How is cervical canal curettage performed? The procedure for curettage of the cervical canal and uterine cavity: what is it, what does separate and diagnostic mean? Therapeutic diagnostic curettage of the cervical canal

After visiting a gynecologist, many patients are prescribed an operation to curettage the uterine cavity. Some women also call this operation a cleansing. There is no need to worry about such an operation, since it is not as scary as it seems, and now you will see for yourself.

Let's figure out what curettage of the walls of the uterus is and why it is used in gynecology?

The uterus is a muscular organ; doctors call it the pyriform body, since the shape of the uterus is very similar to a pear. Inside the piriform body there is a mucous membrane, the so-called endometrium. It is in this environment that the child grows and develops during pregnancy.

Throughout the menstrual cycle, the membrane of the piriform body grows, accompanied by various physical changes. When the cycle comes to an end and pregnancy does not occur, all the mucous membranes leave the body in the form of menstruation.

When performing a curettage operation, doctors remove exactly that layer of mucous membrane that has grown during the menstrual cycle, that is, only the surface layer. The uterine cavity, as well as its walls, are scraped out using instruments along with the pathology. This procedure is needed as in medicinal purposes, and for the purpose of diagnosing such pathologies. Curettage of the walls is carried out under the supervision of hysteroscopy. After the operation, the scraped layer will grow again in one menstrual cycle. In fact, this entire operation is reminiscent of menstruation, performed under the supervision of a doctor and with the help of surgical instruments. During the operation, the cervix is also scraped out. Treated samples from the cervix are sent for analysis separately from scrapings from the piriform body cavity.

Advantages of the technique under hysteroscopy control

Simple curettage of the uterine mucosa is carried out blindly. When using a hysteroscope, the attending physician examines the cavity of the piriform body using a special device, which he inserts through the cervix before starting the operation. This method is safe and of higher quality. It allows you to identify pathologies in the uterine cavity and carry out curettage without any risks to the woman’s health. After the operation is completed, you can check your work using a hysteroscope. The hysteroscope allows you to evaluate the quality of the operation and the absence or presence of any pathologies.

Indications for RDV

Carrying out this type of operation has several goals. The first goal is to diagnose the uterine mucosa, the second is to treat pathologies inside the uterus.

During diagnostic curettage, the doctor obtains a scraping of the lining of the uterine cavity for further study and identification of pathology. Therapeutic curettage of the uterine cavity is used for polyps (growths of the uterine mucosa), since there are no other methods of treating this pathology. Also, curettage can be used as post-abortion therapy, as well as for abnormal thickening of the uterine cavity mucosa. Curettage is also used for uterine bleeding, when the nature of the bleeding cannot be determined, and curettage can stop it.

Preparing a woman for the Russian Far East

With planned curettage, the operation is performed before the onset of menstruation. Before the operation begins, the patient must undergo some tests. First of all this general analysis blood, cardiogram, test for the presence/absence of HIV infection, test for different kinds hepatitis, as well as a blood clotting test. The patient must undergo complete depilation of pubic hair and also purchase sanitary pads. It is recommended not to eat before surgery. You should also bring a clean T-shirt, hospital gown, warm socks and slippers.

Typically, the operation of curettage of the uterine cavity is not very complicated and is carried out within 20 – 25 minutes. There should be no complications after the operation. In the postoperative period, the attending physician may prescribe a short course of antibiotics. This course should be taken to avoid any complications.

Histology results will be ready within 10 days. If you experience abdominal pain during the postoperative period, you should contact your doctor.

I would like to note that the operation of curettage of the uterine cavity is the safest and most painless operation in the field of gynecology.

Many women are prescribed separate diagnostic curettage uterine cavity and cervical canal. This is one of the most traumatic, but indispensable procedures for diagnosing dangerous, including oncological diseases, as well as a method of non-surgical treatment - removal of polyps, hyperplastic endometrium, .

Good specialist, especially those who have secured a hysteroscope, will carry out all manipulations as carefully as possible, without consequences for health. And he will calculate on which day of the cycle it is better to carry out the RDV. Usually elective surgeries are prescribed as close as possible to the expected day of the start of a new menstrual cycle. That is, with a 28-day cycle, on day 26-27. So as not to break the cycle.

RDV - what is it and the technique of implementation, how is it done with and without hysteroscopy

Diagnostic dilation (widening of the cervical canal) and curettage (cleaning of the uterus) were originally intended to identify intrauterine pathology of the endometrium and help with abnormal uterine bleeding. Now new methods have emerged for assessing the uterine cavity and diagnosing endometrial pathologies. For example, pipel or aspiration biopsy. But dilation and curettage still plays a role important role V medical centers where advanced technology and equipment are not available, or when others diagnostic methods do not give results.

Traditionally, cervical dilatation and curettage of the walls of the uterine cavity are performed blindly. Diagnosis can be done under ultrasound guidance or in combination with hysteroscope imaging.

The course of the operation, what a woman sees and feels during curettage

Gynecological intervention is performed in a hospital setting to ensure complete sterility, in the operating room. Woman empties bladder. Afterwards, in his room he undresses, takes off his underwear (usually they are allowed to leave only a nightgown). Upon entering the operating room, a non-woven cap is placed on her head, a non-woven shirt on her body, and non-woven shoe covers on her feet.

He lies down on something like a gynecological chair, but improved. An IV is placed on one arm through which drugs will be administered to provide anesthesia. And on the other - a sensor for measuring blood pressure and pulse. The latter is optional.

By right hand the anesthesiologist gets up and usually begins to “talk her teeth.” This is done in order to relieve anxiety. At this time, the gynecologist who will do the curettage conducts a gynecological examination to clarify the size of the uterus and its location (inclination relative to the cervix). This is the most unpleasant moment, but not painful.

There is no need to be afraid, the insertion of gynecological instruments into the vagina, dilation of the cervix, which is really very painful, and so on will be carried out after the woman “falls asleep”.

After everyone is gathered in the operating room and ready, the drug is delivered through an IV into the patient’s vein. And within a few seconds she falls asleep. This is usually preceded by a feeling of warmth in the throat.

Afterwards, the doctor installs a gynecological speculum (dilator) in the vagina, uses a probe to measure the length of the uterus and begins to dilate the cervix. Alternately, he inserts Hegar dilators into it, each time with a larger diameter. In this way, the process is gradual. The cervical canal is scraped out with a curette, the material is taken onto histological examination.

Further, if this is not a simple curettage, but a hysteroscopy, liquid is injected into the uterus so that its walls can be examined. Then the hysteroscope is inserted. Using it, the doctor can notice foci of adenomyosis (internal endometriosis), by the way, very common reason infertility, polyps, fibroids growing into the uterine cavity (submucosal) and cancerous tumors.

Many tumors can be removed immediately. This is called hysteroresectoscopy. And all without an incision, through vaginal access! Even 4-centimeter fibroids can be removed with a hysteroresectoscope.

Thus, RDV turns into LDV, that is, the procedure is not just diagnostic, but therapeutic and diagnostic.

If not hysteroscopy is performed, but exclusively RDV, fluid and the hysteroscope are not introduced into the uterus. And its walls are immediately scraped out with a curette. The scraping is sent for histological examination. It usually takes 7-10 days.

The entire procedure usually takes no more than 20 minutes. Afterwards, the IV is removed, and the patient immediately or almost immediately begins to wake up. Next, she is usually left for a short time on a gurney near the intensive care unit, and then transported to the ward.

Place absorbent diapers under her, as there will be bleeding.

Within 3-4 hours after anesthesia, dizziness, abdominal pain (you can ask the nurse to inject a painkiller), and nausea are felt.
When all this stops, you are allowed to get up.

Indications for separate therapeutic and diagnostic curettage of the uterus and c/canal

A mini-operation, also called abrasion of the uterine cavity, is performed to evaluate the endometrium and take material for histological examination. A separate diagnostic curettage also includes evaluation of the endocervix (the lining of the cervix) and taking a biopsy material from the ectocervix (the lower part of the cervix that protrudes into the vagina) and (the place where the cancer is usually located).

Indications for fractional curettage in gynecology are as follows.

Abnormal uterine bleeding:
- irregular bleeding;
- menorrhagia (too heavy and prolonged periods);
- regular large loss of blood (more than 80 grams during one period) and large clots in the discharge.
Suspicion of malignant or precancerous conditions (for example, endometrial hyperplasia) based on ultrasound and symptoms.
Endometrial polyp according to ultrasound or fibroids growing inside the uterine cavity, that is, submucosal).
Removal of fluid and pus (pyometra, hematometra) in combination with histological assessment of the uterine cavity and removal of cervical stenosis.
Office or outpatient endometrial biopsy has failed due to cervical spasm or the histological result is equivocal.
Curettage of the cervical canal is required in case of an atypical finding during an oncocytological study (atypia in a smear) and (or).

RDV is often performed simultaneously with other gynecological procedures (for example, hysteroscopy, laparoscopy).

Assessment of the uterine cavity during dilatation and curettage, if the doctor uses a hysteroscope, is much more accurate than with ultrasound. Often ultrasonography does not give a complete picture of the condition of the endometrium due to shadowing from leiomyoma, pelvis, and intestinal loops.

Dilation and curettage can also be a treatment procedure. Therapeutic and diagnostic curettage of the uterus is performed for:

removal of remnants of placental tissue after incomplete abortion, failed abortion, septic abortion, artificial termination of pregnancy;
stops uterine bleeding in the absence of results from hormonal therapy;
diagnosis of gestational trophoblastic disease and removal of all pregnancy products during hydatidiform mole.

Contraindications to intrauterine manipulation

TO absolute contraindications Separate diagnostic curettage (including under the control of hysteroscopy and ultrasound) includes:

availability of desired intrauterine pregnancy;
inability to visualize the cervix;
severe malformations, anomalies of the cervix and (or) uterine body, vagina.

Relative contraindications are as follows:

severe cervical stenosis;
congenital anomalies of the uterus;
blood clotting disorder;
acute infection in the pelvic area.

These contraindications can be overcome in some cases. For example, magnetic resonance imaging determines the anatomy of the cervix or its body with certain structural features, thereby ensuring a safe examination of the endocervix and endometrium.

Complications and consequences of RDV

Complications may arise during the work of doctors. Possible complications include the following:

heavy bleeding;
cervical rupture;
perforation of the uterus;
infection of the wound surface;
intrauterine adhesions (synechia);
anesthetic complications.

Complications, in particular uterine perforation, are more common in patients after childbirth, with gestational trophoblastic disease, altered genital anatomy, cervical canal stenosis, or existing acute infection at the time of the operation.

Injuries and ruptures of the cervix

Rupture mainly occurs during dilatation - widening of the neck. Doctors have tools in their arsenal that minimize this complication. In addition, the use of prostaglandin preparations or kelp as preparation for the opening of the uterus significantly improves the picture.

Perforation of the uterus with gynecological instruments

Perforation is one of the most common complications of dilation and curettage. The risks are especially great during pregnancy (abortion), after childbirth (removal of a placental polyp), and with malformations of the uterus. Perforation of the uterus is rare during menopause.

If the perforation occurred with a blunt instrument, medical observation of the victim's condition is required for several hours, and that's all that is needed. If perforation is suspected with a sharp instrument, such as a curette, laparoscopic surgery is required. Possibly suturing the wound. At heavy bleeding A laparotomy (surgery with an incision) is performed.

Infections associated with diagnostic dilation and curettage are rare. Problems are possible when cervicitis (inflammation of the cervix) is present during the procedure. The study recorded a 5% frequency of bacteremia after curettage of the uterine cavity and isolated cases of sepsis - blood poisoning. before the Russian Far East is usually not carried out.

Intrauterine synechiae (Asherman's syndrome)

Curettage of the uterine cavity after childbirth or abortion can lead to injury to the endometrium and subsequent formation intrauterine adhesions. This is called Asherman's syndrome.

Intrauterine synechia complicates future intrauterine interventions, including diagnostic curettage, and increases the risk of perforation.

Intrauterine synechiae is one of the causes of scanty and irregular menstruation and infertility.

Anesthesia (intravenous anesthesia, “general anesthesia) for RDV

To avoid complications, since most often curettage is performed under general anesthesia (intravenous sedation), patients are asked not to eat anything 8 hours before the procedure. And do not drink 2-4 hours before it. This is necessary, since after the administration of drugs vomiting may occur, and vomit if it enters the Airways cause their blockage and even death from asphyxia.

In very rare cases, during anesthesia it happens anaphylactic shock- a deadly condition.

If you have entered large doses medications, a few weeks after curettage, hair may fall out more and your head may hurt.

Preparation for hysteroscopy, curettage, hysteroresectoscopy

If there are indications for a diagnostic or therapeutic procedure, the doctor will draw up an anamnesis based on your words, conduct a gynecological examination and write a referral. But before coming to the hospital, you must undergo the following examinations and tests:

Ultrasound of the pelvic organs (usually based on this, a referral for cleaning the uterus is given);
general urine analysis;
general blood analysis;
coagulogram;
blood test for viral hepatitis B and C, HIV, syphilis;
analysis for blood group and Rh factor;
vaginal smear for purity.

On the appointed day, the woman comes to the gynecological department, emergency room (described Russian realities) with a referral from a doctor, the results of all tests, ultrasound, passport and insurance policy. Be sure to take with you absorbent diapers, sanitary pads, a mug, a spoon, a plate, a bottle of water (you can drink it after coming out of anesthesia if you feel well), a robe, a nightie, and slippers.

The gynecologist who will do the cleaning and the anesthesiologist talk with the woman. Find out what chronic diseases she has, acute diseases what medications she uses or has taken in the recent past, whether she is allergic to anything, smokes, often takes alcohol, drugs, has there been a concussion, etc. All this is necessary to decide which anesthesia to use (sometimes a decision is made on local anesthesia) and possible contraindications for execution in currently procedures.

If you had unusual discharge from the vagina 1-2 days before, if you suspect, for example, that you have thrush, then warn your doctor about this.

After the conversation, papers are signed regarding consent to the operation and anesthesia. In some cases, the patient is immediately called to the nurse to receive a prophylactic antibiotic injection.

Important!

6 hours before curettage, in case of intravenous anesthesia, you should not drink dairy or fermented milk drinks, juices with pulp. It is not advisable to smoke on the day of the procedure.
You cannot drink anything, including water, for 4 hours.
You cannot eat 10-12 hours before surgery. Food and drink can provoke mechanical asphyxia if vomiting occurs after anesthesia.
There is no need to paint your nails or do their extensions.
You should not use decorative cosmetics.
Please note that you will not be able to drive away, since the effect of the drugs, including inhibition of reactions, is possible for about a day.
Find out in advance whether you need to take it with you compression stockings. Sometimes this is a requirement of anesthesiologists.

Before going to the operating room, for your own convenience, put panties, a pair of pads, mobile phone(be sure to charge it in advance), since you will be lying down for the first 1-2 hours after anesthesia. Place an absorbent diaper on the bed.

After curettage, it is advisable to abstain from pregnancy for 1-3 months. Therefore, doctors prescribe oral contraceptives (birth control pills) hormonal pills), as the most reliable way to prevent pregnancy. You can start taking pills right on the day of the procedure. This will be the first day of the new menstrual cycle.
Abstain from sexual activity for 2-4 weeks. This is necessary so as not to accidentally introduce an infection into the uterus.
The doctor may also recommend the use of vaginal suppositories with chlorhexidine (Hexicon) to prevent the inflammatory process. Antibiotics are usually prescribed when there is a high risk of developing an inflammatory process. If the operation was performed not as planned, but as an emergency, then antibacterial therapy necessary. In parallel with this, the woman takes tablets with fluconazole (an antifungal agent, preferably Diflucan - original drug or “Flucostat”), so that against the background of antibiotics, candidiasis (thrush) does not start - a very common complication.

You should immediately consult a doctor if:

severe bleeding (when the pad gets completely wet in 1-2 hours);
the appearance of large clots in vaginal discharge (indicates large blood loss, heavy bleeding, sometimes clots reach the size of a fist - this is dangerous for the development of anemia);
severe abdominal pain (occurs with perforation);
an increase in body temperature above 38 degrees without signs of ARVI (symptoms of acute respiratory viral disease- runny nose, sore throat, cough).

Delayed menstruation also requires attention. If there are no critical days 5 weeks after curettage, this may indicate complications- formation of intrauterine synechiae, hormonal imbalance or pregnancy. a woman can immediately after cleaning. More precisely, in 2 weeks, when she will ovulate and possibly conceive.

In the video, a gynecologist talks about the features of uterine curettage.

The external genitalia and cervix are treated both before and after the procedure.

Diagnostic curettage under hysteroscopy control

Curettage in combination with hysteroscopy of the uterus is considered more modern, informative and safe. Hysteroscopy is an examination of the uterine cavity using a special optical system.

Carrying out curettage in combination with hysteroscopy has several advantages:

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

Separate diagnostic curettage

Such a procedure as separate ( factional) diagnostic curettage involves alternately scraping first the walls of the cervix and then the body of the uterus. This approach allows us to determine the localization of detected tumors. After separate diagnostic scraping, the scrapings are placed in different tubes and sent to the laboratory for histological examination. To prevent cell damage, the material in the test tube is treated with formaldehyde or other drugs.

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

How to prepare for uterine curettage?

Before curettage of the uterus in mandatory A number of studies are being carried out to assess the condition of the female genital organs, as well as to assess general condition woman's body. Preoperative preparation is usually carried out on an outpatient basis.

Tests before curettage of the uterus

Before performing diagnostic curettage, the doctor prescribes laboratory and instrumental studies.

Studies that precede uterine curettage are:

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

When a patient is admitted to the hospital, the doctor conducts a physical examination and takes an anamnesis ( medical history information). When collecting anamnesis, special attention is paid to the presence of gynecological diseases and allergic reactions to certain drugs. Taking an anamnesis is of particular importance when choosing a method of pain relief. If the patient has previously undergone such an intervention, the doctor should familiarize himself with its results. The doctor carefully studies the results of the studies and, if necessary, prescribes additional studies.

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

It is recommended not to use before scraping by special means For intimate hygiene And medicines for topical use ( vaginal suppositories, pills). Immediately before surgery, the bladder must be emptied.

What can be the results after diagnostic curettage?

After curettage, the biological material is sent to the laboratory for histological examination. In the laboratory, thin sections of the resulting tissue are made, stained with special solutions, and then examined under a microscope. A pathologist performs a detailed macroscopic examination ( visible to the naked eye) and a microscopic description of the preparation followed by writing a conclusion. It is the histological examination of materials obtained during diagnostic curettage that makes it possible to establish a diagnosis and prescribe appropriate treatment.

In order to understand what pathological changes can be detected using diagnostic curettage, you need to know what the uterine mucosa should be like normally.

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

Characteristics of the endometrium in different phases menstrual cycle are:

Proliferative phase. The epithelium that lines the uterine glands is single-row prismatic. The glands look like straight or slightly convoluted tubes. In the glands it is noted increased activity 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 glandular cells, pronounced secretion processes are observed, which gradually end towards the end of the phase. The appearance of tangles of spiral vessels in the stroma is characteristic ( connective tissue basis of the organ). The thickness of the functional layer is about 8 cm. In this phase, the superficial ( 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 stem cells of the basal layer.

In the case of the development of uterine pathologies, the histological picture changes with the appearance of characteristic pathological signs.

Signs of uterine diseases identified after diagnostic curettage are:

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

It is worth noting that curettage results can be false negative or false positive. This problem is rare and, as a rule, is associated with errors during sample collection, transportation to the laboratory, as well as violation of the sample examination technique or examination by an unqualified specialist. All samples are stored in the archive for a certain time; therefore, if false results are suspected, they can be re-examined.

What diseases can be detected using curettage?

Diagnostic curettage is an intervention that can be used to detect a number of pathological conditions of the mucous membrane of the body and cervix.

Pathological conditions that can be identified using curettage are:

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

Endometrial polyp

An endometrial polyp is a benign formation that is localized in the area of the uterine body. The formation of multiple polyps is called endometrial polyposis.

Small polyps may not appear clinically. Symptoms usually appear as their size increases.

The basis of the structure of polyps is the stromal ( connective tissue) and glandular components, which, depending on the type of polyp, can be in different proportions. 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 predominantly by the uterine glands, the stromal component is represented in small quantities. Cyclic changes are not observed in the glands.
Fibrous polyp. The histological picture is represented by fibrous ( fibrous) connective tissue, no glands.
Glandular fibrous polyp. The structure of such polyps consists of connective tissue and uterine glands. 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 present in large numbers. An adenomatous polyp is characterized by intense proliferation of the epithelium.

Cervical polyp

Cervical polyps ( cervical polyps) are most often located in the cervical canal, less often they are localized in the vaginal part of the cervix. These formations are considered a precancerous condition.

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

Adenomatous endometrial hyperplasia

Adenomatous endometrial hyperplasia is a precancerous disease of the uterus. Characteristic of this pathological condition is the presence of atypical ( atypical) cells, and therefore this condition is also called atypical hyperplasia. Atypical structures resemble tumor cells. Pathological changes may be diffuse ( common) or observed in certain areas ( focal hyperplasia).

Characteristic signs of adenomatous endometrial hyperplasia are:

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

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

Glandular hyperplasia of the endometrium

The main cause of glandular endometrial hyperplasia is hormonal imbalance. Glandular hyperplasia of the endometrium is considered a precancerous condition. This condition is most often observed in mature women. Glandular hyperplasia usually regresses after curettage.

Macroscopic characteristics show thickening of the mucous membrane, and polypoid growths are noted in some areas.

Microscopic characteristics of glandular endometrial hyperplasia include the following signs:

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

If glandular cysts are detected, this pathological condition is called glandular cystic endometrial hyperplasia. With glandular cystic hyperplasia, the epithelium becomes cubic or close to squamous epithelium.

Endometrial cancer

For clinical course There are no pathognomonic signs of endometrial cancer ( characteristic of this particular disease), therefore histological examination is one of the main criteria for making a diagnosis. Approximately 2/3 of women develop uterine cancer in adulthood after menopause.

When examining endometrial scrapings, endometrial cancer is most often represented by adenocarcinoma. Also malignant diseases of the endometrium include squamous cell carcinoma ( aggressive form cancer, which is characterized by the rapid appearance of metastases), undifferentiated cancer ( a tumor in which cancer cells significantly different from normal cells), however such forms are much less common. Typically, such a tumor is characterized by exophytic growth ( into the lumen of the organ). The tumor can be highly differentiated, moderately differentiated and poorly differentiated. Prognosis upon detection of such a pathological condition ( especially poorly differentiated tumor) is usually unfavorable, but timely detection allows effective treatment. The higher the degree of tumor differentiation, the more similar elements it has to normal endometrium and the better she responds to hormonal treatment.

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

Cervical cancer

Cervical cancer is malignant tumor. Cervical cancer is much more common than endometrial cancer. The effectiveness of treatment directly depends on the timely diagnosis of this pathological condition. The earlier cancer is detected, the higher the likelihood of recovery and the survival rate. It has been established that the development of cervical cancer is associated with the human papillomavirus ( HPV) .

The histological picture of cervical cancer may vary depending on the location of the malignant process ( vaginal part of the cervix, cervical canal).

Histological characteristics of cervical cancer

Cervical cancer is characterized by the early appearance of metastases, which spread more often lymphogenously ( with lymph flow), and later hematogenously ( with blood flow).

Endometriosis

Endometriosis is a pathological condition characterized by the growth of tissue identical to the endometrium beyond its boundaries. Pathological changes can be localized both in the internal genital organs and in any other organs and tissues.

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

Signs of cervical endometriosis are also detected during colposcopy, but 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. Endometrioid 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 responds relatively weakly to various hormonal influences.

Endometritis

Endometritis is an inflammation of the lining of the uterus. This pathological condition can be acute or chronic.

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

Characteristic histological signs of endometritis are:

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

When making a diagnosis, a differential diagnosis of hypertrophic endometritis and glandular endometrial hyperplasia is carried out, since the histological picture of these two pathological conditions is similar.

Uterine fibroids

Uterine fibroids are a benign tumor that is localized in muscle layer uterus. Some doctors also call this formation leiomyoma. If the structure of fibroids is dominated by connective tissue ( fibrous) elements above the muscular component, then it is called fibroma. Many people believe that uterine fibroids are a precancerous condition, but this is incorrect, since uterine fibroids cannot become malignant ( degenerate into a malignant formation). Most often, fibroids are found in patients over 30 years of age. Detection of uterine fibroids before puberty is considered casuistic ( rare) phenomenon.

Myomatous nodes are round-shaped formations that consist of chaotically intertwined muscle fibers.

Diagnostic curettage in the case of uterine fibroids can only be performed for differential diagnosis with other diseases of the uterus. This method is not informative for identifying fibroids, since the material for examination during diagnostic curettage is the mucous membrane, and myomatous nodes are usually located under the mucous membrane. Carrying out diagnostic curettage without indications is fraught with the development of serious complications. In this regard, to diagnose this pathological condition, other research methods are recommended, which are more informative - aspiration biopsy ( a research method in which a section of tissue is excised for subsequent examination), hysteroscopy.

Cervical dysplasia

Dysplasia is a condition in which the cells of the cervix become atypical. There are two options for the development of this condition - recovery and malignant degeneration ( in cervical cancer). The main cause of cervical dysplasia is the human papillomavirus.

Curettage allows you to obtain biological material from the epithelium of the cervical canal, which is then subject to histological examination. When located pathological process in the vaginal part of the cervix, material for examination is obtained during colposcopy. A Pap test is performed to confirm the diagnosis.

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

There are three degrees of cervical dysplasia:

1st degree. Pathological changes cover up to 1/3 of the epithelium.
2nd degree. Damage to half of the epithelial cover.
3rd degree. Pathological change in more than 2/3 of the epithelium.

In the third stage of cervical dysplasia, the risk of malignant degeneration is about 30%.

Pathology of pregnancy

Histological examination after curettage allows us to identify changes associated with the pathological course of pregnancy ( ectopic pregnancy, frozen pregnancy, miscarriage).

Signs of pregnancy pathology identified by histological examination are:

areas of necrotic decidua ( the membrane that is formed 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 ( for pregnancy disorders early stages );
tangles of spiral arteries in the superficial layer of the uterine mucosa;
Arias-Stella phenomenon ( detection of atypical changes in endometrial cells characterized by hypertrophied nuclei);
decidual tissue with chorion elements ( membrane that eventually develops into 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 veins;
Overbeck's light glands ( sign of a disturbed pregnancy);
Opitz glands ( pregnancy glands with papillary projections).

During intrauterine pregnancy, chorionic villi are almost always found. Their absence may be a sign of an ectopic pregnancy or spontaneous miscarriage before curettage.

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

Histological examination allows us to confirm the fact of termination of pregnancy, to detect possible reasons such a phenomenon. For a more complete assessment clinical picture, and also to prevent a recurrence of the problematic course of pregnancy in the future, it is recommended to undergo a series of laboratory and instrumental studies. List necessary research determined by the doctor individually for each patient.

What to do after curettage?

After surgery, patients remain in the hospital for at least several hours. Usually the doctor discharges patients on the same day, but if there is an increased risk of complications, hospitalization is recommended. The doctor should warn patients what symptoms may appear after curettage and which of them are normal. When pathological symptoms You should consult a doctor immediately, as these may be signs of complications.

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

Physical activity on the body ( for example, sports) must be stopped for a while, as it may cause post-operative bleeding. You can engage in sports at least one to two weeks after the procedure, but this must be discussed with your doctor.

After curettage, after some time, 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 examination of a vaginal smear. An ultrasound examination of the pelvic organs may also be prescribed to assess the condition of the endometrium.

If inflammatory complications develop, anti-inflammatory drugs for local or general use may be prescribed.

Sexual life after diagnostic curettage

Doctors recommend starting sexual activity no earlier than two weeks after curettage. This recommendation is associated with an increased risk of infection in the genital tract and the development of an inflammatory process, since after surgery the tissues are more susceptible to infections.

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

Menstruation after diagnostic curettage

You need to know that the first menstruation after curettage of the uterine mucosa may occur late ( up to 4 – 6 weeks). This is not a pathological condition. During this time, the uterine mucosa is regenerated, after which menstrual function is restored and menstruation resumes.

Consequences of uterine curettage

Curettage is a procedure that requires caution when performed. The consequences of such a procedure can be positive and negative. TO positive consequences include the diagnosis and subsequent treatment of uterine pathologies. The negative consequences of curettage include complications, the occurrence of which can be associated both with poor-quality work of a specialist and with the individual reaction of the body to this intervention. Complications can occur both during the operation or immediately after its completion, or after long time (long-term complications).

Complications of uterine curettage may include:

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 deep damage the walls of the uterus, tissue remains in its cavity after curettage. Bleeding is a serious complication that requires immediate attention. The doctor decides whether repeated intervention is necessary to eliminate the bleeding or whether hemostatic drugs can be prescribed ( hemostatics). Bleeding may also be due to bleeding disorders.
Infection. Curettage of the uterine lining carries a risk of infection. With this complication, antibacterial 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.
Permanent damage to the cervix may be after curettage for stenosis ( narrowing) 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 abundant or scanty menstruation after curettage, accompanied by a deterioration in the woman’s general condition, is a reason to consult 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 this condition is fraught with subsequent menstrual irregularities and infertility. Damage to the germ layer can occur if the rules of the operation are not followed, especially if the curette moves too strongly and aggressively. 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 mucous membrane. In response to damage, inflammatory mediators are released and inflammatory reaction.
Anesthesia-related complications. Such complications may be associated with the development allergic reaction in response to drugs used in anesthesia. The risk of such complications is minimal, since before choosing an anesthesia method, the anesthesiologist, together with the attending physician, carefully examines the patient and collects a detailed history to identify contraindications to a particular method of pain relief and prevent complications.

Diagnostic curettage of the cervical canal, as well as its cavity, is the removal of the surface layer of the mucous membrane that covers the cervical canal and the body of the uterus. They resort to it for the purpose of diagnosis and differentiation gynecological diseases. The term “separate diagnostic curettage of the uterine cavity and cervical canal”, abbreviated as RDV, is also used.

Separate curettage is called because curettage of the uterine cavity and cervical canal is carried out separately.

Curettage of the cervical canal of the cervix and its cavity is classified as diagnostic procedures, since the removed tissue is further examined under a microscope.

During the procedure, only top part endometrium. Since she is recovering well, negative consequences will not happen if curettage was performed:

with proper qualifications of the doctor;
according to a strictly specified scheme.

The main purpose of curettage is to confirm or exclude malignant degeneration of uterine tissue. So, the clinic will offer curettage of the uterine cavity for endometrial hyperplasia. The manipulation is carried out two to three days before the start of menstruation.

The attending physician informs the patient in advance how the procedure is going, what its consequences are, talks about pregnancy after uterine curettage, and the like.

Indications for curettage

Curettage itself injures the uterine mucosa. This means that bleeding and pain after curettage of the uterus must be controlled, and the manipulation itself must be carried out strictly according to indications. Indications:

disruptions of the ovario-menstrual cycle, the appearance bloody discharge between two consecutive menstruation;
unusually heavy, prolonged or painful periods;
bloody discharge after menopause;
suspected malignant metaplasia. In this light, curettage of the cervical canal of the cervix and its body is of particular importance;
inability to get pregnant;
before surgery due to uterine fibroids.

Curettage may not always be possible. In addition, complications can develop after it.

Contraindications to the procedure:

acute infectious nosologies;
inflammatory processes in the female genital organs - in particular, acute ones, at the peak of development.

Complications may be:

perforation of the uterus (formation of a pathological hole);
tear (partial disruption of the integrity) of the cervix;
inflammation of the tissues of the uterus;
hemometra - accumulation bleeding in the uterine cavity. It is observed if the contraction of the uterus after curettage is normal, but the cervix spasms, causing the outflow of contents to be blocked;
destruction of the endometrium is the result of too vigorous scraping. In this case, a rather delicate germ layer is damaged - the endometrium loses its ability to recover, its renewal does not occur.

Examination before the RDV

Each patient must undergo a thorough examination before curettage. Its results may determine how long you need to stay in the hospital after curettage of the uterine cavity. The most informative are:

examination in a gynecological chair with a doctor’s report;
complete blood count - especially important for existing anemia;
coagulogram - it is used to analyze the clotting abilities of the blood and the possibility of such consequences of curettage of the uterine cavity as bleeding;
electrocardiography is important for analyzing vascular-cardiac activity, because curettage is performed under general anesthesia;
tests for the presence of various hepatitis;
Wasserman reaction - detection of syphilis;
blood test for HIV;
examination of a vaginal smear under a microscope.

Preparation for separate diagnostic curettage of the uterine cavity

Before scraping the uterine cavity and cervical canal, you should unquestioningly adhere to a certain preparation regimen.

Two weeks before the procedure you need:

stop taking medications unless prescribed by the doctor who will perform the curettage;
give up all nutritional supplements.

Two to three days before separate diagnostic curettage of the uterine cavity, you should:

stop sexual intercourse;
do not douche;
do not use any intimate hygiene products – pharmaceutical or homemade. Wash only with warm water;
stop using vaginal suppositories, tablets or sprays.

On the last day, 8-12 hours before curettage, you need to stop eating, and in the morning before the procedure, you should stop drinking.

Curettage procedure

Separate diagnostic curettage of the uterine cavity and cervical canal is carried out in a hospital under intravenous anesthesia. The patient is on the gynecological chair. A speculum is inserted into the vagina, and the cervix is grasped with special forceps. The depth of the uterine cavity is measured with a probe.

Curettage is done with a curette. This is a surgical instrument that looks like a small spoon with a sharp edge - they use it to scrape off upper layer mucous membrane, which is then placed in a special solution and sent to the laboratory. After the procedure, they wait for the patient to wake up from drug-induced sleep, and, if there are no complications, she is discharged home by the end of the current day.

Bloody discharge after curettage of the uterine cavity can come out over several hours.

Discharge after curettage of the uterine cavity and other consequences

A number of restrictions have been formed for the next two weeks after curettage - the patient cannot:

engage in sexual intercourse;
insert tampons into the vagina;
douche;
doing heavy physical work, exercise in the gym is also contraindicated;
take a bath, as well as visit the sauna and steam bath;
take medications based on acetylsalicylic acid.

The patient should immediately consult the doctor who performed the curettage if:

discharge after curettage of the uterine cavity begins to smell bad;
almost immediately after curettage, vaginal discharge has stopped or severe bleeding is noted;
body temperature reaches 38 degrees Celsius or more;
severe pain in the lower abdomen;
general health worsened.

On our website Dobrobut.com you can also read about therapeutic curettage - for example, how curettage of a polyp in the uterus is done.

Curettage of the cervical canal is a fairly common operation in gynecology. With its help, it is possible to identify diseases of the female organs responsible for childbirth in the early stages of development. This allows you to start treatment on time. What else can this procedure be prescribed for?

What is this procedure?

The cervical canal is the space that connects the vagina and the uterine cavity. It is along it that sperm move towards the egg to fertilize it. Inflammatory processes can pass not only inside the uterus, but also in the cervical canal. Often there may be sexually transmitted infections. However, during the examination, the doctor will only see the presence of suspicious mucus. In order to establish an accurate diagnosis, a vaginal smear is taken from the patient and sent for histology. But very often the cause of the disease is not easy to find out. In such cases, curettage of the cervical canal is used.

Thanks to this procedure, it is possible to detect the disease by initial stage development, which greatly simplifies treatment. During the operation, only the top layer of the endometrium is removed with a special instrument, so over time the surface of the uterus will completely restore its structure. For diagnostic purposes, curettage is used mainly to check the presence or absence dangerous diseases, which are malignant in nature.

Types of curettage and indications

Gynecologists distinguish three types of cervical canal curettage.

Diagnostic. Samples are taken to test for diseases.

Separate diagnostic curettage (RDC). When carrying out this procedure, scrapings are taken separately. First from the cervical canal, then from the uterus. The finished sample is also sent for histological examination. For diagnostic purposes, RDV can be performed in cases where there are endometrial polyps, fibroids and other neoplasms on the uterus.

Separate type scraping. Separate diagnostic curettage under hysteroscope control. This operation is performed using a hysteroscope (a device that is designed to diagnose the condition of the internal cavity of the uterus during gynecological manipulations). A hysteroscope is indispensable for abnormal shape and position of the uterus. During diagnosis, a special tube with a camera is inserted into the uterus, with which you can monitor the procedure. The hysteroscope is used not only during the operation, but also after it to check the results. It is able to show whether all tumors have been removed and how carefully the scraping was taken.

Read also: How can you shorten your periods?

It is worth noting that all of the above types of scraping can be used for both diagnosis and treatment. In the first case, they check whether the diagnosis is correct, and in the second, pathological neoplasms are removed.

Indications for curettage of the cervical canal for treatment purposes:

Uterine bleeding. This type of bleeding can occur for a variety of reasons. This procedure can identify them and stop the bleeding.
Fusion of the uterine cavity (synechia). In this case, curettage is performed to eliminate intrauterine adhesions. This operation is always performed using a hysteroscope to avoid damage to the walls of the uterus, since careless movement can cause bleeding.
Endometrial polyposis (localization of polyps on the uterine layer). As is known, treatment of polyps medicines does not give any results, which is why curettage is performed. Today it is the most effective method. It is very important to perform such an operation on time, otherwise the polyp may turn into a malignant tumor.
Inflammation of the mucous membrane. Before prescribing treatment, curettage is performed. This must be done for better action drug therapy.
Thickening of the walls of the uterus that differs from normal. Curettage will help diagnose this problem. In addition, it is also used to treat pathologies.
The presence of fetal tissue remains after an abortion or membranes after childbirth. Scraping will help get rid of data foreign bodies inside the cervical canal.

For diagnostic purposes, the procedure is prescribed for:

Suspicious changes in the uterus.
Changes in the endometrial layer.
Long, heavy, painful menstruation.
Menstruation, during which blood clots, mucus, and other impurities are released.
Difficulties conceiving a child.
Preparation for another planned gynecological operation.
Discharge of blood between periods.

Preparation and performance of the operation

Before any operation, preparation is necessary. Scraping is no exception. First they give up necessary tests, an ultrasound of the pelvic organs and an ECG are performed. As a rule, the procedure is prescribed 2-3 days before the expected menstruation. This allows you to assess the natural state of the endometrium. The patient should not eat or drink anything immediately on the day of surgery.

The curettage procedure itself is very unpleasant and painful, so it is performed under general anesthesia.

Using a specially designed instrument, the doctor cleans the cervical canal and uterine cavity. The extracted tissue particles are sent for examination. As a rule, there is no postoperative rehabilitation period after such an intervention. Within a few hours the patient can return to normal life.