causes light sleep and has virtually no side effects.

Methodology, postoperative period

A speculum is inserted into the vagina to locate the cervix. Then the neck is fixed with special forceps. This is done to keep the uterus still throughout the procedure.

Using a special probe, the doctor passes through the cervical canal, enters the uterine cavity and measures its length. After determining this parameter, the uterine cavity is expanded. For this purpose, special expanders with different thicknesses are used. The doctor alternately inserts each of them into the cervical canal. Such expansion is continued until the diameter of the canal reaches the size into which the curette - the tool for scraping - can freely pass.

Then the upper layer of the lining of the uterus is scraped off. Use the smallest curette. It looks like a spoon with a long handle and one sharp edge. This is the part that cleans up. A sample of the mucous membrane is placed in a special container and sent to the laboratory for histological analysis. With severe bleeding during surgery, a clamp is applied to the bleeding vessel.

In addition to instrumental scraping, vacuum cleaning is carried out. In this case, the mucous membrane of the uterus is sucked in with a special syringe. Vacuum cleansing is less traumatic and can sometimes be done under local anesthesia. Such curettage is often performed after a miscarriage.

After surgery, the woman remains in the hospital. How much time she has to spend in the hospital depends on the complexity of the operation and is determined by the attending physician. Usually a woman goes home after 1-3 days.

In the recovery period, you need to closely monitor body temperature and vaginal discharge. Spotting spotting is considered normal. How long they last depends on the characteristics of the woman's body. The discharge is considered normal for no more than 10 days.

If there is no discharge, but there is pain in the lower abdomen, you should immediately inform your doctor. Similar signs indicate a hematometer - the accumulation of blood in the uterine cavity during its blockage. The cause of this condition is a spasm of the cervical canal.

To prevent the development of hematomas, in the first days after the operation, no-shpu should be taken.

The doctor also prescribes antibiotics. They are needed to prevent infection and inflammation. The labia and vagina should be washed with antiseptics once a day during the entire recovery period.

There are cases when, after curettage, uterine bleeding occurs. In this case, there is a release of copious amounts of blood from the vagina. It poses a threat to life and requires an immediate stop. If the bleeding is not severe, oxytocin injections are given. Severe bleeding may require surgical arrest.

Hygiene must be especially carefully observed if scraping was carried out due to a miscarriage. It is as a result of such cleaning that inflammatory processes often develop. There are cases when, after a miscarriage, a woman becomes infertile, and the reason for this is banal inflammation.

Curettage of the uterine cavity is a surgical procedure in which the top layer of the uterine lining is removed. For anesthesia, only general anesthesia is used. Cleaning is often carried out after a miscarriage, as well as in some diseases of the reproductive system. This is a fairly simple surgical intervention, however, in order to avoid complications, the postoperative period should be under the strict supervision of a doctor.

In gynecology, diseases of the endometrium, the inner mucous layer of the uterine cavity, are widespread, which can occur for various reasons and manifest themselves differently. They are of a very different nature (inflammation, neoplasms, growths, etc.), but almost always cause severe discomfort to patients, therefore it is very important to establish their cause and quickly cure such diseases. Curettage of the uterine cavity is one of the treatment and diagnostic procedures that can be used both for diagnosis and for the treatment of a particular disease.

Definition

Curettage or curettage of the uterus is a procedure for removing the endometrium - the inner mucous layer of the uterus. This layer changes depending on the menstrual cycle and normally has a thickness of a few millimeters, up to one and a half (and sometimes even more) centimeters. During menstruation, it is rejected, and most of it leaves the body along with menstrual bleeding. Therefore, on the 5th-6th day of the menstrual cycle, it has a minimum thickness and gradually increases over the course of a month, reaching a maximum thickness by the beginning of the next menstruation.

This tissue grows under the influence of the hormone estrogen, therefore hormonal disruptions primarily affect the nature of the growth and thickness of these tissues. Their excessive thickening can develop for one reason or another and cause significant discomfort. That's why scraping is done.

A curette or loop is used to scrape the uterus. A scraping curette is a surgical instrument most reminiscent of a spoon, with which the mucous layer is scraped off from deeper tissue formations. It is because of him that the procedure got its “official” name - curettage. Much less often, a surgical metal loop is used to cut off the mucous membrane, but it is often only suitable for treating small areas of the surface.

The scheme of this intervention can be seen in the photo and illustrations in the material.

Kinds

This procedure is of various types. There are several classifications by which such procedures can be divided. For example, curettage of the uterine cavity and cervical canal or only the organ cavity can be carried out. In addition, it can be local or total. With a local one, only a certain area, the mucosa, is scraped, while with a total one, absolutely the entire mucosa is removed from all parts of the cavity.

In addition, the classification according to the methods of scraping and what it is carried out with (for example, a curette or a loop, etc.) is also widespread. But the most important classification is carried out according to the purpose for which the procedure is carried out. According to this parameter, therapeutic and diagnostic cleaning of the uterus are distinguished. More details about the features and differences of such scrapings are described below.

Medical

Such curettage, as the name implies, is carried out for therapeutic purposes, when the patient's condition no longer needs to be diagnosed. For example:

• As a result of an imbalance of hormones, the endometrium can grow strongly, which is accompanied by bleeding outside the menstrual cycle, significant blood loss during menstruation, and severe pain. In this case, in order to quickly alleviate the symptoms, patients, in addition to hormonal treatment, also carry out curettage. In this case, often the entire uterine cavity is cleaned;
• Such a procedure is also carried out when changes in the endometrium of a particular nature are detected. In this case, it is necessary to eliminate the focus of change and all altered tissues. If the focus is one, then the mucous membrane is removed aimingly, locally, but if there are many of them, then the entire cavity is cleaned;
• In the presence of a large number of small cysts, fibroids or polyps, scraping is performed in order to immediately eliminate them all. Also, depending on the location and number of neoplasms, it can be local or total;
• In a sense, surgical abortion can also be attributed to medical procedures, during which the entire mucosa of the uterine cavity is also scraped along with the products of gestation.

There may be other indications for the procedure, which will be discussed below.

Diagnostic

They talk about diagnostic curettage when the endometrial tissues removed from the uterine cavity are subsequently sent for histological examination. At the same time, the procedure itself does not have any features or differences, but during it, the doctor immediately places the material extracted from the uterus on a glass slide or in a special solution in order to later send it to the laboratory, where a preparation will be made from it for research.

When is cleaning done for diagnostic purposes? In cases where there are changes of an unclear nature on the endometrium in order to establish their nature. And also, in the presence of dysplasia or leukoplakia, in order to determine the presence or absence of atypical cells, which are a sign of a precancerous process (the procedure is carried out for the same purposes when relatively oncologically active strains of the human papillomavirus are detected). In inflammatory and infectious processes, the procedure helps to establish the type of pathogen.

In most cases, the procedure is therapeutic and diagnostic in nature. That is, all damaged tissues are removed, and they are sent to the laboratory for further research and diagnosis.

Indications

In what cases is such a procedure necessary? It is done in the presence of the following indications:

1. Violation of the structure of the endometrium;
2. The presence of neoplasms on the mucosa;
3. Growth of the mucous layer;
4. The presence of an infectious or inflammatory process;
5. Hyperplasia, dysplasia, leukoplakia;
6. polyps;
7. Presence of non-menstrual bleeding;
8. Too plentiful, painful and prolonged menstruation;
9. Menstrual irregularities;
10. Bleeding after menopause;
11. Endometrial changes of an unclear nature, detected, for example, during hysteroscopy or colposcopy;
12. early miscarriage;
13. The presence of a precancerous process or suspicion of it;
14. Frozen pregnancy ( cm. );
15. endometriosis;
16. The presence of adhesions in the uterus;
17. Abortion;
18. The remains of gestational products in the uterus after an abortion (surgical or medical), miscarriage or childbirth.

Also, separate diagnostic curettage of the uterine cavity is carried out in the diagnosis of infertility, and sometimes when planning a pregnancy.

Training

If the intervention is planned, then special preparation for curettage should be carried out. It includes several diagnostic studies that allow you to confirm the absence of contraindications to the procedure. The following studies are required:

1. General and biochemical blood test;
2. General urine analysis;
3. A smear on the flora from the vagina;
4. Consultation of a therapist and gynecologist, sometimes hysteroscopy;
5. Coagulogram;
6. Tests for HIV, hepatitis, syphilis.

It is important to pay close attention to the results of such studies, since it is impossible to carry out intervention in the presence of any infections in the pelvic organs, as this leads to an increase in the risk of infection. Poor blood clotting, which can be diagnosed by the results of a coagulogram, is also a contraindication. Urine and blood tests are needed because systemic inflammatory processes (which are noticeable in their results) are also contraindications.

In the presence of neoplasms, cleaning is canceled or should be carried out with caution. ECG and examination by the therapist are necessary because the manipulation is often performed under general anesthesia, and the anesthesiologist needs to know how the patient will react to it. The rest of the contraindications are relative, since in most cases only careful medical preparation is necessary - normalization of blood clotting, cure of infections, if any.

Order of conduct

How is the uterus cleansed? The procedure takes about half an hour and is performed under general anesthesia, which is injected into a vein. The patient is placed in a chair, she is given anesthesia. As soon as it begins to act, dilators are placed on the vagina and cervix. The genitals are sanitized with an antiseptic. A curette is inserted into the cervix, and the doctor performs curettage, during which material is removed from the uterine cavity.

After the end of the procedure, the sanitation is repeated, and the dilators are removed. The patient is transferred to the ward, where he recovers from anesthesia.

When bleeding

Curettage during menstruation is not carried out, since during this period the endometrium is thinned and deeper tissues can be damaged. The optimal time is considered to be 15-20 days of the menstrual cycle. However, curettage of the uterine cavity during bleeding between menstruation with its strong activity is carried out urgently in order to reduce blood loss, in this case, neither tests for infections nor the day of the menstrual cycle matter. But with such a conduct, after manipulation, broad-spectrum antibiotics, such as Ceftriaxone, are prescribed for a week.

In some cases, bleeding begins after curettage. Clots form in the uterus after curettage. This is a fairly rare complication. When it occurs, hemostatic drugs are prescribed - Vikasol, Dicinon or Tranexam.

Hospitalization

How many lie in the hospital after cleaning? It depends on the characteristics of the organism, but, usually, no more than a day. Strictly speaking, the patient should lie down only until she is completely out of anesthesia and is able to go home. In most cases, it takes 6-8 hours.

Recovery

The recovery period after curettage of the uterus depends on the extent to which it was carried out, with total curettage, the endometrium is completely restored within one month, and after this period the menstrual cycle is restored, sometimes in the first days pain is observed after curettage. In order to recover from the procedure as quickly as possible, it is recommended to avoid overheating, excessive physical exertion, swimming in natural reservoirs, etc. Usually, no specific treatment is required, but with an initial hormonal imbalance, the patient may be prescribed hormone therapy estrogens (and sometimes progesterones).

Price

How much does a therapeutic or diagnostic curettage of the uterus cost? It depends on many factors: the goals of the procedure (treatment or diagnosis), its volume (total or local), the presence of circumstances that complicate the process (for example, in case of bleeding). In addition, third-party factors also influence, such as the popularity of the medical institution, the region in which the procedure is performed, the services included in the price of the intervention, and more. The table shows the prices for the service in different medical centers and different regions.

In addition, therapeutic and diagnostic curettage can be carried out free of charge under the policy of Compulsory Medical Insurance. This may take some time, as sometimes there is a small queue for this service, but if the state of health is such that rush is not required, then it is quite possible to carry out the procedure in this way. But if delay can harm the patient's condition, then it is undesirable to waste time, and it is better to resort to the services of commercial medical centers.

Conclusion

Although curettage is a rather unpleasant procedure that can cause significant discomfort to the patient, it nevertheless belongs to the category of ordinary gynecologists. It is quite simple, because any risks are almost completely excluded even in severe cases. This method of diagnosis or treatment is considered close to operational, therefore it is prescribed only if there are serious indications. And for this reason, it can not be avoided, as it can significantly harm health.

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Diagnostic curettage under hysteroscopy control

Curettage in combination with hysteroscopy has several advantages:

• better performance of scraping;
• the possibility of scraping under visual control;
• reducing the risk of injury to the walls of the uterus;
• the possibility of surgical treatment if necessary.

Separate diagnostic curettage

The results of diagnostic curettage are based on the data of histological analysis, which involves the study of the structure of tissues and cells using microscopy of sections of biological material. The test results are usually issued within two weeks after the operation.

How to prepare for curettage of the uterus?

Tests before curettage of the uterus

Investigations that precede curettage of the uterus are:

• vaginal examination ( in order to assess the morphological and functional state of the genital organs);
• colposcopy ( examination of the vagina with a colposcope);
• coagulogram ( study of the state of the blood coagulation system);
• study of microbiocenosis of the vagina ( bacteriological examination);
• glycemia ( blood glucose level);
• Wassermann reaction ( method for diagnosing syphilis);

The day before the procedure, you must refuse to eat, and also do not drink water for several hours before the study. Also, on the eve of the study, a cleansing enema is performed. Compliance with these requirements allows for the cleansing of the gastrointestinal tract ( gastrointestinal tract). Under general anesthesia, this is necessary to prevent food masses from entering the respiratory tract.

Before scraping, it is recommended not to use special means for intimate hygiene and medicines for topical use ( vaginal suppositories, tablets). Immediately before the operation, the bladder must be emptied.

What can be the results after diagnostic curettage?

In order to understand what pathological changes can be detected using diagnostic curettage, it is necessary to know what the normal uterine mucosa should be like.

Depending on the phase of the menstrual cycle, characteristic physiological changes are observed in the uterine mucosa associated with the effect of sex hormones on the endometrium. If physiological changes characteristic of one phase of the cycle occur in another phase, then this is considered a pathological condition.

Characteristics of the endometrium in different phases of the menstrual cycle are:

• proliferative phase. The epithelium that lines the uterine glands is single-row prismatic. The glands look like straight or slightly twisted tubules. In the glands, there is an increased activity of enzymes ( alkaline phosphatase) and a small amount of glycogen. The thickness of the functional layer of the endometrium is 1-3 cm.
• secretory phase. There is an increase in the number of glycogen granules in the glands, and the activity of alkaline phosphatase is significantly reduced. In the glandular cells, pronounced secretion processes are noted, which gradually end by the end of the phase. Characterized by the appearance of tangles of spiral vessels in the stroma ( connective tissue base of an organ). The thickness of the functional layer is about 8 cm. In this phase, the surface ( compact) and deep layers of the functional layer of the endometrium.
• menstruation ( bleeding) . During this phase, desquamation occurs ( rejection of the functional layer of the endometrium) and epithelial regeneration. The glands become collapsed. Areas with hemorrhages are noted. The desquamation process is usually completed by the third day of the cycle. Regeneration occurs due to the stem cells of the basal layer.

Signs of uterine diseases identified after diagnostic curettage are:

• presence of atypical not normally found) cells;
• hyperplasia ( pathological growth) endometrium;
• pathological change in morphology ( structures) uterine glands;
• an increase in the number of uterine glands;
• atrophic changes ( tissue malnutrition);
• inflammatory damage to endometrial cells;
• swelling of the stroma;
• apoptotic bodies ( particles that are produced when a cell dies).

What diseases can be detected by scraping?

Pathological conditions that can be detected with curettage are:

• endometrial polyp;
• cervical polyp;
• adenomatous hyperplasia of the endometrium;
• glandular hyperplasia of the endometrium;
• endometrial cancer;
• endometriosis;
• pregnancy pathology.

Endometrial polyp

Small polyps may not show up clinically. Symptoms usually appear when they increase in size.

The structure of polyps is based on stromal ( connective tissue) and glandular components, which, depending on the type of polyp, can be in different ratios. At the bases of polyps, dilated blood vessels with sclerotic changes in the wall are often found.

Endometrial polyps can be of the following types:

• glandular polyp. The structure is represented mainly by the uterine glands, the stromal component is represented in small quantities. There are no cyclical changes in the glands.
• fibrous polyp. The histological picture is represented by fibrous ( fibrous) connective tissue, glands are absent.
• Glandular fibrous polyp. The structure of such polyps consists of connective tissue and glands of the uterus. In most cases, the stromal component predominates over the glandular component.
• adenomatous polyp. Adenomatous polyps consist of glandular tissue and an admixture of atypical cells. The uterine glands are presented in large numbers. An adenomatous polyp is characterized by intensive proliferation of the epithelium.

cervical polyp

From a histological point of view, polyps are formed from prismatic epithelium. They are more often glandular or glandular-fibrous. Other types of cervical polyps are much less common.

Adenomatous hyperplasia of the endometrium

The characteristic signs of adenomatous hyperplasia of the endometrium are:

• increased number and intense proliferation of the uterine glands;
• the presence of numerous branching glands;
• tortuosity of the uterine glands;
• the location of the glands close to each other with the formation of conglomerates ( crowding);
• the introduction of glands into their surrounding stroma;
• structural restructuring of the endometrial glands;
• increased mitotic activity ( intensive process of cell division) epithelium;
• cell polymorphism ( the presence of cells with different shapes and sizes);
• pathological mitoses ( disruption of normal mitotic activity).

It is extremely rare for this precancerous condition to reverse. In about 10% of cases, it degenerates into adenocarcinoma ( malignant neoplasm of glandular epithelium).

Glandular hyperplasia of the endometrium

With a macroscopic characteristic, a thickening of the mucous membrane is noted, in some areas polypoid outgrowths are noted.

Microscopic characteristics of endometrial glandular hyperplasia include the following features:

• cylindrical epithelium;
• intensive proliferation of the epithelium;
• elongated and sinuous shape of the glands ( corkscrew or sawtooth glands);
• fuzzy boundary between the basal and functional layers;
• stroma growth;
• the presence of areas of the endometrium with impaired blood circulation;
• increased mitotic activity;
• dilated blood vessels;
• inflammatory and dystrophic changes.

endometrial cancer

When examining endometrial scrapings, endometrial cancer is most often represented by adenocarcinoma. Squamous cell carcinoma (SCC) is also referred to as malignant diseases of the endometrium. an aggressive form of cancer that is characterized by the rapid appearance of metastases), undifferentiated cancer ( a tumor in which cancer cells differ significantly from normal cells), but these forms are much rarer. Typically, these tumors are characterized by exophytic growth ( into the lumen of the organ). The tumor may be highly differentiated, moderately differentiated, or poorly differentiated. The prognosis upon detection of such a pathological condition ( especially poorly differentiated tumor) is usually unfavorable, but early detection allows for effective treatment. The higher the degree of tumor differentiation, the more similar elements it has with normal endometrium and the better it responds to hormonal treatment.

Most often, endometrial cancer develops against the background of precancerous conditions - atypical endometrial hyperplasia, endometrial polyposis.

Cervical cancer

The histological picture in cervical cancer may be different depending on the localization of the malignant process ( vaginal part of the cervix, cervical canal).

Histological characteristics of cervical cancer

endometriosis

Curettage allows you to identify endometriosis localized in the body of the uterus ( adenomyosis), isthmus, various parts of the cervix.

Signs of endometriosis of the cervix are also detected during colposcopy, however, the final diagnosis can only be established on the basis of curettage of the mucous membrane of the cervical canal, followed by histological examination.

Histological examination reveals an epithelium atypical for the cervix, similar to the structure of the endometrium. Endometrial tissue ( tissue affected by endometriosis) is also subject to cyclic changes, however, the intensity of these changes is much less compared to the normal endometrium, since it reacts relatively weakly to various hormonal influences.

endometritis

Acute endometritis is most often a complication of childbirth or abortion. The chronic form of endometritis is more common. The disease is caused by pathogenic microorganisms. Endometritis is characterized by signs of inflammation on the mucous membrane, purulent plaque.

Typical histological features of endometritis are:

• hyperemia ( congestion of blood vessels) mucous membrane;
• desquamation and proliferation of the epithelium;
• glandular atrophy ( with atrophic endometritis);
• fibrosis ( proliferation of connective tissue) mucous membrane;
• mucosal infiltration by cells ( plasma cells, neutrophils);
• presence of cysts with cystic endometritis);
• endometrial hyperplasia as a result of a chronic inflammatory process ( with hypertrophic endometritis).

uterine fibroids

Myoma nodes are rounded formations, which consist of randomly intertwined muscle fibers.

Diagnostic curettage in the case of uterine fibroids can only be carried out for differential diagnosis with other diseases of the uterus. For the detection of fibroids, this method is not informative, since the material for research during diagnostic curettage is the mucous membrane, and myomatous nodes, as a rule, are located under the mucous membrane. Carrying out diagnostic curettage without indications is fraught with the development of serious complications. In this regard, for the diagnosis of this pathological condition, other research methods are recommended, which are more informative - aspiration biopsy ( research method in which an excision of a tissue site is carried out for subsequent research), hysteroscopy.

cervical dysplasia

Curettage allows you to obtain biological material of the epithelium of the cervical canal, which is further subject to histological examination. When the pathological process is located in the vaginal part of the cervix, the material for research is obtained during colposcopy. To confirm the diagnosis, a Papanicolaou test is performed.

Histological examination of scrapings reveals foci with an atypical cell structure and intercellular connections.

There are three degrees of cervical dysplasia:

• 1 degree. Pathological changes cover up to 1/3 of the epithelium.
• 2 degree. The defeat of half of the epithelial cover.
• 3 degree. Pathological change in more than 2/3 of the epithelium.

Pathology of pregnancy

Signs of the pathology of pregnancy, identified by histological examination, are:

• areas of necrotic decidua ( a membrane that forms from the functional layer of the endometrium during pregnancy and is necessary for the normal development of the fetus);
• areas with inflammatory changes in the mucous membrane;
• underdeveloped decidual tissue ( in early pregnancy disorders);
• tangles of spiral arteries in the surface layer of the uterine mucosa;
• Arias-Stella phenomenon ( detection of atypical changes in endometrial cells characterized by hypertrophied nuclei);
• decidual tissue with elements of the chorion ( membrane that eventually becomes the placenta);
• chorionic villi;
• focal deciduitis ( the presence of areas with inflamed decidua);
• fibrinoid deposits ( protein complex) in decidual tissue;
• fibrinoid deposits in the walls of the veins;
• light glands of Overbeck ( symptom of a failed pregnancy);
• Opitz's glands ( glands of pregnancy with papillary outgrowths).

When a histological examination of biological material is suspected of a pathology of pregnancy, it is important to know when the patient had her last menstruation. This is necessary for a complete analysis of the results obtained.

Histological examination allows you to confirm the fact of termination of pregnancy, to detect possible causes of this phenomenon. For a more complete assessment of the clinical picture, as well as to prevent the recurrence of the problematic course of pregnancy in the future, it is recommended to undergo a series of laboratory and instrumental studies. The list of necessary studies is determined by the doctor individually for each patient.

What to do after scraping?

It is not recommended to use gynecological tampons after scraping and douching ( washing the vagina with solutions for hygienic and medicinal purposes). As for intimate hygiene, it is recommended to use only warm water for this purpose.

Physical stress on the body for example, sports) must be stopped temporarily, as this may cause postoperative bleeding. You can play sports at least one to two weeks after the procedure, but this must be discussed with your doctor.

After scraping, after a while, the patients should come to the doctor for control. The doctor talks with the patient, analyzing her complaints and assessing her condition, then a vaginal examination and colposcopy are performed, followed by a vaginal smear. An ultrasound examination of the pelvic organs may also be prescribed to assess the condition of the endometrium.

With the development of inflammatory complications, anti-inflammatory drugs for local or general use may be prescribed.

Sexual life after diagnostic curettage

After the operation, the first sexual intercourse may be accompanied by pain, itching and discomfort, but this phenomenon quickly passes.

Menstruation after diagnostic curettage

The consequences of curettage of the uterus

Complications of curettage of the uterus can be:

• heavy bleeding. The uterus is an organ with an intensive blood supply. In this regard, the risk of bleeding after curettage is quite high. The cause of bleeding may be a deep damage to the walls of the uterus, the remnants of tissues in its cavity after curettage. Bleeding is a serious complication that requires immediate attention. The doctor decides whether re-intervention is necessary to control the bleeding or whether hemostatic drugs can be prescribed ( hemostatics). Bleeding may also be associated with bleeding disorders.
• Infection. Curettage of the lining of the uterus is associated with the risk of infection. With such a complication, antibiotic therapy is prescribed.
• Perforation of the uterus. When working with curettes, there is a risk of perforation of the uterine wall and other adjacent organs ( intestines). This is fraught with the development of infection in the uterus and abdominal cavity.
• Irreversible damage to the cervix may be after performing curettage with stenosis ( constriction) of the cervix.
• Synechia formation (adhesions) is one of the long-term complications that often occurs after curettage. Synechiae are formed from connective tissue and interfere with the functions of the uterus ( generative, menstrual).
• Menstrual irregularities. The appearance of heavy or scanty menstruation after curettage, accompanied by a deterioration in the general condition of the woman, is a reason to see a doctor.
• Hematometer. This condition is an accumulation of blood in the uterine cavity. The cause of this phenomenon is often a spasm of the cervix, as a result of which the process of evacuation of the contents of the uterus is disrupted.
• Damage to the growth layer of the endometrium. This complication is very serious, since such a condition is fraught with subsequent menstrual irregularities, infertility. Damage to the germ layer can be due to non-compliance with the rules for performing the operation, especially with too strong and aggressive movements of the curette. In this case, there may be a problem with the implantation of a fertilized egg in the uterus.
• endometritis. Inflammation of the uterine mucosa can develop as a result of infection or mechanical damage to the mucosa. In response to injury, inflammatory mediators are released and an inflammatory response develops.
• Complications related to anesthesia. Such complications may be associated with the development of an allergic reaction in response to drugs used in anesthesia. The risk of such complications is minimal, because before choosing an anesthesia method, the anesthetist, together with the attending physician, carefully examines the patient and collects a detailed history to identify contraindications to a particular method of anesthesia and prevent complications.

“I was cleaned” or “I was cleaned” - these phrases I often hear from my patients, and they sound to me as unbearable as the movement of foam on glass. "Cleaning" we colloquially call curettage of the uterus - the most frequent procedure performed in gynecology in the vast majority of cases without any indications for it.

This accustomed name itself - "purge" - already reflects a rough, clumsy and primitive approach to solving the problem. By the way, the term has smoothly moved from medical jargon into the lexicon of many women, who even believe that they need to “go through cleaning” or “clean up” from time to time. Perhaps they put the same meaning in this as in the notorious "cleansing the body of toxins", assuming that "dirt" accumulates in this organ.

Before continuing the story, it is necessary to explain what exactly is at stake.

Curettage is an outpatient medical procedure performed under intravenous anesthesia, during which a special curette is used to remove (scrape) the lining of the uterus. The procedure is called a diagnostic and treatment procedure, since it removes disease-modified tissue (if any), which can be examined under a microscope and an accurate diagnosis can be made. From the previous sentence, it is clear that curettage is carried out not only in the presence of a disease, but if it is suspected, that is, for the purpose of making a diagnosis.

While everything is clear, logical and obvious. However, there is another side to this manipulation. The procedure is performed with a sharp iron curette, with the help of which the mucous layer of the uterus is actually “torn off”, and the inevitable injury of the uterus itself occurs. As a result, there is a risk of several serious complications: damage to the growth layer of the endometrium (which disrupts its growth in the future), the appearance of adhesions in the uterine cavity, and the development of inflammation.

In addition, this procedure contributes to the development of such a disease as - due to violation of the boundary between the layers of the uterus, which contributes to the germination of the endometrium into the uterine muscle. As a result, the transferred curettage can lead to problems with conception or trigger the development of adenomyosis.

It is quite obvious that such a procedure should be done strictly according to the indications and the benefit-risk ratio should be seriously assessed. But this is possible anywhere, but not here, and this is very sad.

Scraping "just in case"

I think that in more than 80% of cases, curettage is carried out in vain, that is, either completely without indications, or in cases where the problem can be solved with medication or through a simple outpatient procedure.

Here are the situations in which you may be asked to perform scraping.

• You have been bleeding for a long time or have uterine bleeding.
• On ultrasound, you have been diagnosed with endometrial hyperplasia, adenomyosis, uterine fibroids, or chronic endometritis.
• You are planning to spend.
• You suspect an ectopic pregnancy.
• You complain that you have heavy periods, intermenstrual spotting or brown "smearing" discharge before and/or after your period.

In general, they are sent for "cleaning" very often, even in the absence of the reasons that I listed above. Curettage is often accompanied by any surgical treatment in gynecology. As if they are trying to do it all the time "at the same time", in order to "just in case check" whether everything is fine. It shouldn't be like that, it's too frivolous an attitude to a rather traumatic procedure.

So the instruction how to avoid scraping.

• If you do not have profuse uterine bleeding (as they say, “pouring down your legs”), but just prolonged spotting and pregnancy (uterine and ectopic) is excluded, check with your doctor about the possibility of stopping the bleeding with medication. Yes it is possible. Against the background of taking the drug (I will immediately warn you that this is a hormonal drug, but it is safe), the bleeding may stop, and your condition will need to be re-evaluated after the next menstruation. In many cases, the treatment will be enough, and nothing else will need to be done.
• If during an ultrasound scan you have found a polyp or endometrial hyperplasia, do not rush to agree to curettage. Ask your doctor about the possibility of prescribing you the drug in this cycle and then repeat the ultrasound after the end of the next menstruation. If a polyp or hyperplasia is confirmed, alas, curettage under the control of hysteroscopy must be done. But you have a very high chance that after menstruation there will be no indications for the procedure.

Polyp- this is an outgrowth on the mucous membrane of the uterus (looks like a finger or a mushroom), most often benign. There are polyps that are themselves rejected during menstruation, and those that grow from the germ layer. The latter need to be removed.

Hyperplasia- thickening of the mucous membrane of the uterine cavity. There are two types: simple and complex. Simple hyperplasia is the most common, it is not dangerous, for its development there must be a mandatory reason (functional cyst in the ovary, polycystic ovary syndrome, and a few more). Usually, 10 days of taking the drug is enough for it to pass and not recur.

Complex hyperplasia - poor hyperplasia, an error in the structure of the endometrium, usually occurs after 35 years, more often against the background of overweight. It is treated first by removing the mucous membrane (curettage) and then by a multi-month course of hormonal preparations or by installing an intrauterine hormonal spiral "Mirena". An accurate diagnosis is possible only with histological examination.

• If you are offered to do curettage only for diagnostic purposes before surgery or to clarify the condition of the mucous membrane, ask your doctor to start with an endometrial biopsy (another name is "pipel biopsy" or "aspiration biopsy"). This is a simple outpatient procedure that does not require any anesthesia. A thin tube is inserted into the uterine cavity and a small amount of tissue is sucked up, which is then sent to a laboratory for examination. This is a fairly informative analysis.

Important: the material obtained as a result of curettage or biopsy is only the mucous membrane of the uterus, it does not carry any information about other diseases. The fact is that often scraping is prescribed for the purpose of its characteristics; and so - scraping will not give any information.

• Remember, almost all modern ultrasound machines allow you to evaluate the uterine mucosa and identify signs of pathology in it. If the doctor writes during an ultrasound scan that the endometrium is not changed, and you do not have heavy menstruation, intermenstrual bleeding, then the likelihood that you have a pathology that requires curettage is close to zero.
• In general, the main manifestations of the pathology of the endometrium (only scraping is directed to this tissue) are bleeding, heavy menstruation and intermenstrual spotting. Thus, if you do not have this, discuss with the doctor how justified his desire to treat you is.
• "Chronic endometritis" is a common diagnosis on ultrasound and in the results of the histological conclusion after curettage. This is a chronic inflammation of the uterine mucosa. However there are no generally accepted criteria for making this diagnosis by ultrasound in evidence-based medicine. Simple histology also cannot reliably confirm this diagnosis.. Often this diagnosis is made where there is none, since they are guided by "leukocytes".

A reliable diagnosis is possible only when conducting a special type of study - immunohistochemistry. This study is not available in all laboratories, and the material for it can be obtained by biopsy, and not by curettage. I think it is now clear that scraping is not necessary to confirm the diagnosis of "chronic endometritis". In general, the diagnosis and treatment of this endometrial disease makes sense only within the framework of the problem of infertility and miscarriage.

In what situations to agree to curettage?

• Severe uterine bleeding: yes, curettage is a way to stop it.
• Suspicion of an ectopic pregnancy (difficulty in making a diagnosis).
• A polyp or hyperplasia of the endometrium that has not disappeared after menstruation or drug treatment.
• The remains of the membranes (after an abortion, miscarriage, pregnancy).
• Any spotting after menopause.

Now, I hope you have reliable instructions on how to avoid, perhaps, an unnecessary operation for you. Don't be afraid to ask the doctor questions. Offer alternatives (endometrial biopsy, drug treatment). Ask to justify the need for just scraping. The answer "this is how it is with us" should not be accepted. Of course, all this applies only to those situations in which you do not have a threat to life and health (profuse bleeding).

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Discussion

If he appoints, then he agrees. Usually such a procedure is simply not prescribed.

Comment on the article "Gynecologist prescribes curettage of the uterus: agree or not?"

Hospitalization for an operation is scheduled for tomorrow and menstruation has just begun (((). RFE with hysteroscopy can be done when not the usual RFE is done "blindly", but with hysteroscopy - an examination of the uterine cavity with a mini-camera before the RFE and after - so nothing. ..

Discussion

I was put off hospitalization in this case

I also had. They did a gentle scraping.
Yes, and then it is also done for polyp and myoma bleeding, etc., which means that this does not interfere.
If there is a doctor's phone number, call in the morning just in case and ask

Did a hysteroscopy with curettage to remove the polyp. RDV + GS - separate diagnostic curettage under hysteroscopy control - is a modern ...

Discussion

You know, the point is not in the RFE (which is done in many places), but for an intelligent doctor to do hysteroscopy (this is an analogue of gastroscopy, inserting a mini-camera into the cavity and examining it before and after the RFE). It's like an ultrasound will be done by an intelligent doctor, or a stupid one, they see everything differently.
I won’t tell you the place, I did it according to compulsory medical insurance in the 17th maternity hospital about endometriosis at the head of the department Ostapishina.
In principle, there are commercial services, you can find out.

As far as I remember, RDV is done immediately after menstruation (7-10 days). The analyzes are valid for 2 weeks for the most part.
In general, these are all conventions. RFE is done to almost everyone admitted to the ambulance with bleeding without any tests.
Planned, at least for a fee, at least for free, you still have to take all the tests. And a good doctor will not do this procedure without a minimum set of tests (this is actually a risk).
I do not recommend you to contact those who do it without tests and hassle, it is still an operation.
And I'm afraid the order of prices will be about the same. You can take all the tests during your period, only smears are needed a little in advance.
If you have heavy periods, arrange with your doctor to send you to the ambulance, as with bleeding, you will be done urgently and quickly.

Section: Diagnostics (weight gain after curettage). Scraping. Can you put on weight? Tell me, please, if anyone knows.

It is possible to make a laparotomy with an examination, checking the patency of the tubes and curettage in one anesthesia. Doubts are driven by the proposal of another doctor not ...

Discussion

IMHO, lapar is more effective in your case. The spikes will be removed immediately.
The first time I did a laparo about polyps, endometritis, the tubes were checked, small adhesions were removed.
Last year, when she removed polyps again - just hystroscopy.

Find a specialist in gynecological massage. The adhesions are well removed and the mobility of the organs returns.

Discussion

The same thing happened to me. True, curettage was done after the fetal egg came out (miscarriage). There is no need to be afraid of this. I didn't have any inflammation. Only now the first menstruation came after that after 2 months.
Is there any point in waiting a little longer? After all, the heartbeat is not always heard at 6 weeks, or was it established by a more error-free method?
Fanny had it. She didn't give in. True, the pregnancy turned out to be really frozen and she carried it off for another month already with a threat to her own life.
Is there bloody discharge? As far as I understand, the frozen fetus itself begins to be rejected ...
In any case, Natasha, hold on! Do not be afraid of this operation - you will not feel anything. The main thing is not to fall into a protracted depression later. And there will definitely be a baby. and confirmation of this by Joo. Ask her.
I wish you good luck and keep your fingers crossed!

Natasha, they did it to me last October. In order not to get upset, I’ll say right away that now my pregnancy is 14 weeks and everything is in order. So, in the clinic where they did the scraping, they gave me a reminder of what and how to drink, and all the pills were sold right there. I honestly drank them all. Be sure to drink Nystatin with antibiotics, otherwise you will suffer with the intestines later. After scraping and taking all this filth, gardnerellosis was discovered, and I had to be treated for it. Then I didn’t have my period for two months, and when they came, I almost died from pain - I had a hematometer. But this is already the individual characteristics of my body. And no more complications happened, and having passed all the tests and treated the hormones, I got my current state.
As for mental trauma... the biggest one was received by me in the clinic, looking at the number of girls (namely, young ones) having abortions. By the way, if possible, be sure to do a histological examination of what is scraped out. I am very sorry that I did not do it - it was difficult to identify the cause of the fading. If you have any questions - ask. And listen to the doctors - do everything they say - everything should be fine))