Separate diagnostic curettage
First, the mucous membrane of the cervical canal is taken separately with a curette, then the canal is expanded and the uterine cavity is scraped out - separate sampling allows the histologist to accurately determine the location of the pathology (canal or cavity). In case of bleeding, the procedure is simultaneously therapeutic: removal of the hyperplastic endometrium stops the bleeding. Optimally performed under the control of hysteroscopy - the doctor sees polyps and tissue remains. The patient spends up to 4 hours in the ward under observation and is discharged with recommendations; histology after 7–10 days determines further treatment (hormonal therapy, IUD with levonorgestrel, for atypia - consultation with a gynecological oncologist).
Indications
- endometrial hyperplasia, polyps, abnormal uterine bleeding, bleeding during menopause - diagnosis and stop of bleeding;
- non-developing (frozen) pregnancy, incomplete miscarriage, remnants of the fertilized egg;
- suspicion of endometrial pathology in preparation for operations and IVF;
- fibroids with bleeding - assessment of the endometrium before treatment.
Security and control
Curettage is performed under short-term intravenous anesthesia and takes 15–30 minutes; the modern standard is control by hysteroscopy before and after, in order to remove all contents and not injure the cavity, and during pregnancy, vacuum aspiration, which is less traumatic for the endometrium. The resulting tissue must be examined histologically (in case of a missed miscarriage, with the possibility of genetic analysis). Complications (perforation, infection, synechiae) are rare if the technique and prevention are followed; recovery of the cycle - after 4-6 weeks.
