A curettage or curettage is a procedure to remove tissue from the uterus. Curettage usually begins with dilation, which is an action to widen the cervix (cervix).. Therefore, This procedure is oftentimes called dilation and curettage (dilation & curettage).
The curette can be done by the scraping method using a metal tool or the suction method.suction) using a special tool. With this method, the tissue in the uterus will be removed. The tissue that will be removed from the uterus (uterus) through curettage is endometrial tissue.
The endometrium is the slimy tissue that forms the inner wall of the uterus. The thickness of the endometrium will change during the menstrual cycle. The endometrium will thicken and contain many blood vessels to prepare for pregnancy. If pregnancy does not occur, the endometrial wall will shed and menstruation occurs.
In addition to removing endometrial tissue, a curette can also be used to remove a fetus that died from miscarriage and remove the placenta that is still attached to the uterus after delivery (placental retention).
Curettage Indication
Curettage may be performed for diagnostic purposes or to treat certain conditions. Curettage for diagnostic purposes is generally performed on people with the following conditions:
- Experiencing abnormal bleeding from the uterus
- Bleeding after menopause
- Have abnormal endometrial cells found during a Pap smear
By using a curette for diagnosis, diseases or disorders as below can be detected more accurately:
- Endometrial hyperplasia
- Cervical cancer
- Miom
- Uterine polyps
- Abnormal tissue growth in the uterus
Meanwhile, as a treatment method, dilatation and curettage are carried out with the following objectives:
- Removing the remaining endometrial tissue in women who have had a miscarriage, to avoid infection and bleeding
- Removing benign uterine or cervical polyps
- Removing the placenta that is still in the uterus postpartum (placental retention)
- Removing abnormal tissue that is formed due to pregnancy wine
- Overcoming postpartum bleeding
Curettage is often performed together with hysteroscopy, which is an action to observe the condition of the endometrial tissue using a special instrument in the form of a thin tube with a camera.
Warning Undergoing Curette
Before undergoing a curettage procedure, tell your doctor if you have the following conditions:
- Suffering from blood clots
- Suffering from pelvic inflammatory disease, such as endometritis and salpingitis
- Have uterine stenosis, which is a narrowing of the uterus
- Have you had a procedure on the endometrium before?
- Suffering from cervical dysplasia
Before Curette
Before undergoing curettage, patients are advised to first consult with a doctor. In the consultation session, the doctor will ask questions about what drugs are being consumed, whether they are pregnant, and whether there are allergies to certain drugs or the latex which is the material of the doctor's gloves.
In addition, the doctor will also discuss the anesthetic that will be given to the patient, such as general anesthesia, regional anesthesia (half body), or local anesthesia.
After the consultation session is over, the doctor will suggest several things for the patient to do before undergoing curettage, namely:
- Fasting for 6–8 hours before the procedure
- Undergo a physical examination to make sure the body is healthy enough to undergo a curettage
- Clear the schedule for curettage and recovery period
- Asking family, relatives, or close friends to accompany you during the curettage procedure
In certain cases, cervical dilatation can be done a few days before the curettage. This dilation will help the cervix to open slowly, making the curettage procedure easier. To help dilate, the patient will be given the drug misoprostol by the doctor.
Curettage Procedure
To begin the procedure, the patient will be asked to change into hospital-specific clothing. The following are the steps involved in the curettage procedure:
- The doctor will ask the patient to lie on his back with the legs bent and knees brought to the chest and extended.
- The doctor will administer local, regional, or general anesthesia according to the plan previously discussed. If needed, the doctor will give intravenous fluids and antibiotics to prevent infection during the curettage procedure.
- Just in case the patient urinates unnoticed during the curettage procedure, the doctor will place a urinary catheter in the patient's urinary opening.
- The doctor will insert a special instrument (speculum) to widen the vagina to keep it open during the procedure.
- The doctor will dilate the cervix (cervix) slowly using a metal-based instrument whose thickness increases gradually, also known as the busination process, until the cervix is felt to be open enough for a curette to be inserted.
- When the cervix is open enough, the doctor will insert a curette. This stage will cause cramps in the pelvic area.
- The curette will remove endometrial tissue or other tissue as needed, either for diagnosis or for treatment.
- If the curettage procedure is performed with a hysteroscopy, then the doctor will then insert a special instrument in the form of a thin tube with a camera into the uterus to see the condition in the uterus, to support the diagnosis.
- Endometrial tissue or other tissue that has been taken will be put into a container and taken to a laboratory for examination.
The curettage procedure generally lasts about 20-30 minutes. After all curettage processes are completed, the curette and speculum will be removed from the vagina. The patient will be asked to stay in the hospital for a few hours to be monitored for the effects of the anesthetic or if bleeding occurs.
After Curette
After the procedure, the patient usually needs to stay in the hospital for several hours for recovery and monitoring. After that, the patient is allowed to go home. Even so, patients still have to rest at home for a few days until they are fully recovered.
After curettage, the uterus needs time to re-form the endometrial tissue, so the patient's menstrual schedule may be delayed or delayed. Patients may also experience the following symptoms after undergoing curettage:
- Cramps in the pelvic area
- The appearance of blood spots or light bleeding from the vagina
- Dizziness, nausea, vomiting, and dry throat after the procedure, especially in patients who are under general anesthesia
If the patient feels cramps in the pelvis that are uncomfortable and bothersome, the doctor may prescribe pain medication to relieve the cramps.
Apart from the symptoms that the patient may experience after the procedure, there are also some things that patients need to pay attention to after undergoing the curettage procedure, namely:
- Do not have sex for 3 days after curettage or as directed by a doctor.
- Keep doing daily activities slowly, to prevent blood clots in the legs
- Do not do strenuous physical activity or lift heavy objects.
If the patient underwent curettage for diagnostic purposes, the results of the examination usually only came out after a few days. The doctor will explain the results of the examination to the patient and plan treatment if needed.
Complications Curette
Curettage is a safe medical procedure. However, this does not mean that this procedure has no risks at all. Although rare, curettage can cause complications such as:
- Damage to cervical and uterine tissues
- Infections that occur after curettage
- Asherman's syndrome, which is the formation of sores on the uterus, especially in patients undergoing curettage after miscarriage or childbirth
- Perforation or tearing of tissue in the uterine wall, especially in postmenopausal patients
Patients who have undergone curettage should see a doctor immediately if they experience the following symptoms:
- Fever
- Stomach cramps that last more than 2 days
- Discharge of foul smelling discharge from the vagina
- Heavy bleeding
- Pain in the stomach area that doesn't get better