DnC.pptx

Dilation and curretage
Gyane and obs

1. dilatation and curettage Presented by : (ARNAV)219 (ARTI)220 (ASHA)221 (ASHISH)222

2. Dilatation and curettage The operation consists of dilatation of the cervix and evacuation of the products of conception from the uterine cavity

3. Indications :

4. Diagnostic Indications : Uterine polyps Fibroid/ Myoma Endometrial hyperplasia Uterine cancer Sample of endometrium is taken and send for histopathological examination

5. Elective termination of pregnancy Abortions – missed/incomplete/ inevitable Molar pregnancy Treat excessive bleeding after delivery by clearing out any placenta that remains in the uterus. Remove cervical and uterine polyps (benign). Therapeutic indications :

6. PRE - REQUISITE INFORMED CONSENT EMPTY BLADDER PART PREPARATION – with savlon

7. Instruments used in D&C Uterine sound Sims vaginal speculum Ovum forceps ANTERIOR vaginal wall retractor Sponge holder V ul sellum foreceps Hegar’s dilator

8. Sims vaginal speculum

9. Hegar dilator

10. Uterine sound To check the uterocervical length

11. Sponge holder CLEANING THE PART

12. OVUM FORCEPS

13. Sims uterine curette

14. Valsellum forcep

15. CONTRAINDICATIONS DESIRED TO CONTINUE VIABLE INTRAUTERINE PREGNANCY BLEEDIND DIATHESIS PATIENT ON ANTICOAGULATION THERAPY

16. STEP : Oxytocin 20 units in 500 mL of normal saline IV is given intraoperatively and continued after the operation for 30 minutes. The vagina and the cervix are swabbed with antiseptic (povidone-iodine) solution. Vaginal examination is done to note the size of the uterus, position of the uterus and state of dilatation of the cervix. Posterior vaginal speculum is introduced and is to be held by an assistant. The anterior lip of the cervix is to be grasped by the Allis forceps to steady the cervix. The cervix is dilated with the graduated metal dilators to facilitate introduction of the ovum forceps. The products are removed by introducing the ovum forceps.

17. The posterior vaginal speculum and the Allis forceps are removed. The uterus is massaged bimanually and after being satisfied that the uterus is empty (evidenced by a well contracted uterus with minimal bleeding), the patient is sent to her bed after placing a sterile vulval pad. Prophylactic antibiotics (doxycycline and metronidazole) are prescribed.

18. COMLICATIONS : Immediate: (1) Excessive hemorrhage—incomplete evacuation/ atonic uterus (2) injury - hematoma/ uterine perforation. (3) Shock (4) Perforation—injury to major blood vessels, bowel or bladder. (5) Sepsis—endometritis, myometritis and pelvic peritonitis. (6) Hematometra may cause pain

19. LATE COMPLICATIONS (1) Pelvic inflammation (2) infertility (3) cervical incompetence (4) uterine synechiae and in subsequent pregnancy (5) preterm labor (6) ectopic pregnancy.

20. Extensive scarring of the uterus may occur after over aggressive scraping leading to Ashermans syndrome. It’s major symptoms are light or absent menstrual periods, infertility and recurrent miscarriage.

21. Aftercare A woman who has had a D&C performed in hospital can usually go home the same day or the next day. Many woman experience backache and mild cramps after the procedure. May pass small bloodclots for a day or so. Vaginal staining or bleeding may continue for several weeks Patient should avoid sexual intercourse , douching and tampon use for atleast 2 weeks.

22. THANK YOU