Curettage

What is Curettage?

The medical termination of intrauterine pregnancies is called curettage. Curettage is most commonly used to terminate unwanted pregnancies.

Each country's legal curettage limit is different. In our country, curettage can be done until 10 weeks (according to first day of last mestrual period) to terminate unwanted pregnancies.

Curettage is a surgical procedure. It is performed under sterile conditions with local or sedation anesthesia. Today, the vacuum technique is most commonly used for curettage. Vacuum technique is an effective and safe method in curettage applications. Curettage can be done with this technique for 5 weeks ( according to first day of last mestrual period) and over pregnancy

Apart from termination of pregnancy, curettage can also be performed to investigate abnormal vaginal bleeding, biopsy from the endometrium, and removal of subendometrial fibroids and polyps.

How Is Curettage Performed?

Curettage is a procedure performed under sterile surgical conditions under anesthesia. In the past, it used to operate with a spoon-like instrument called a metal curette. However, nowadays, it is performed with the vacuum technique, which is more effective, safe and has low complication rates.

In vacuum technique, first the cervix is slightly dilated, then curettage is performed with special plastic cannulas that are 4-6 mm diameter. This procedure is called Dilatation and Curettage (D&C) in the medical literature. The curettage stages are:

• The doctor inserts an instrument called a speculum into the vagina. Speculum is a metal or plastic instrument used in vaginal examination. It allows curettage to be done comfortably.
• The vagina is washed with sterile solutions. This is a precaution against infections.
• The cervix is fixed with an instrument called a tenaculum. The teneculum is a special scissor-like instrument with a pointed tip. It is used to prevent the cervix from moving during the procedure.
• The cervix should be dilated for easy curettage. This process is achieved with special tools called Hegar bougis. Another name for Hegar bougis is dilator. Hegar spark bougis are pencil-like tools with blunt ends made of metal or plastic.
• After the cervix is dilated, the curettage cannulas are inserted into the uterus. These cannulas are plastic pipette-like instruments that can be bent and have holes in the tip. A negative pressure mechanism is obtained by attaching a special injector to the outside end.
• Different length and thickness cannula can be used for each woman. Cannulas are disposable and sterile.
• After the cannula is inserted into the uterus, negative pressure is applied to the injector and the pregnancy and its gestational tissues are taken out in small pieces. The movement of the cannula with back and forth and side maneuvers allows the uterus to be evacuated without leaving any parts inside.

What is the top limit for curretage?

Unwanted pregnancies can be legally terminated until 10 weeks according to Population Planning Law that came into force in 1983 in Turkey. However, this limit may differ in European Union member states and others.

Curettage can be done at the earliest 5 weeks of pregnancy. Pregnancy under 5 weeks is difficult to detect with ultrasound. If curettage is performed on pregnancies under this week, there is a risk that the pregnancy will not be terminated. In addition, the risk of bleeding is higher than between 5-10 weeks.

The most suitable weeks for curettage are the 5-6 th weeks of pregnancy. There is a lower risk of pain, bleeding, rest tissue or continuation of pregnancy when compared to early weeks.

In case of certain fetal anomalies and medical reasons that endanger the mother's life, curettage can be performed for pregnancies over 10 weeks with the approval of 3 physicians.

What are the Curettage Terms?

For curettage approval, the age and marital status of the woman must be known. In our country:

• Spouse approval is requested for married 18 aged and over.
• Parental consent is obligatory for between 15 and 18 aged.
• For persons under the age of 15, the pregnancy has to be reported to the judicial units.

What are Pre-Curettage Preparations?

For the curettage procedure, a companion had better accompany the patient on the clinic. Because side effects such as drowsiness and attention deficit can be seen after anesthesia.

If you have a known disease, you can bring documents related to it with you. Before the procedure, the person is asked to fast for 6 hours and not to eat or drink anything, including water, alcohol and cigarettes. Comfortable and loose clothing should be preferred while coming to the clinic.

Unnecessary drugs should be avoided before curettage. Over-the-counter cold, stomach, and constipation medications can increase the risks of curettage.

Inform your doctor if you have diabetes, hypertension and other diseases before curettage. If necessary, your doctor may order blood, urine and other tests before the procedure.

If an infection, bleeding disorder, heart and lung diseases involving the reproductive organs are detected before the curettage, the curettage may be postponed.

Post-Curettage Recommendations and Points to Consider

After the curettage, the person is kept under observation for 30-45 minutes. There may be symptoms such as nausea, drowsiness, and weakness due to anesthesia. These symptoms go away on their own within 1-2 hours.

Menstrual pain-like complaints may be seen after curettage. There may be vaginal bleeding in the form of spotting for a few days. Cramp-like lower abdominal pain subsides within a few days.

Persons receiving sedation anesthesia should not drive for the first 24 hours. Because drowsiness, fainting sensation, inattention, coordination disorder and delay in reaction may occur due to the effect of anesthesia.

Oral food intake can be started half an hour after the curettage. You can drink water, eat something.

There is no harm in going to the toilet after an curettage. Genital area cleaning should be done from front to back with warm water. Sanitary pads should be used for vaginal bleeding.

It is desirable not to have sexual intercourse for the first 2 weeks. Tampons should not be used for 2 weeks. Vaginal douching should not be applied. There is no need for a special dressing after curettage.

As the uterus will recover and heal within a certain time, obeying the advices will reduce the risk of infection.

10 days after the curettage, your doctor will want you to come back for a check-up. In this control, the uterus is evaluated with ultrasound. Examination is made in terms of rest tissue, continuation of pregnancy or other conditions.

What Are the Risks of Curettage?

Curettage is a medical intervention. Like any surgical procedure, it has some risks. These risks are:

1. Bleeding: Bleeding may occur if the curettage cannula damages the uterine wall. Life-threatening bleeding is very rare. As the gestational week increases, the risk of bleeding increases.
2. Infection: Not paying attention to the cleaning of the genital area, skipping the doctor's control and performing the procedure in non-sterile conditions ascend the risk of infection. Foul-smelling vaginal discharge, abdominal pain and fever are signs of infection. Most infections are treated with antibiotics. In case of abscess development, hospitalization and abscess drainage may be required.
3. Uterine perforation: Uterine perforation is a very rare complication. As the gestational week progresses, the uterine wall thickness reduces and the risk of perforation goes up. The feeling of strain during an curettage and the cannula coming out afterward is an indication of perforation. In this case, the pelvic area is checked with ultrasound. The newly developing and increasing amount of free fluid is an indicator of bleeding. In such a case, the woman is followed and additional intervention is made if necessary. In clinical practice, most perforations heal spontaneously without the need for additional intervention.
4. Rest tissue in the uterus: The uterus is normally in an anatomically anterior position. In some women, it may be posterior position. This is called a retroverted uterus. Sometimes it can be sideways sloping. The position of the uterus, the presence of septa in the uterus, double uterus and vagina elevate the risk of remaining tissue after curettage. Remaining intrauterine fragment poses a risk in terms of bleeding and infection. In this case, the remainder should be cleaned with additional intervention.
5. Intrauterine adhesions: Intrauterine adhesions are more common in women who have had more than one curettage. After repeated curettage, adhesions occur while the endometrium is healing. Sometimes the adhesions are so large that they cover the uterus. The woman cannot menstruate and infertility problem may be experienced.
6. Menstrual irregularity: Menstrual delay, irregularity or absence of menstruation is common after curettage. Generally, within 4-6 weeks, the woman begins to menstruate and the menstrual cycle returns to normal.
7. Continuation of pregnancy: If curettage is performed on pregnancies below 5 weeks, the pregnancy may not be terminated. For this reason, 5-6 weeks of pregnancy should be waited for curretage.