D&E procedure

dilatation and curettage

1. DILATATION AND EVACUATION NUR FARRA NAJWA BINTI ABDUL AZIM 082015100035

2. ONE STAGE PROCEDURE

3. PRELIMINARIES ANESTHESIA —either general or local is used. In some cases, the operation may be performed with intravenous diazepam sedation. LITHOTOMY position. Full SURGICAL ASEPSIS  is to be taken: Surgical team is to wear sterile cap, mask, thorough hand wash and to wear gown and gloves Vulva and vagina are to be swabbed with antiseptic solution Cervix is cleaned with povidone -iodine solution Leggings. To empty the EMPTY  THE  BLADDER  before  she  is placed on the table or catheterization Vaginal examination  is done

4. Cont. Pudendal block or perineal infiltration with 1% lignocaine is sufficient. It may be applied even without anesthesia, especially in parous women.  The instrument should be assembled The vacuum is tested prior to its application

5. POST ABORTION CARE Emergency treatment of abortion complication Family planning counselling and referral services Involve male partners also

6. TWO STAGE PROCEDURE

7. MANAGEMENT OF UTERINE PERFORATION STOP ALL PROCEDURE !! Don’t forgot to resuscitate and give antibiotics

8. SUCTION EVACUATION Procedure in which product of conception is sucked out from uterus with help of a cannula fitted to a suction device

9. INDICATION MTP during 1st trimester * Inevitable abortion Recent incomplete abortion Hydatidiform mole

10. PROCEDURES Preliminaries: As mentioned before GA is usually not needed If patient is apprehensive, IV Diazepam 5-10 mg (conscious sedation) Supplemented by paracervical block isquite effective Patient is put on the table after bladder is emptied

11. MENSTRUAL REGULATION Aspiration of the endometrial cavity within 14 days of missed period in a woman with previous normal cycle

12. MENSTRUAL REGULATION EQUIPMENT - KARMANN CANNULA AND SYRINGE

13. PROCEDURE Operation is done as an out patient Aseptic precautions Sedation or paracervical block anesthesia may be employed Introduction of posterior vaginal speculum & Allis forceps Gentle dilatation of cervix using 4-5mm size dilators Insertion of 5-6mm suction cannula (Karman’s) & attached to 50mL syringe Cannula is rotated, pushed in & out with gentle strokes

14. Cont. Operator should examine the aspirated tissues by floating it in a clear plastic dish over a light source Placenta tissue appears fluffy and feathery when floats in normal saline Help to detect failed abortion, molar pregnancy or ectopic pregnancy

15. REFERENCES Mudaliar and Menon’s Clinical Obstetrics, 11 th edition, Sarala Gopalan and Vanita Jain, Ventouse DC Dutta’s Textbook of Obstetrics, 9 th edition, Hiralal Konar , Ventouse Essential Of Obstrectric , Lakshmi Seshadri , Gita Arjun , Ventouse