Diagnostic curettage of the cervical canal and uterine cavity: appointment of the procedure, preparation and rehabilitation. Curettage of the walls of the uterine cavity

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 drug 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:

Violation of the structure of the endometrium;
The presence of neoplasms on the mucosa;
Growth of the mucous layer;
The presence of an infectious or inflammatory process;
Hyperplasia, dysplasia, leukoplakia;
polyps;
Presence of non-menstrual bleeding;
Too plentiful, painful and prolonged menstruation;
Menstrual irregularities;
Bleeding after menopause;
Endometrial changes of an unclear nature, detected, for example, during hysteroscopy or colposcopy;
early miscarriage;
The presence of a precancerous process or suspicion of it;
Frozen pregnancy ( cm. );
endometriosis;
The presence of adhesions in the uterus;
Abortion;
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.

Preparation

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:

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

It is important to be attentive to the results of such studies, since it is impossible to carry out an 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 anesthetist 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 pain is observed after curettage in the first days. 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 purpose 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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Curettage of the uterine cavity (curettage) is what many women know about this procedure. It is performed for different purposes: to terminate an unwanted pregnancy, treat, diagnose gynecological and oncological diseases. When a curettage of the uterine cavity is done, the specific day of the cycle depends on the reason for which the doctors prescribed this minor surgical intervention. In the case of pregnancy, it is performed for a period of more than 7 and less than 12 weeks. If the goal is to stop intermenstrual bleeding - regardless of the day of the cycle. They try to prescribe diagnostic curettage of the uterine cavity for the last 1-2 days of the menstrual cycle so as not to disturb it. Thus, the woman seems to start menstruating a little earlier.

Some indications for curettage of the uterine cavity:

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

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

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

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

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

Pregnancy is possible in a shorter time. For example, if a woman is over 35 years old, and this procedure has eliminated her cause of infertility or miscarriage. But one way or another, while there is a discharge after scraping the uterine cavity, sexual activity is prohibited. That is, for about 14 days after cleaning, you need to refrain from intimacy, since it can become a provocateur of the onset of an infectious process.

One very important question remained unsolved - how painful is curettage of the uterine cavity and cervical canal. You can often hear from experienced women that this is an extremely painful procedure. Yes, it is, but only if performed with little or no local anesthesia. Particularly painful is the opening of the cervix, although curettage of its cavity is also very unpleasant and palpable. Fortunately, now in most hospitals, general intravenous anesthesia is performed free of charge or for a fee. The woman sees absolutely nothing, does not feel, is unconscious. And after the procedure, he quickly recovers and in almost all cases he can go home on his own the same day.

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, 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, a 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 physician.

Curettage of the walls of the uterine cavity is an instrumental removal of the functional layer of the uterine mucosa along with possible pathological formations. The procedure is performed for both therapeutic and diagnostic purposes. If possible, curettage of the walls of the uterine cavity should be carried out under the control of hysteroscopy.

INDICATIONS FOR CUTTAGE

Curettage of the walls of the uterine cavity is performed with uterine bleeding, dysfunctional uterine bleeding, suspicion of a hyperplastic process or a malignant tumor of the endometrium, incomplete abortion, placental polyp after an abortion or childbirth.

CONTRAINDICATIONS

Curettage of the walls of the uterine cavity is contraindicated in the detection of acute inflammatory processes of the genital organs, except in those cases when the curettage of the mucous membrane of the uterine body is performed for therapeutic purposes (for example, in acute endometritis against the background of retention of placental tissue).

CONDITIONS FOR THE OPERATION

The absence of an acute inflammatory process in the genital organs.

PAIN RELIEF METHODS

The operation is performed under intravenous anesthesia or paracervical anesthesia.

OPERATIONAL TECHNIQUE

treatment of the external genitalia and vagina;
exposure of the cervix with the help of mirrors and fixation of the cervix with bullet forceps;
expansion of the cervical canal;
curettage of the mucous membrane of the uterus with a curette;
treatment of the cervix with tincture of iodine and removal of instruments.

After emptying the bladder, in the position of the patient on the gynecological chair, immediately before the operation, a two-handed vaginal examination is performed, in which the size and position of the uterus are established. After treating the external genital organs and the vagina with alcohol and iodine tincture, the cervix is exposed with spoon-shaped mirrors, which are passed to the assistant.

The cervix is grasped with two pairs of bullet forceps by the anterior lip and brought down to the entrance to the vagina. The bullet tongs are transferred to the left hand. Using a uterine probe, determine the length and direction of the uterine cavity. In most cases, the uterus is in the anteflexioversio position, so all instruments are inserted into the uterus with an anterior concavity. In the position of retroflexio uteri, the direction of the instruments should be posterior in order to avoid injury to the uterus.

If necessary, the cervical canal is expanded with metal Hegar dilators to a value corresponding to the largest curette that will be used (most often up to No. 10–11). The dilators are introduced, starting small, without excessive force, advancing them only with the force of the hand, and not with the whole hand. The dilator is advanced forward until it overcomes the obstacle of the internal pharynx. Each dilator is left in the canal for a few seconds, if the next largest dilator enters with great difficulty, then the previous one should be re-introduced.

Curettes are used for scraping. The movement of the curette forward should be careful to the bottom of the uterus, the reverse movement is performed more vigorously, with pressure on the wall of the uterus, while capturing and removing parts of the mucous membrane or the fetal egg. The anterior, posterior, lateral walls and corners of the uterus are scraped out sequentially, gradually reducing the size of the curettes. Curettage is performed until the feeling that the wall of the uterus has become smooth.

Features of curettage of the walls of the uterine cavity depend on the nature of the pathological process. An uneven, bumpy surface of the uterine cavity can be observed with interstitial or submucosal fibroids. In these cases, curettage should be performed carefully so as not to damage the capsule of the myomatous node. Such damage can cause bleeding, node necrosis and infection.

With adenocarcinoma of the endometrium, scraping can be very abundant, and if the tumor grows through the entire thickness of the uterine wall, during the operation, the uterine wall can be injured with a curette. During pregnancy, you should not scrape the uterus to a “crunch”, since such scraping severely damages the neuromuscular apparatus of the uterus.

After scraping, the bullet forceps are removed, the cervix is treated with iodine tincture, and the mirrors are removed. Scraping is carefully collected in a container with a 10% formalin solution and sent for histological examination. In all cases of suspected malignancy, a separate diagnostic curettage should be performed. First, the mucous membrane of the cervical canal is scraped, without going beyond the internal pharynx. The scrapings are collected in a separate tube. Then the mucous membrane of the uterine cavity is scraped off, and this scraping is placed in another test tube. In the directions for histological examination, it is noted from which part of the uterus the scraping was obtained.

COMPLICATIONS AFTER CUTTERS OF THE WALLS OF THE UTERINE CAVITY

Among the complications, perforation of the uterus, exacerbation of inflammatory diseases of the internal genital organs, and the development of intrauterine synechia should be noted.

FEATURES OF THE POSTOPERATIVE PERIOD

In the postoperative period, it is necessary to prescribe antibiotic therapy. The patient should refrain from sexual activity for 1 month after the operation.

INFORMATION FOR THE PATIENT

The appearance of signs of an acute (or exacerbation) inflammatory process of the genital organs after scraping the walls of the uterine cavity is an indication for a visit to the local gynecologist.

Content

The period after curettage of the uterine cavity requires a special approach on the part of the doctor and the responsible implementation of all recommendations on the part of the patient. The reproductive and physical capabilities of the female body are not unlimited, therefore, an important task of the gynecologist who performed the cleaning of the uterus is considered to be full, careful monitoring and ensuring a protective regime.

In the period after cleaning the uterus, experts identify three main areas of work for full rehabilitation:

Prevention of infections.
Restoration of the endometrium and the menstrual cycle.
Recovery of physical and mental health.

To achieve the set goals, gynecologists give recommendations in terms of taking antibacterial drugs, oral contraceptives, limiting physical activity, maintaining sexual rest and performing general strengthening measures.

Feeling good after cleansing

Not everyone is able to quickly enter the usual rhythm of life, resume sports and physical activity. Recovery time largely depends on the individual characteristics of the organism.

After curettage, mild abdominal pain, mild anesthesia-related dizziness, and moderate bleeding are usually noted.

Recovery of the uterus after curettage, both therapeutic and diagnostic, lasts one menstrual cycle, the whole body - from 2 to 6 months.

General well-being after scraping:

Body temperature up to 37.2-37.3 is considered normal in the first 2-3 days.

Moderate abdominal pain lasts up to 7 days.

Mild dizziness is allowed.

Allocations after the cleaning procedure:

The first few days marked discharge from the genital tract in the form of fresh blood, as during menstruation.
A week later from the moment of curettage, the discharge takes on a bloody character: they become mucous and have a brown color due to the admixture of altered blood.
The restoration is completed with secretions that have a yellow color, which gradually take on a classic look: a scanty, mucous discharge, which, when dried, takes on a yellowish tint.
The duration of discharge is normal in the recovery period is 10-12 days.

Following after curettage menstruation should begin after 25-45 days.

Normally, the first day of menstruation should come after a period of time equal to the length of the cycle before cleaning (provided that it is regular).

What you should pay attention to, and when you need to seek help from medical professionals if a woman has undergone curettage:

Prolonged (more than 20 days) bloody discharge.
Scanty or heavy menstruation, spotting, not associated with menstruation in the long term after curettage. These symptoms may indicate the development of endometriosis of the cervix, hormonal failure.
Unpleasant smell of discharge.
Type of discharge, like "meat slops."
Increased secretions during light physical exertion.
Pain in the lower abdomen lasting more than a week after scraping.
A sharp cessation of discharge after uterine curettage, which may indicate the accumulation of clots in the cavity of the organ (hematometer).
Profuse bleeding.
Increase in body temperature.
Loss of consciousness.

The above symptoms may indicate the development of endometritis.

The severity of some purulent-inflammatory diseases of the internal genital organs after curettage may not correspond to the clinical picture and laboratory parameters.

That is why it is extremely important to be under the supervision of a doctor in the presence of even minimal signs of infectious complications.

What is the dangerous period after the procedure

The uterine cavity after cleaning is an extensive wound surface. The lion's share of recommendations after curettage will be aimed at preventing microorganisms from entering the cavity of the operated organ. Gynecologists are aimed at preventing the development of inflammation of the reproductive organs and its chronicity.

Specialists distinguish two groups of risk factors for the development of infectious complications after uterine curettage:

Main group. This category includes women with a history of endometritis, chronic recurrent chlamydia, urea- and mycoplasmosis, candidiasis, human papillomavirus infection, persistent vaginal dysbacteriosis. In such patients, the likelihood of developing purulent-inflammatory diseases in the gynecological area during curettage is most likely. Patients are subject to the closest attention from physicians. This also includes emergency cases of scraping.

Additional group. Patients who underwent uterine cleaning due to bleeding (endometrial hyperplasia), abortion, curettage of placental or ovum remnants have a lower risk of infectious complications compared to the main group.

Women who have undergone diagnostic curettage have the lowest risk of developing complications of an infectious nature. Typically, this type of study is carried out with infertility of unknown origin, in preparation for IVF, suspected polyps and subserous fibroids, and menstrual irregularities.

Factors indirectly affecting the period after curettage:

Obesity.
Diabetes.
Anemia.
Hypothyroidism.

The above diseases have an indirect effect on the course of the recovery period of curettage, but their presence significantly reduces physical strength, the body's resistance to infections and slows down the healing process of the wound surface in the uterus after curettage.

The most common complication of an infectious nature after curettage considered endometritis - inflammation of the inner layer of the uterus.

The causative factor of the disease is the conditionally pathogenic flora of the vagina (staphylococci, streptococci, E. coli), as well as representatives of the pathogenic flora, if the patient before the operation had untreated sexually transmitted infections - chlamydia, ureaplasmosis, mycoplasmosis, gardnerellez and others. That is why, in the period after therapeutic curettage, gynecologists recommend taking antibacterial drugs without fail, regardless of the infectious history. After diagnostic cleaning, you can limit yourself to taking sulfonamides.

According to statistics, the frequency of endometritis after uterine cleansing is 20%.

Not always purulent-inflammatory diseases of the genital area after curettage appear due to non-compliance with the doctor's recommendations. Nosocomial infection is relevant in our time. A woman should opt for modern clinics with rich obstetric and gynecological experience.

Poor cleaning can be the result of the penetration of endometrial cells into the tissues of the neck, which leads to endometriosis.

Sexual life is excluded for 3 weeks after cleaning. The goal is to prevent infectious complications and bleeding. In addition to bacteria, semen contains prostaglandins that relax the uterus.
Within 6 months after curettage, it is recommended to use a condom to prevent pregnancy.
For a month, you should not take a bath and visit the pool.
It is not recommended to use swabs to absorb blood after curettage. This can provoke the development of inflammatory processes in the uterine cavity.
After scraping, physical activity should be limited as much as possible.

Recommendations for taking antibiotics and other drugs for curettage:

Antibacterial drugs should be taken strictly at regular intervals.
The minimum duration of taking antimicrobial agents: 3 days for Azithromycin and 5 days for other drugs.
The dosage of the drug should correspond to the weight of the patient.
Drinking alcohol while taking antibiotics is not recommended.
To relieve pain, you should take Ibuklin or Diclofenac.
To prevent the formation of adhesions, as a rule, enzyme preparations are prescribed (Wobenzym, Longidase).

Restoration of menstrual function is an important part of the rehabilitation period after curettage. The cyclic work of the female body is very sensitive to various fluctuations and outside interference. "Artificial" disposal of the endometrium sends the wrong signals to the main regulators of the menstrual cycle - the hypothalamus and pituitary gland. The ovaries, as performers, will also respond to this type of impact.

The drugs must be taken from 2 to 6 months, depending on the diagnosis that served as the reason for cleaning the uterus.

Oral contraceptives after the procedure for cleaning the uterus:

Jess.
Logest.
Belara.
Janine.
Silhouette.
Newsletter and others.

The first tablet is taken on the day of scraping. The selection of the drug is carried out only by a gynecologist and based on the results of a blood test for hormones.

After curettage, physical activity is recommended to be resumed no earlier than after 2 months. With a visit to the gym, you should wait, and lifting weights (more than 3 kg) and running are also excluded. Any physical activity is stressful for the body, which, of course, reduces immune activity and will prevent healing.

One of the important recommendations of a gynecologist after curettage is the implementation of physiotherapy measures. The most effective methods of physiotherapy in gynecology include:

EHF-therapy. The therapeutic effect is achieved by irradiation with electromagnetic waves of the EHF range, which increases the nonspecific resistance of the body, increasing resistance. It is recommended to use EHF-therapy after cleansing to prevent endometritis.
ultrasound therapy. The method is recommended for the prevention of the formation of adhesions in the uterus and small pelvis, resulting from curettage.
Phototherapy. Infrared rays have an anti-inflammatory effect.

After manipulation of curettage, many experts recommend using sorption therapy as part of a preventive focus, the essence of which is the introduction of a special solution into the uterine cavity that has the properties of a sorbent and an antiseptic. Usually a mixture of Enterosgel and Dioxidin is used. The composite solution is inserted into the uterus using a thin catheter. Due to its thick consistency, the mixture does not flow out, therefore, special restrictive recommendations for physical activity are not required. An aspiration biopsy is used to monitor healing. The aspirate is examined under a microscope and the condition of the obtained cells is assessed.

After the procedure for cleaning the uterus, doctors monitor the healing process using the method of aspiration biopsy. It is carried out on the 23-25th day of the cycle after 2 months after all types of curettage.

Artificial termination of pregnancy by curettage for medical reasons- a strong stress factor that negatively affects the adaptive-compensatory capabilities of the body.

An equally important task facing the gynecologist is to provide comprehensive rehabilitation using funds aimed at restoring psychovegetative disorders.

As a rule, after curettage, the patient is recommended the following therapeutic measures and drugs:

Acupuncture.
Psychotherapy.
Herbal soothing preparations for 2 weeks after cleansing (Phytosedan, soothing teas with lemon balm, sedative preparations).
Antidepressants (Coaxil, Gelarium, Azafen) for 10-20 days.

The problem of purulent-inflammatory diseases in gynecological practice after curettage continues to be one of the leading ones. Full, adequate appointments and compliance with them by the patient in the recovery period guarantee the complete absence of consequences and complications in terms of reproductive function.