Dilation and Curettage

CHAPTER 141 Dilation and Curettage



Dilation and curettage (D&C) is a valuable diagnostic and therapeutic tool in the management of abnormal uterine bleeding (AUB) and pregnancy-related disorders. Endometrial biopsy techniques have replaced D&C in most diagnostic situations, and hysteroscopy (see Chapter 140, Hysteroscopy) is now often performed in place of the “blind” D&C when initial diagnostic and therapeutic interventions fail. When the operator is experienced and the proper ancillary personnel are available, the office D&C proves to be a very cost-effective and safe procedure for the patient. Otherwise, the procedure can be performed in the operating room. In many instances of abnormal bleeding, diagnosis is facilitated if the sampling is done just before an anticipated period (e.g., for anovulatory bleeding). Unless the procedure is pregnancy related, the clinician should ensure that the patient is not pregnant and should know the status of the Papanicolaou (Pap) smear before the surgery. In addition to this chapter, it would be helpful for the clinician to review Chapter 143, Endometrial Biopsy.


On reaching menopause all women should be informed about the risks and symptoms of endometrial cancer and strongly encouraged to report any unexpected bleeding or spotting to their physician.



Indications







Equipment


See Figure 141-1.
























NOTE: Review Chapter 149, Loop Electrosurgical Excision Procedure for Treating Cervical Intraepithelial Neoplasia, for information regarding local anesthetic use (it is not needed if general anesthesia is given).







Preprocedure Patient Education


Each patient should be comfortable with the decision to perform a D&C. All questions regarding the procedure, alternatives, and risks should be explained carefully so the patient can give informed consent (see the sample patient consent form online at www.expertconsult.com). If performed in the office with sedation, appropriate knowledge and equipment must be available for possible complications and resuscitation. A nurse should be available throughout the procedure to aid with preparing the patient for the procedure, injecting IV medications, and handling equipment, and to provide assistance during the postoperative and recovery periods. The patient’s vital signs must be stable for the clinician to perform an office D&C. If bleeding has been prolonged or heavy, a hemoglobin or hematocrit should be obtained. The ability to obtain IV access is also important should the need arise to correct hemodynamic instability.


May 14, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Dilation and Curettage

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