Curette or curettage, is a procedure that aims to remove the tissue in the uterus. Curettage is usually preceded by an action called dilation, to dilate the uterine liver (cervix), so it is often referred to as dilatation and curettage (D&C). Curette can be done by scraping method using metal tools or suction method using special tools.
Tissue that will be removed from the uterus (uterus) through the action of a curette is endometrial tissue. Endometrium is a slimy tissue that forms the inner uterine wall. Endometrial thickness will change during the menstrual cycle. The endometrium will thicken and contain many blood vessels to prepare for pregnancy. If pregnancy does not occur, the endometrial wall will decay and menstruation occurs.
In addition to removing endometrial tissue, curettage can also remove fetuses that have died due to miscarriage from within the uterus. Curettage can also remove the placenta that is still attached to the uterus postpartum (retention of the placenta). Remaining placenta in the uterus after delivery can cause infection and postpartum bleeding.
Curette Indications
Curette can be done for diagnostic purposes or for the treatment of certain diseases. Curettage performed for diagnostic purposes is generally done on the condition:
- Having abnormal bleeding from the uterus.
- Having bleeding after menopause.
- There are abnormal endometrial cells which are found during pap smear examination.
With a curette, it can be seen if there are diseases or abnormalities, such as:
- Endometrial hyperplasia or enlarged endometrial cells.
- Cervical cancer.
- Uterine polyps.
- Miom
- Scarring of the uterus.
- Abnormal tissue growth in the uterus.
Often, curettage is also performed together with hysteroscopy, which is an action to observe the condition of endometrial tissue by using a special camera shaped like a thin tube.
Dilation and curettage can also be used to treat certain medical conditions, such as:
- Removing the remaining endometrial tissue in miscarried women, to avoid infection and bleeding.
- Dispose of benign polyps in the uterus or cervix.
- Removing abnormal tissue that is formed due to pregnancy wine.
- Overcoming postpartum bleeding.
- Removing the placenta that is still present in the uterus postpartum (retained placenta).
Caution Warning and Risk
The presence of blood clotting disorders or pelvic inflammatory diseases, such as endometritis and salpingitis, are things to be aware of before taking a curette.
Preparation for Curette
Patients are usually asked to fast for 6-8 hours before undergoing a curette so that the curette procedure runs smoothly. Patients must be accompanied by family members before, during and after undergoing a curette procedure.
Patients must notify the doctor if they are pregnant, have blood clotting disorders, take blood-thinning drugs, are allergic to certain drugs or latex, which is the material from gloves worn by the doctor. The doctor will discuss the anesthetic that will be given to the patient, whether local, regional (half body), or total anesthesia. Before undergoing a curette, patients will be asked to change into hospital clothes, and urinate first.
In some patients, cervical dilatation can be done several days before the implementation of the curette. Dilatation done a few days before the curette will help the cervix to open slowly so that the curette procedure is easier to do. To help with dilation, the patient can be given the drug Misoprostol by a doctor.
Curette Procedure
After changing clothes with special hospital clothes, the patient will be asked to lie down by bending both legs (knees close to the chest) and thighs dilated. This position is similar to the position at the pelvic examination. The patient is then given an anesthetic and sedative as planned. If deemed necessary, patients will be given intravenous fluids and can also be given antibiotics to prevent infection during the curette procedure, especially for patients suffering from pelvic infections.
The obstetrician then inserts a special tool to dilate the vagina (speculum) to hold the vagina open during the procedure. Then the cervix will be dilated slowly using a metal-based device, whose thickness increases gradually (busination) until the patient's cervix is open enough to be inserted into a curette. As a precaution if the patient urinates unnoticed during the curette procedure, the patient will be placed with a urine catheter in his urinary opening.
If the opening of the cervix (cervix) is felt to be wide enough, the doctor will insert a curette into the uterus, either curette through scraping with a special tool made of metal or curette through suction. The curette tool will then remove as much endometrial tissue as needed, either for diagnosis or treatment purposes. Hysteroscopy can also be inserted into the uterus, to see the condition in the uterus visually to help determine the diagnosis. The uterine tissue is removed and then stored in a special sample container and brought to the laboratory for examination.
Patients who undergo curettage using local anesthesia will experience cramping in the pelvic area when the busination tool and the curette device are inserted into the uterus. After all the curette procedures are completed, the curette tool and speculum will be removed from the vagina. The patient will be asked to stay in the hospital for several hours after the curette procedure is completed, to monitor the effects of the anesthetic and if bleeding occurs.
After undergoing a curette
Patients who undergo curettage are allowed to go home immediately after the curette procedure is complete, although it usually needs to stay in the hospital for several hours for post curette recovery. Patients also need to rest for several days after the curette to help with recovery. After undergoing a curette, the patient can feel:
- Cramps in the pelvic area.
- Spots of blood or mild bleeding from the vagina.
- If given general anesthesia, the patient can feel dizzy, nausea, vomiting, and dry throat after the procedure.
If the patient feels cramps that are uncomfortable, the doctor can give pain relievers to relieve cramps. Patients are not allowed to have sexual relations at least 3 days after the curette or according to doctor's orders. After the curette is done, the uterus needs time to re-form endometrial tissue, so the patient's menstrual schedule may be delayed or delayed.
Try not to do heavy physical activity or lift heavy loads after undergoing a curette. In general, patients are allowed to eat food as usual, unless the doctor recommends avoiding certain foods. Patients who undergo curettage due to miscarriage and want to get pregnant again, should consult a doctor if they want to start the pregnancy program again.
Patients can set a control schedule after undergoing a curette with the relevant doctor. If the patient undergoes curettage for diagnostic purposes, the results of uterine tissue analysis can be taken several days later. The doctor will explain the results of examination of the uterine tissue sample to the patient, and plan treatment if needed.
Curette Risk
Curette is a medical procedure that is quite safe to undergo and rarely causes complications. However, some complications remain at risk for patients undergoing curettage, including:
- Damage to cervical and uterine tissue.
- Infection that occurs after a curette.
- The formation of scars in the uterus known as Asherman syndrome. Asherman syndrome often occurs in patients undergoing post-miscarriage or childbirth curettets.
- Perforation (tearing of tissue) in the uterine wall. This is more risky for women who are menopausal. Perforation can heal by itself, but if it does not heal, further medical procedures are needed to treat the perforation.
Patients who are already undergoing curettage should immediately consult with a related doctor, if experiencing the following:
- Fever.
- Abdominal cramps that occur more than 2 days.
- Odorous discharge from the vagina.
- Heavy bleeding.
- Pain in the stomach area that does not go away.
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