Dilatation and curettage

The preferred method of evacuation of the uterus is by manual vacuum aspiration. Dilatation and curettage should be used only if manual vacuum aspiration is not available.

• Review for indications.

• Review general care principles.

• Provide emotional support and encouragement and give pethidine IM or IV before the procedure. If necessary, use a paracervical block.

• Administer oxytocin 10 units IM or ergometrine 0.2 mg IM before the procedure to make the myometrium firmer and reduce the risk of perforation.

• Perform a bimanual pelvic examination to assess the size and position of the uterus and the condition of the fornices.

• Apply antiseptic solution to the vagina and cervix (especially the os).

• Check the cervix for tears or protruding products of conception. If products of conception are present in the vagina or cervix, remove them using ring (or sponge) forceps.

• Gently grasp the anterior lip of the cervix with a vulsellum or single-toothed tenaculum (Fig P-32).

Note: With incomplete abortion, a ring (sponge) forceps is preferable as it is less likely than the tenaculum to tear the cervix with traction and does not require the use of lignocaine for placement.

• If using a tenaculum to grasp the cervix, first inject 1 mL of 0.5% lignocaine solution into the anterior or posterior lip of the cervix which has been exposed by the speculum (the 10 o’clock or 12 o’clock position is usually used).

• Dilatation is needed only in cases of missed abortion or when some retained products of conception have remained in the uterus for several days:

- Gently introduce the widest gauge cannula or curette;

- Use graduated dilators only if the cannula or curette will not pass. Begin with the smallest dilator and end with the largest dilator that ensures adequate dilatation (usually 10-12 mm) (Fig P-33);

- Take care not to tear the cervix or to create a false opening.

Figure P-32

 Inserting a retractor and holding the anterior lip of the cervix

  Figure P-33

  Dilating the cervix

• Gently pass a uterine sound through the cervix to assess the length and direction of the uterus.

The uterus is very soft in pregnancy and can be easily injured during this procedure. 

• Evacuate the contents of the uterus with ring forceps or a large curette (Fig P-34). Gently curette the walls of the uterus until a grating sensation is felt.

Figure P-34

 Curetting the uterus 

• Perform a bimanual pelvic examination to check the size and firmness of the uterus.

• Examine the evacuated material. Send material for histopathological examination, if required.

POST-PROCEDURE CARE

• Give paracetamol 500 mg by mouth as needed. 

• Encourage the woman to eat, drink and walk about as she wishes.

• Offer other health services, if possible, including tetanus prophylaxis, counselling or a family planning method.

• Discharge uncomplicated cases in 1-2 hours.

• Advise the woman to watch for symptoms and signs requiring immediate attention: 

- prolonged cramping (more than a few days);

- prolonged bleeding (more than 2 weeks);

- bleeding more than normal menstrual bleeding;

- severe or increased pain;

- fever, chills or malaise;

- fainting.

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