DNC Presentation.pptx

Dilation and curettage

1. MITTAL COLLEGE OF NURSING AJMER (RAJ.) SUBMITTED TO- MRS.SNEHLATA PARASHAR (LECTURER) PRESENTATION ON- DILATATION AND CURETTAGE SUBJECT – MIDWIFERY & OBSTETRICAL NURSING SUBMITTED BY- SANJAY JANGID (B.SC NURSING IVth YEAR

2. DILATATION AND CURETTAGE Content DEFINITION INDICATIONS CONTRAINDICATIONS ARTICLES PROCEDURE POSTOPERATIVE CARE COMPLICATIONS

3. DEFINITION Assisting in expansion of cervical canal of uterus and scraping the surface lining of the uterine wall using a metal instrument called curette. This procedure is done during the premenstrual phase. This is an operative procedure whereby dilatation of the cervical casal followed by uterine curettage is done. This is the most common gynecological operation done

4. INDICATIONS Diagnostic Infertility
Dysfunctional uterine bleeding
Pathologic amenorrhea Endometrial tuberculosis
Endometrial carcinoma
Postmenopausal bleeding Chorion epithelioma .

5. Therapeutic Dysfunctional uterine bleeding
Endometrial polyp
Removal of intrauterine contraceptive device (IUCD)
Incomplete abortion Evacuation of hydatidiform mole
Prior to insertion of intrauterine radium implants To prevent cervical stenosis in Manchester operation for uterine prolapse
To drain pyometra .

6. CONTRAINDICATIONS Vaginal and cervical infection Pelvic infections
Suspected uterine pregnancy

7. ARTICLES The procedure is carried out in the operation theater (OT) and may be performed as adjunct procedure Dilators (different sizes of Hegar’s dilators) Vulsellum forcep Uterine sound
Curette. Mayo scissor
Sims speculum
Kidney tray
Sponge holding forcep

8. PROCEDURE Nursing action~ • Before procedure: Explain procedure to patient
Obtain informed consent from patient. Instruct patient to empty the bladder prior to operation.
Maintain NPO for 6 hours before procedure. •During procedure 5. Administer premedication as per physician’s order. 6. Start IV line. 7. Maintain lithotomy position and clean the perineum with antiseptic solution.

9. 8. Physician performs vaginal examination to note condition of vulva, vagina, and cervix including the size, consistency, position, and mobility of the uterus. 9. Assist the physician in administering anesthesia. 10. Physician introduces Sims vaginal speculum inside the vagina. - In nulliparous women, the blade of the speculum is lubricated with savlon solution and introduced from the side of the vaginal outlet after separating the labia minora with the other hand till the entire blade is introduced inside the vagina.
-In parous women, the blade is introduced on separating
labia minora .

10. 11. The anterior lip of the exposed cervix is grasped by the toothed vulsellum and pulled down near the vaginal introitus . 12. A uterine sound is introduced with the tip directed forward into uterus. 13. Assist in dilatation of the cervix. The tip of the dilator should directed anteriorly or posteriorly according to position of the uterus. 14. After the desired dilatation, the uterine cavity is curetted by uterine curette 15. Take out the vulsellum and curette. 16. Clean the cervix with antiseptic solution and check for any unusual bleeding.

11. • After procedure
17. The curetted material is preserved in 10% normal saline, labeled properly, and sent for histological examination.
18. Record the data and time of procedure with patient’s reactions. Either in clockwise or anticlockwise direction in a smooth manner.

12. POSTOPERATIVE CARE Check the vital signs.
Instruct the patient to rest in bed until the anesthetic effect is reversed.
Check the amount of bleeding

13. COMPLICATIONS Immediate Complications 1. Injury to the cervix 2. Uterine perforation 3. Bowel injury 4. Pelvic inflammation.

14. •Remote complications Cervical incompetence due to injury to internal os resulting in midtrimester abortion. Uterine synechiae (adhesion) due to injury to uterine muscle resulting in secondary amenorrhea.