OBSTETRICS II

Minor Gynecological Procedures (Dr. Dumaup)

September 2008

DILATATION AND CURETTAGE 4. Dilators

- Most common procedure - Curved
- For DUB (dysfunctional uterine bleeding) - Insert according to uterine position
o Diagnostic: determine the cause a. Hank’s dilator
o Therapeutic: remove layer not shed off (functional o S-shaped
layer)
- What is accomplished?
o Bleeding stops
o Myometrium contracts effectively
(interlacing/middle layer)
 Close dilated blood vessels
- In incomplete abortion b. Hegar’s dilator
o Completion curettage o Tobacco shaped

Instruments: Order of Use and Definition

1. Posterior vaginal retractor
- To retract posterior vaginal wall
- To visualize the cervix (inspection)
c. Goodell’s dilator
o With adjustments

2. Tenaculum forcep
- Sharp teeth on the edge 5. Curette
- For thick, firm non-pregnant cervix - Inserted when the cervix has already dilated
- Grasp the lip of the cervix at 12 o’clock position - Scrape endothelial lining
- Evacuate functionalis layer
- Not basalis layer (Ashermann’s syndrome)
o Amenorrhea
o No regeneration capacity
o Synechia formation
- Curette systematically (follow the face of the clock, start
**For pregnant cervix – use ovum forceps from 12 o’clock to 12 o’clock)
- Stop when a gritty sensation is felt
a. Dull/blunt curette

3. Hysterometer/Uterine Sound
- Check depth of the uterus to prevent perforation b. Sharp curette
- A guide for positioning other instruments
- To know the size of the uterus
- Has gradations in cm/in
- Bent – version
- Position according to bimanual palpation during PE
- Measure starting from the external OS

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raych_eanne
 OBSTETRICS II
Minor Gynecological Procedures (Dr. Dumaup)
September 2008

6. Uterine forceps - Abortion: gritty sensation + bubbly bleeding

- Insert vaginal strip into uterine cavity after curettage
- Turn (to be able to clean the uterus)
- Remove after use
- After which, insert vaginal strip with betadine (swab the
endometrium with antiseptic)

FRACTIONAL CURETTAGE
- Uterus and cervix (3 cm)
- Localize pathology
*Remove tenaculum forceps - Curette cervical canal with sharp curette before insertion
- make sure that there is no bleeding upon removal of hysterometer
- if there is bleeding o To prevent contamination of specimens
o apply gauze and pressure until the bleeding stops
COMPLETION CURETTAGE
*Anesthesia - Evacuate products of conception to prevent sepsis
- sedation and analgesic - Use OVUM FORCEPS
- IV - Retract upward
o Opioid - Stop when
o Novaine a. Uterus contracts
- Valium and Demerol b. Decrease blood loss
- Inhalational anesthesia can also be used c. Gritty sensation
- It is important to sedate the patient!!
POSTPARTUM CURETTAGE
*Difficult to sedate - PLACENTAL CURETTE
1. Those who drink alcoholic beverages o Big with dull edges
2. Smokers
3. Anxious patients
4. Patients who drank coffee

** It is only a 10 minute procedure!!!

Complications **Kevorkian punch biopsy forceps

- Hemorrhage - To biopsy cervix
- Sepsis - Very small piece of tissue
- Trauma

ENDOMETRIAL BIOPSY
- No need to dilate the cervix
- For infertility work-up
- No anesthesia need
- Swab vaginal canal only
- Submit tissue to histopathology

1. Posterior wall retractor

2. Tenaculum forceps
3. Hysterometer
4. Kevorkian curette
- To get endometrial samples
- Scrapings: anterior first then posterior  lateral 
fundus
- Stop when a gritty sensation is felt

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raych_eanne