What is uterine aspirate? How is aspirate taken from the uterine cavity? Contraindications for vacuum aspiration

Vacuum aspiration of the uterine cavity is the easiest and most reliable way to extract the contents of the uterus for examination. Unlike diagnostic curettage, this method is much more gentle on the delicate mucous membrane of the uterine cavity, does not injure it, and leads to complications such as inflammatory processes much less often. Taking aspirate from the uterine cavity is indicated in the following cases:

at ;
for infertility;
with endometriosis;
at ;
for ovarian tumors;
if you suspect malignant tumors in the endometrium;
when monitoring the effectiveness of hormone therapy.

Cytological examination of the aspirate helps to track whether the endometrium corresponds to the phase of the cycle, whether malignant formations are developing in it, and to identify uterine cancer at the earliest, preclinical stage.

How is aspirate taken from the uterine cavity?

A woman who is about to undergo aspiration of the contents of the uterine cavity is usually interested in how painful such a manipulation is, on what day of the cycle it can be performed and how to properly prepare for it.

Until recently, Brown syringes were used to take aspirate from the uterine cavity - plastic containers with a length of 300 mm and an outer diameter of 3 mm, while a woman could experience unpleasant, even acute painful sensations. Nowadays more advanced tools are used for these purposes: vacuum syringes American made and cannula made in Italy. In order to minimize discomfort, 30-60 minutes before the procedure you should take a painkiller. The study is usually scheduled for 20-25 days menstrual cycle.

During the procedure for taking aspirate from the uterine cavity, the doctor performs the following manipulations:

Examines the patient.
Disinfects the external genitalia with iodonate.
Exposes the cervix using speculum.
Grasps the cervix using bullet forceps.
Probes the uterus to determine the size of its cavity.
Take aspirate using a vacuum syringe.
Removes instruments and re-treats the external genitalia with iodonate.

Vacuum aspiration of the contents of the uterine cavity is performed within the walls of a regular district antenatal clinic and takes only a few minutes. This procedure does not require any specific preparation, so the woman only needs to perform the usual hygiene procedures, as before an ordinary visit to the gynecologist.

Contraindications to vacuum aspiration of the uterine cavity

Taking aspirate from the uterine cavity should not be performed during acute and exacerbation chronic diseases genitourinary area, the presence of inflammatory processes in the cervix and vagina.

Complications after taking aspirate from the uterine cavity

In a small percentage of cases, in the process of taking aspirate from the uterine cavity, the mucous membrane of the uterine walls may be injured, which is manifested by abdominal pain that radiates upward to the collarbone. If you are injured during the procedure blood vessels, internal bleeding may occur. As a result of blood loss, blood pressure drops, a feeling of nausea and dizziness appears, bloody issues from the genitals.

To others possible complication after aspiration of the uterine cavity, development may occur inflammatory process in the uterus. In this case, the woman experiences weakness, pain in the lower abdomen, and a rise in body temperature. Symptoms of inflammation may appear either a few hours after taking the aspirate or several days later.

An aspirate from the uterine cavity is taken to analyze the endometrial lining. Vacuum aspiration is a more gentle way of taking material for a biopsy compared to curettage; it does not injure the uterine mucosa and is much less likely to lead to various kinds of complications.

Indications for aspirate collection

Vacuum aspiration of the uterine cavity is performed in the following cases:

For menstrual irregularities;
For infertility of unknown etiology;
With uterine bleeding;
For various gynecological diseases, in particular, endometrial hyperplasia and endometriosis, ovarian tumors;
If you suspect malignant processes in the organs of the reproductive system;
For atypical vaginal discharge;
If the results of ultrasound of the pelvic organs are unfavorable;
For control when taking hormonal drugs.

An additional indication is the long-term use of a contraceptive such as an intrauterine device. Exceeding the period of use intrauterine device leads to thinning of the endometrium of the uterus and the development of the inflammatory process. Therefore, after removing the spiral, aspiration is necessary, followed by cytological examination of the material.

Goals of cytological examination

Cytological examination of the aspirate allows one to analyze the structure of the endometrium, determine its compliance (or non-compliance) with a given phase of the menstrual cycle, as well as timely identify possible malignant formations at the very end. early stage and differentiate them from others pathological conditions endometrium.

Other diagnostic studies, such as ultrasound, visual examination, blood test, do not provide such an accurate picture, since many gynecological diseases have similar symptoms.

The results of the cytological examination are prepared within 1-2 days. If, according to the results of the analysis, atypical cells were found in the uterine mucosa, then additional treatment is usually prescribed. histological examination uterine tissue and cervical canal, which helps clarify the nature and extent of prevalence pathological process.

The procedure for taking aspirate from the uterine cavity

Previously, so-called Brown syringes were used to take aspirate - plastic containers that were inserted into the uterine cavity. At the same time, women experienced some painful sensations. Currently, more advanced tools are used - vacuum syringes made in America and Italy. No special preparation is required for this procedure, but it is recommended that you take some kind of pain medication about an hour before the aspiration. The antispasmodic will relax the cervix, and this will make the procedure easier.

Typically, vacuum aspiration is prescribed on days 6-9 or 20-25 of the menstrual cycle. Douching should not be done during the day before the procedure.
The aspirate collection process includes:

Disinfection of the external genitalia with iodonate solution;
Exposure and fixation of the cervix using mirrors;
Grasping the cervix with forceps;
Probing the uterus to determine its size;
Taking an aspirate with a vacuum syringe;
Removal of instruments and re-treatment of organs with a disinfectant.

Since only cells need to be taken for analysis uterine endometrium, the movements of the syringe must stop before removing it, so that the cells of the cervical canal and vagina do not get into the syringe.

In general, the procedure takes no more than 10 minutes, and taking the aspirate itself takes 10-15 seconds. After aspiration, some women experience nagging pain lower abdomen or bloody discharge, but these symptoms pass fairly quickly.

Contraindications for vacuum aspiration

Acute gynecological or urological diseases or exacerbation of chronic diseases;
Any inflammatory processes of the cervix and vagina;
Pregnancy.

In this case, damage to the uterine mucosa and relapse of existing diseases is possible.

Possible complications after aspiration

If damage to the blood vessels of the uterus occurs during the procedure, there is a risk of developing internal bleeding. At the same time, there is a decrease blood pressure, rapid heartbeat, dizziness, feeling of nausea, dry mouth, bleeding from the vagina.

Another possible complication may be the development of an inflammatory process in the uterus. In this case, the temperature rises, weakness and pain in the lower abdomen appear. These symptoms can appear either a few hours after the procedure or several days later. However, if the procedure is carried out correctly, using sterile instruments, this is excluded.

Since the uterine mucosa is slightly injured, minor painful sensations and discomfort in the lower abdomen.

In what cases can cytology results be incorrect?

When taking an aspirate during menstruation;
If vaginal antibacterial agents were used on the day of aspiration;
If there is gel left on the internal genital organs after the ultrasound;
If the procedure was performed during an exacerbation of a chronic infectious disease.

If at work reproductive organs women, deviations are observed and suspicions arise about the development of pathological processes, then doctors carry out comprehensive examination. One common type of examination is taking an aspirate from the uterine cavity. As is known, aspirate is taken for cytological analysis endometrial mucosa.

Collecting samples via vacuum aspiration is considered a more gentle method when compared with traditional curettage to take a biopsy, since during such a procedure no trauma is caused to the mucous membrane of the uterine cavity. It should also be noted that the consequences of aspiration are minor, and complications of various types occur quite rarely.

When is aspiration of the uterine body cavity prescribed?

Biopsy analysis by taking an aspirate is prescribed in the following cases:

If there are serious disturbances in the menstrual cycle;
In case of bleeding from the uterine cavity;
For primary and secondary infertility;
In the case of the development of diseases of the reproductive organs, such as: endometriosis, endometrial hyperplasia, neoplasms on the ovaries, etc.;
At vaginal discharge atypical character;
If there is a suspicion of the development of malignant processes in the genital internal organs.

Additional information about a disease such as hyperplasia can be found in this video:

Aspirate collection may be ordered based on the results ultrasound examination and as a control analysis after long-term use hormonal pharmacological substances. The analysis is also carried out in cases where a woman wears a contraceptive device installed inside the uterine cavity for longer than the prescribed period.

In what cases is vacuum aspiration contraindicated?

Despite a large number of indications for taking an aspirate from the uterine cavity and the relative safety of the procedure, there are still certain contraindications to its use. Thus, sampling of epithelial areas is not carried out in the following cases:

In the presence of urological and gynecological diseases those in the acute stage;
If inflammatory processes of any type are detected in the uterine body or in the vaginal cavity;
For colpitis and cervicitis.

It is important to note that for women who are pregnant, an aspirate test is strictly prohibited.

Carrying out a uterine biopsy using a vacuum method

How is uterine cavity aspiration performed?

Of course, any surgical intervention, even the most gentle one, still involves the occurrence of painful spasms. When taking samples from the cavity of the uterine body, painful sensations also occur. The degree of pain depends on the level pain threshold patients. In any case, an hour before the procedure, the treating gynecologist prescribes an anesthetic, so you should not be afraid of this manipulation. To obtain a more reliable result, the aspirate is taken from the 6th to the 9th, as well as within 20-25 days from the beginning of the menstrual cycle.

The procedure itself, as a rule, is carried out in a antenatal clinic and does not imply registration for an inpatient stay in a hospital. The aspirate is taken according to the following steps:

External genital organs are treated with iodonate;
Using speculums (gynecological) provides access to the cervical section of the uterine organ;
The cervix of the uterine cavity is grasped using bullet forceps;
The material is taken with a vacuum-type syringe.

Possible complications from the procedure

As already mentioned, taking samples using the vacuum method is an easily tolerated procedure that practically does not cause serious complications. However, there is still the possibility of some complicated consequences. So, if during collection of material for analysis the blood vessels of the uterine cavity are damaged, then severe internal bleeding may occur. It is often accompanied by dizziness, severe pain in the abdominal area, nausea, low blood pressure.

Another quite serious complication may be the development of inflammation in the uterine cavity. The first signs of the development of the inflammatory process are considered to be a significant increase in general temperature, a feeling of weakness and the occurrence of abdominal pain. It is worth noting that the threat of inflammation will not arise if all the instruments used to collect the aspirate are sterile. Therefore, in order to avoid complications of various kinds, you need to carefully choose a gynecological clinic and not ignore the recommendations of the treating gynecologist regarding lifestyle during the recovery period.

[12-043 ] Cytological examination of aspirate from the uterine cavity

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Study of the characteristics of cells, their nuclei (size, shape, degree of staining) and endometrial glands, used for the diagnosis of benign diseases, precancerous conditions and endometrial cancer.

Synonyms Russian

Endometrial aspiration biopsy

English synonyms

Endometrialcytology
Endometrial cytopathology
Endometrial aspiration for cytology
Pipelle biopsy

Research method

Cytological method.

What biomaterial can be used for research?

Aspirate from the uterine cavity.

How to properly prepare for research?

No preparation required.

General information about the study

There are several ways to diagnose endometrial diseases. Today the main research method is diagnostic curettage(uterine cavity curettage) is an invasive procedure in which fragments of uterine tissue can be obtained using a special surgical instrument. These fragments are sent to histological study, allowing us to establish the nature of the cells and their ratio in the sample. Curettage involves artificial expansion of the cervical canal (dilation of the cervix) at the first stage of the procedure and is performed under general anesthesia in a hospital setting.

Cytological examination- This is an addition to histological examination. The main differences between the two methods are as follows:

Material for cytological examination is obtained during the so-called aspiration biopsy. This method involves inserting a special cannula (blunt-tipped needle) into the uterine cavity and creating negative pressure at one of its ends to aspirate a fragment of the endometrium. Although the material obtained during aspiration contains intact (not involved in pathology) cells, their natural ratio in pathology is disrupted. Therefore, the aspirate is sent not for histological, but for cytological examination.
The aspiration biopsy procedure does not require cervical dilatation and is therefore less traumatic. It can be performed with local anesthesia in a clinic setting.

Indications for cytological examination of aspirate from the uterine cavity overlap with indications for diagnostic curettage:

Dysfunctional uterine bleeding;
Infertility;
Postmenopausal bleeding.

Cytological examination allows to identify signs of impaired endometrial proliferation or inflammatory process, as well as pathogenic microorganisms. The pathologist studies the characteristics of cell nuclei and the characteristics of the glands and comes to one of the following conclusions:

Normal endometrium in the proliferation phase;
Normal endometrium in the secretion phase;
Normal endometrium in the menstrual phase;
Endometrial atrophy;
Endometrial hyperplasia without atypia and other benign proliferation disorders. There are no cytological criteria for differentiating “simple” and “complex” hyperplasia, like the WHO histological classification;
Endometritis;
Endometrial hyperplasia with atypia, other precancerous conditions and endometrial cancer.

When using the aspiration biopsy technique, material adequate for a full analysis can be obtained in more than 90% of cases. This is comparable to the result using the curettage method. According to one study, the sensitivity of cytological analysis for any pathological process in the endometrium is approximately 88%, the specificity is 92%, the positive predictive value is 79%, and the negative predictive value is 95%. It was also shown that the results of cytological examination are in very good agreement with the results of histological examination. On this basis, some authors suggest using cytological examination as the first stage of diagnosis, and curettage and histological examination as the second stage of diagnosis in women with a pathological result of cytological examination. This approach, however, is not universal.

What is the research used for?

For the diagnosis of benign diseases, precancerous conditions and endometrial cancer.

When is the study scheduled?

If the patient has dysfunctional uterine bleeding/ infertility / postmenopausal bleeding.

What do the results mean?

Endometrial atrophy;
Endometritis;
Epithelial metaplasia of the endometrium (squamous, syncytial, morular and others);
Endometrial adenocarcinoma.

What do the results mean?

Based on the submitted material, a doctor’s report is issued.

Examples of cytological examination conclusions:

Normal endometrium (in the proliferation/secretion/menstruation phase)
Endometrial atrophy;
Endometrial hyperplasia without atypia;
Endometritis;
Epithelial metaplasia of the endometrium (squamous, syncytial, morular and others);
Endometrial hyperplasia with atypia;
Endometrial adenocarcinoma.

What can influence the result?

Phase of the menstrual cycle;
Physician experience in performing aspiration biopsy;
Volume of material received.

Important Notes

Cytological examination is an addition to histological examination.

Histological examination of biopsy samples of organs and tissues (except for the liver, kidneys, prostate gland, lymph nodes)
Ultrasound examination of the uterus and appendages (transabdominal/intravaginal)
Appointment with a doctor - obstetrician-gynecologist, candidate medical sciences primary

Who orders the study?

Obstetrician-gynecologist.

Literature

Maksem JA, Meiers I, Robboy SJ. A primer of endometrial cytology with histological correlation. Diagn Cytopathol. 2007 Dec;35(12):817-44. Review.
S. Ashraf, F. Jabeen. A Comparative Study Of Endometrial Aspiration Cytology With Dilitation And Curretage In Patients With Dysfunctional Uterine Bleeding, Perimenopausal And Postmenopausal Bleeding. JK-Practitioner, Vol.19, No (1-2) Jan-June 2014.
Sweet MG, Schmidt-Dalton TA, Weiss PM, Madsen KP. Evaluation and management of abnormal uterine bleeding in premenopausal women. Am Fam Physician. 2012 Jan 1;85(1):35-43. Review.

Many gynecologist patients hear about such manipulation as aspirate from the uterine cavity. Let's talk about what this procedure is, why it is performed on women in different ages, what are its advantages and disadvantages.

The term “aspiration” literally means “to suck out.” In medicine, aspiration biopsy is widely used - that is, obtaining tissue fragments using “suction”, usually based on a pressure difference. The procedure is carried out with a syringe, special probes, vacuum electric aspirators, and so on.

Such aspirate can be taken from the lungs, bronchi, stomach, nasal sinuses, volumetric liquid formations. In gynecology, aspiration biopsy from the uterine cavity is very common.

There are three main types of this procedure:

Aspiration biopsy of the endometrium using a vacuum aspirator;
Aspiration biopsy using a syringe or manual (manual) vacuum aspiration;
Pipelle endometrial biopsy or aspirate using a special uterine probe.

IN Lately These manipulations have become widespread for various indications:

Approximate and initial diagnosis for suspected various diseases body of the uterus. This manipulation can be performed to diagnose conditions such as uterine cancer, endometrial hyperplasia, chronic endometritis, various options abnormal conditions of the uterine cavity - hematometer, serosometer.
Routine examination before various gynecological manipulations and operations. An endometrial biopsy is performed before IVF, insemination, and stimulation of ovulation in women with infertility.

In gynecological patients, this manipulation is performed as a primary stage before planned operations, for example, before removal of uterine fibroids, pelvic floor plastic surgery. Previously, separate diagnostic curettage of the uterine cavity was used for these purposes, but last years in most cases there is no need for such traumatic examination.

Diagnosis of the causes of infertility in women. In this case, endometrial tissue can be obtained for histological examination. This is important for assessing the usefulness of the endometrium, its correspondence to the phase of the menstrual cycle, and the presence or absence of an inflammatory response.
Monitoring and evaluating the effectiveness of treatment for a particular condition. An aspirate from the uterine cavity can give an answer as to whether prescribed medications help, for example, for endometrial hyperplasia, or whether chronic endometritis has been treated with antibiotics.

Now let's look at each type of aspiration biopsy separately.

Vacuum biopsy

It's more old method, which, in addition to diagnosing the condition of the endometrium, has been and continues to be used to terminate short-term pregnancies and also to clean the uterine cavity from blood clots, hematometers, serozometers, remnants of the fertilized egg after abortion, and postpartum lochia when they are delayed.

Source: vashamatka.ru

The essence of the method is to use the principle of a vacuum cleaner. A vacuum aspirator is an electrical device consisting of a compressor, a thin aspiration probe or catheter inserted into the uterine cavity, and a container for the resulting aspirate.

This type of aspirator is also used to terminate early pregnancies.

The aspiration procedure is as follows:

The patient lies on the gynecological chair in a standard position.
The cervix is brought out in the speculum, fixed with forceps, using a button probe, the doctor passes through the cervical canal and inserts a catheter into the uterine cavity.
The catheter is fixed, the doctor presses the pedal of the device, the “vacuum cleaner” creates negative pressure and the tissues of the uterine cavity are sucked into the container.
The doctor removes the instruments and treats the vagina and cervix with antiseptics. The procedure is over.

The resulting tissues are fixed depending on their quantity. If there is a good, abundant aspirate, the biopsy can be placed in formaldehyde and sent for histological examination. When the aspirate is scanty, histology is usually uninformative. It is better to place such a biopsy on a cytological slide and send it for cytological examination of the cellular composition.

Manipulation is usually carried out without general anesthesia under local anesthesia, the cervix is injected at certain points with a solution of novocaine or lidocaine. In young people who have given birth naturally For women, the procedure is sometimes carried out quietly without anesthesia at all, causing the patient a moment of minor discomfort.
Manual aspiration

The meaning of the procedure is generally similar, only instead of electrical power, manual force is used to “suck out”. A manual aspirator is a kind of large syringe with a tight piston and a container for collecting the resulting tissue.

Pipel biopsy

This is the most modern, technologically advanced and minimally invasive method of obtaining endometrial tissue. For this type of aspirate, special aspiration probes are used.

The operation technique is similar, but does not require dilatation of the cervix, nor the use of “brute” force - manual or electric. Pipe probes are very thin, flexible, easily enter the cervical canal, and are very convenient to use.

Advantages and disadvantages

Let's start with the positive points:

Low invasiveness and practical complete absence traumatization of the mucous membrane of the uterine cavity, in contrast to separate curettage uterine cavity and hysteroscopy. This is very important and relevant for young people nulliparous women, patients planning pregnancy, because the mucous membrane of the uterine cavity is one of the fundamental factors for the successful onset and course of pregnancy.
No need for general anesthesia, and, consequently, the absence of risks of anesthesia, its possible complications.
Simplicity and speed. Unlike hysteroscopy, these methods are widespread, available in almost every institution, and are not expensive.
No need for hospitalization or hospital stay.

In the USA, this kind of manipulation is called “office” or “clerical” because it is carried out not in a hospital, but in a purely outpatient setting– on a regular gynecological chair in a regular gynecologist’s examination room, they do not require special training, anesthesia and sick leave.

That is, the woman undergoes this procedure and can return to work, to the “office”.
Few complications. Considering its minimally invasive nature, the procedure has virtually no serious complications, unlike RDV or hysteroscopy.

The disadvantages of manipulation are:

There is no “eye control”, that is, the procedure is, in principle, carried out blindly, in contrast to hysteroscopy, in which a biopsy can be taken under visual control, from the most suspicious area.
Orientation of diagnosis. As a rule, in serious cases, for example, when detected in aspirate from the uterine cavity cancer cells, a clarifying diagnosis is indicated - hysteroscopy.
Lack of significant therapeutic effect - that is, with aspiration biopsy it is impossible to stop the bleeding or remove the polyp. At most, vacuum aspiration can empty the cavity of liquid, blood, and exudate. When
Pipel biopsy healing effect is generally impossible due to the extremely thin diameter of the probe.

Preparation

Although the procedure is called “office”, a minimum examination is still required before it:

Ultrasound of the pelvic organs, so that the doctor understands the picture and indications for the procedure, as well as in case of any structural features of the genital organs in this patient - for example, a bicornuate uterus or a septum in the uterus.
General blood and urine tests to exclude acute inflammatory processes in the body.
Gynecological smear for flora to exclude an inflammatory process in the vagina.
A smear from the cervix for atypical cells - oncocytology.

Complications

Complications with this type of procedure are extremely rare, but it is important to know the possible ones:

Perforation of the uterine walls with instruments or a probe is an almost casuistic situation, since in this version of manipulation there are no sharp, hard instruments, as in hysteroscopy or RDV.
Secondary infection is acute or chronic endometritis, which can occur due to poor smears in the patient and violation of aseptic rules.

In conclusion, I would like to say that aspirate from the uterine cavity is an excellent alternative surgical methods diagnostics, a real salvation for patients with contraindications to anesthesia and invasive procedures.