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Wednesday, April 15, 2009

Dilation and Curettage

1:24 PM

Also known as

Dilation and curettage is also known as D&C, and refers to dilation of the cervix (widening the cervix) and curetting of the endometrium (the lining of the uterus).

Description

1. The cervical os or 'opening of the uterus' is dilated and a curette (spoon-shaped instrument) is used to scrape the wall of the uterus and remove some of the endometrium, or lining of the uterus. This tissue can be sent to the pathologist for examination.



2. Dilation can be carried out in many ways. If the patient is having a miscarriage, the cervix may already be dilated as a result of the process of miscarriage. More commonly, one uses a set of 'dilators.' These are usually a set of instruments of varying sizes, and incrementally they are introduced into the cervix slowly increased the opening to the desired size. Alternatively, one can use a product called laminaria to dilate the cervix. Laminaria are cigarette-shaped pieces of seaweed, Laminaria japonicum, which grow in the Sea of Japan. One or more laminaria are inserted into the cervix and left in place for a period of time. They absorb moisture from the surrounding tissue and slowly expand, dilating the cervix.
3. Once the cervix is dilated, the interior of the uterus can be accessed by a multitude of 'curettes' depending on the reason for the procedure.
4. If one is performing an abortion or completing a miscarriage, a long plastic tube with a hole on the side near the end is inserted into the cavity. The outer end is attached to suction, and the contents of the uterus are aspirated.
5. If one is looking for polyps in the uterus, a pair of grasping forceps is inserted into the uterus and closed. Then, the forceps are pulled out of the uterus and, if polyps are present, hopefully they will be pulled out in this manner.
6. In the standard D&C, a uterine curette is inserted into the uterine cavity and the wall of the cavity is scraped. The material scraped away from the wall can then be sent for pathological examination.



Treatment

1. Vacuum Aspiration
# From 6 to 13 weeks, vacuum aspiration is used to empty the uterus. This traditional first trimester abortion involves three main steps: (1) an injection to numb the cervix, (2) insertion of a soft flexible tube through the cervix into the uterus, and (3) suction created by an aspirating machine to remove the uterine contents. It takes less than 5 minutes to complete.
2. IPAS syringe-early abortion with manual vacuum aspiration (MVA)
# As soon as the pregnancy can be detected by ultrasound (typically 3-4 weeks), an abortion can be performed using a manual aspiration device called the IPAS Syringe. Similar to the suction aspiration procedure, the IPAS system consists of thin flexible tubing, but instead of using a machine to create suction a hand-held syringe is used. The procedure usually takes less than 5 minutes to complete. Aftercare is the same as with suction aspiration method.
3. Dilate and Evacuate (D&E)
# From 13 to 24 weeks, some clinics find it useful to employ uses the dilation and evacuation (D&E) procedure. Appointments are made for 2-3 consecutive days. On the first day, an ultrasound (sonogram) is performed to determine the size of the fetus. Then, the abortion procedure begins, and the cervix is numbed with injections and dilators are inserted into the cervix. Overnight, these dilators gently expand, opening the entrance to the uterus. The next day, the cervix is again numbed, the dilators are removed, and the doctor uses special instruments inserted into the uterus to remove the fetus. The final step is suction, using the aspirating machine. In more advanced pregnancies, additional dilators are inserted on the second day and the fetus is removed on the third day. Removal of the pregnancy actually takes about 10-15 minutes.

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