Non-developing pregnancy is a special form of miscarriage, characterized by the death of an embryo or fetus for up to 20 weeks. in the absence of expulsion of the elements of the fetal egg from the uterine cavity. The proportion of non-developing pregnancy in the structure of early reproductive losses ranges from 45 to 88.6%, the figure increases by 7% annually. Careful emptying of the uterine cavity is an important factor in the prevention of complications of non-developing pregnancy. To evacuate the fetal egg from the uterine cavity, two main methods are used: surgical - vacuum aspiration of the contents of the uterine cavity and conservative - drug induction of miscarriage. Various options for emptying the uterine cavity are possible, and with all types of surgical methods, dilatation of the cervix is \u200b\u200bnecessary in most cases. It can be mechanical and medical. AT last years for this purpose, a hygroscopic cervical dilator Dilapan-S, made of hydrogel, is used. The article presents a clinical case of the successful use of the Dilapan-S dilator for a long period of non-developing pregnancy in combination with the use of antiprogestogens with prostaglandins. The use of the Dilapan-S dilator reduces the duration of the abortion procedure, contributes to a more careful opening of the cervix and emptying of its cavity, reducing the risk of trauma to the cervix and, thus, preventing isthmic-cervical insufficiency.
Keywords: non-developing pregnancy, reproductive losses, miscarriage, isthmic-cervical insufficiency, Dilapan-S.
For citation: Dobrokhotova Yu.E., Ilyina I.Yu., Mikhneva D.A. Safe emptying of the uterus during non-developing pregnancy. Our opportunities today // RMJ. Mother and child. 2017. No. 26. S. 1983-1985
Safe uterus emptying in non-developing pregnancy. Our opportunities today
Dobrokhotova Yu.E., Ilina I.Yu., Mikhneva D.A.
Russian National Research Medical University named after N.I. Pirogov, Moscow
Non-developing pregnancy is a special form of miscarriage, characterized by the death of an embryo or fetus for up to 20 weeks without the expulsion of the elements of the ovum from the cavity of the uterus. The proportion of non-developing pregnancy in the structure of early reproductive losses ranges from 45 to 88.6%, the rate increases by 7% annually. For evacuation of the ovum from the cavity of the uterus, two main methods are used: surgical - vacuum aspiration of the contents of the uterus cavity, and conservative - medication induction of the miscarriage. Safe uterus cavity emptying is an important factor in preventing complications of an non-developing pregnancy. There are various ways of emptying the uterus cavity and in most cases, in all types of surgical methods the cervix dilatation is necessary. There are mechanical and medicated cervix dilatation. In recent years, the hygroscopic cervix dilatator Dilapan-S containing hydrogel has been used. The article presents a clinical case of the successful use of Dilapan-S for long periods of non-developing pregnancy combined with the use of antiprogestagens with prostaglandins. The use of Dilapan-S reduces the terms of the termination of pregnancy, promotes more careful opening of the cervix and emptying its cavity, reducing the risk of cervical injury, and thus preventing cervical incompetence.
key words: non-developing pregnancy, reproductive loss, miscarriage, cervical incompetence, Dilapan-S.
For quote: Dobrokhotova Yu.E., Ilina I.Yu., Mikhneva D.A. Safe uterus emptying in non-developing pregnancy. Our opportunities today // RMJ. 2017. No. 26. P. 1883–1985.
The article deals with the issue of safe emptying of the uterus during non-developing pregnancy. A clinical case of the successful use of the Dilapan-S dilator for a long period of non-developing pregnancy in combination with the use of antiprogestogens with prostaglandins is described.
Non-developing pregnancy is one of the main problems of world medicine. The proportion of non-developing pregnancy in the structure of early reproductive losses ranges from 45 to 88.6%, and the rate increases by 7% annually. Therefore, today the problem of reproductive losses continues to be socially significant and relevant in the practice of an obstetrician-gynecologist.
Non-developing pregnancy - the death of an embryo or fetus for up to 20 weeks. in the absence of expulsion of the elements of the fetal egg from the uterine cavity, is a special form of miscarriage.
It has been established that with each interrupted pregnancy, the risk of losing a subsequent desired pregnancy doubles and amounts to 36-38%. This makes us consider the problem of non-developing pregnancy as a socially significant one.
To evacuate the fetal egg from the uterine cavity, two main methods are used: surgical - vacuum aspiration of the contents of the uterine cavity and conservative - drug induction of miscarriage. In a non-developing pregnancy, there is a high risk of developing coagulopathic bleeding and endometritis, either as an initial condition that caused a non-developing pregnancy, or as a result of exposure to pathologically altered tissues during their long stay in the uterine cavity. The risk of losing a subsequent pregnancy increases by 2 times, and this is due to the development of chronic endometritis as a result of a mechanical effect on the walls of the uterus during surgical emptying of its cavity.
Based on the foregoing, we can conclude that careful emptying of the uterine cavity is an extremely important factor in the prevention of complications of non-developing pregnancy.
After a thorough examination and appropriate preparation of the woman (carrying out therapeutic and preventive measures aimed at reducing the risk of developing possible complications), it is necessary to terminate an undeveloped pregnancy. There are various options for the careful emptying of the uterine cavity during non-developing pregnancy, the main thing is that when using various surgical methods, dilatation of the cervix is necessary in most cases, which is carried out in the following ways:
1. Cervical dilation and vacuum aspiration of the contents of the uterine cavity.
2. Cervical preparation with prostaglandins or hydrophilic dilators and vacuum aspiration.
3. Use of antiprogestogens in combination with prostaglandins.
Dilatation of the cervix can be mechanical and medical. Mechanical expansion is carried out with the help of instruments or means that expand the cervical canal, is carried out using metal and plastic dilators. It is also possible to use natural dilators (kelp), in the literature there is information about the use of a Foley catheter as a mechanical dilator.
In recent years, the hygroscopic cervical dilator Dilapan-S, made from hydrogel, has been used for the purpose of dilatation. This is a rigid hydrophilic stick with a plastic handle, which, after being inserted into the cervical canal, swells after 2-4 hours, absorbing moisture from nearby tissues, exerts radial pressure and dilates the cervix.
Antiprogestogens and prostaglandin analogues are used as a medical dilation of the cervix when terminating an undeveloped pregnancy.
In 2013 recommendations, the World Health Organization recognized the positive effect of osmotic dilators (kelp and Dilapan-S) and pharmacological agents (misoprostol, antiprogestogens). Russian scientists also recommend the use of the above methods of dilatation of the cervix.
The most gentle method of terminating an undeveloped pregnancy, in our opinion, is the combined use of antiprogestogens and prostaglandins with the hydrophilic dilator Dilapan-S. This significantly reduces the time of the abortion procedure itself, contributes to a more careful emptying of the uterine cavity and, which is especially valuable, reduces the risk of trauma to the cervix, which is extremely important for subsequent pregnancies and prevention of cervical insufficiency.
Clinical observation
Patient P.E.V., 28 years old, received on January 10, 2017 at the City Clinical Hospital No. 1 named after. N.I. Pirogov in the direction of the doctor of the antenatal clinic with the diagnosis: “Pregnancy 21-22 weeks. Bichorionic di-amniotic twin. Non-developing. Burdened obstetric and gynecological anamnesis (OAGA). Uterine scar after caesarean section in 2013. Mild anemia.” Upon admission, the patient complained about the absence of fetal movement since 01/01/2017.
From the anamnesis: menstruation since the age of 14, for 5 days, after 28 days, was established immediately, regular, moderately painful. Beginning of sexual activity at the age of 18, married. Transferred gynecological diseases: candidal colpitis. This pregnancy - the 2nd, 1st pregnancy in 2013 ended in timely operative delivery due to the primary weakness of labor activity (according to the patient), without complications.
Regarding this pregnancy, she has been registered in the antenatal clinic since 10 weeks, and is observed regularly. Screening at 12 weeks no pathology was found. In the period of 16 weeks. pregnancy suffered an acute respiratory viral infection, without a rise in body temperature. From December 10, 2016, she noted the stirring of the fetuses. Somatic history is not burdened. Since 01/01/2017, she did not feel the stirring of the fetuses. On January 9, 2017, she applied to the antenatal clinic with complaints about the lack of fetal movement. An ultrasound examination (ultrasound) did not detect a fetal heartbeat. For further examination, she was sent to the City Clinical Hospital No. N.I. Pirogov.
Objectively: the condition is satisfactory. Skin of normal color and moisture. Lymph nodes are not enlarged, painless. The mammary glands are soft, there is no discharge. In the lungs, vesicular breathing, no wheezing. Respiratory rate 17 per minute. Heart sounds are clear, rhythmic, no murmurs. Arterial pressure 120/80 mmHg Art. The tongue is moist, not furred. The abdomen is soft, painless on palpation in all departments, enlarged due to the pregnant uterus up to 22 weeks. The symptom of effleurage is negative on both sides. Physiological functions are normal. Gynecological status: body hair female type. The external genital organs are developed correctly. The vagina is narrow. When viewed with the help of mirrors - the cervix is clean, cylindrical, not hypertrophied, dense, the external os is closed. The body of the uterus is enlarged to 22 weeks. pregnancy. The uterus is soft on palpation, painless in all departments. Appendages on both sides are not defined. The vaults are deep and free. Discharge from the genital tract mucous, scanty.
Diagnosis: pregnancy 22 weeks. Bichorionic diamniotic twins. Non-developing. OAGA. Uterine scar after caesarean section in 2013
After a clinical and laboratory examination, a decision was made to induce a medical miscarriage. On January 10, 2017 at 9:00 am, in order to prepare the cervix for a late drug-induced miscarriage, the patient was prescribed an antiprogestogen drug once. On January 11, 2017, at 8:00 am, the patient noted pulling pains in the lower abdomen. A gynecological examination revealed a shortening of the cervix up to 2 cm, the cervix is soft, the cervical canal is passable for 1 finger with difficulty. Taking into account the data of the vaginal examination and in order to further prepare the cervix for a late drug-induced miscarriage at 9:00, Dilapan-S was introduced into the cervical canal behind the internal os in the amount of 1 pc. 01/12/2017 at 8:00 a.m. the cervix is cylindrical, not hypertrophied, soft, the cervical canal is passable for 2 fingers. On January 12, 2017, in order to induce a late medical miscarriage, the patient was prescribed misoprostol 400 mg orally once at 09:00 and an additional 400 mg orally once at 12:00. On January 12, 2017, at 14:00, there were complaints of cramping pains in the lower abdomen. The uterus is painless on palpation in all departments.
On January 12, 2017, at 15:10, at the height of the contraction, a miscarriage occurred with a dead male fetus weighing 305.0 g, 12.5 cm long; after 3 minutes at the height of the contraction, a miscarriage occurred with a dead male fetus weighing 295.0 g, 12.0 cm long.
5 minutes the placenta separated independently and the placenta stood out. Blood loss - 100 ml.
On January 13, 2017, a control echographic examination of the uterine cavity was performed. According to its results, no pathology was found, the patient was discharged from the hospital with recommendations under the supervision of a gynecologist at the place of residence.
Thus, it is obvious that the combined use of antiprogestogens with prostaglandins and the hydrophilic dilator Dilapan-S is advisable in the induction of medical miscarriage at long gestational ages, which can reduce the duration of the abortion procedure. With a late miscarriage when using a medical method of abortion, the process of evacuating the contents of the uterine cavity takes more than 2.5-3 days (60-72 hours), sometimes a second course of prostaglandins is required. In this clinical case, the entire process (from the moment of taking the antiprogestogen to the moment of self-evacuation of the contents of the uterine cavity) took 54 hours, which indicates a reduction in the duration of the abortion in this period. Also, rapid emptying of the uterine cavity is necessary for non-developing pregnancy, which will help prevent the syndrome of disseminated intravascular coagulation, the progression of inflammatory diseases and septic complications. In addition, this combined method contributes to a more careful opening of the cervix and emptying of its cavity, reduces the risk of trauma to the cervix and, thus, prevention of isthmic-cervical insufficiency. The use of one stick, providing adequate expansion of the cervical canal, is technically more convenient. And finally, the hydrogel base is hypoallergenic.
Thus, the correct use of modern methods of abortion is accompanied by minimal side effects and complications.
Literature
1. Early pregnancy / ed. V.E. Radzinsky, A.A. Orazmuradova M.: Status Praesens, 2009. 480 p. .
2. Noskova I.N., Onishevskaya G.P., Trishkin A.G., Artymuk N.V. Non-developing pregnancy, the main causes of abortive outcome // Mother and child in Kuzbass. 2010. No. 4 (43). pp. 39–42.
3. Mandrykina Zh.A. Early embryonic loss. Possible etiological factors: Abstract of the thesis. dis. … cand. honey. Sciences. M., 2010. 25 p. .
4. Agarkova I.A. Non-developing pregnancy: assessment of risk factors and prognosis (review) // Medical Almanac. 2010. No. 4(13). pp. 82–88.
5. Karmyshev A.O., Ryskeldieva V.T. Modern methods of abortion in the first trimester // Science and new technologies. 2014. No. 4. P. 114–118.
6. Hayat T. A comparative Study of vaginal Misoprostol and Cervical Catheter for Priming the Cervix in First Trimester Missed Abortion // ANNALS. 2010 Vol. 16(3). P. 179–183.
7. Wang Y.-X., Huang M.-J., He T. et al. Comparison of clinical efficacy of three methods for cervical ripening followed by surgical evacuation in early missed abortion // Journal of Reproduction and Contraception. 2012. Vol. 23(2). P. 103–110.
8. Dicke G.B., Sakhautdinova I.V. Modern methods of abortion in late terms // Obstetrics and gynecology. 2014. No. 1. P. 83–88.
9. Agarkova I.A. Non-developing pregnancy: the problem of pregravid preparation and reduction of reproductive losses // News of Medicine and Pharmacy. 2011. No. 1. S. 381.
10. Dobrokhotova Yu.E., Jobava E.M., Ozerova R.I. Non-developing pregnancy. M.: GEOTAR-Media, 2010. 144 p. .
Violation of the position of the uterus is not a disease, but a pathology, the occurrence of which has a number of reasons. There are several options for displacement of the body. The nature of the symptoms depends on the individual characteristics of the organism. The consequences can affect reproductive ability, the nature of the menstrual cycle, the general health and well-being of a woman. There are several ways to eliminate ailments when the uterus is bent.
Content:
What is uterine tilt
Many women have such a pathology as displacement of the uterus relative to its natural position in the small pelvis. It is located in it approximately in the center, the neck enters the vagina. In a normal arrangement, spermatozoa enter the organ cavity through the cervix and from there into the tubes, where the egg is fertilized. If there is a deviation from the norm, the course of processes can be disrupted, and various complications appear. Their nature depends on the direction in which the bend occurs, as well as on the degree of deviation.
Varieties of bends
Depending on the direction of the bend, several types of such pathology are distinguished.
Retroflection. The uterus is shifted back towards the rectum, which is why a woman sometimes fails to conceive a child. Such a displacement is observed most often. It is this pathology that is usually meant when they talk about the occurrence of a bend.
Anteflexia. The uterus is tilted forward towards the bladder. In this case, the neck is not displaced. Such a bend is considered a variant of the norm in nulliparous women. Usually, after childbirth, the uterus assumes a natural position.
Anteversion. Simultaneous displacement of the uterus and its cervix to the bladder.
lateroflexion- displacement of the organ to the side, to the right or left ovary.
Another variant of the pathology may be the "twisting" of the uterus when it unfolds relative to the cervix.
Causes of pathology
The causes of the bend of the uterus can be:
- congenital disorders of the pelvic organs, which arose during the development of the fetus;
- weakening of the muscles and ligaments that hold the uterus in its natural position (for example, due to multiple pregnancy or age-related changes in the body);
- rupture of the muscles and ligaments connecting the organ to the walls of the abdominal cavity;
- the occurrence of adhesions between the body of the uterus and other organs;
- the formation and growth of tumors on the outer surface of the uterus;
- inflammatory processes leading to scarring, changes in the shape of the organ;
- diseases associated with hormonal disorders (endometriosis, cysts and ovarian tumors);
- abortions, surgical interventions, caesarean section;
- abdominal trauma;
- lifting weights, intense sports during menstruation;
- frequent childbirth, especially heavy;
- sharp weight loss;
- bowel disease, and bladder tumors.
Note: There is an opinion that baby girls should not take the “sitting” position too early, as this will subsequently cause a uterine bend. However, doctors refute this assertion.
Symptoms of a tilted uterus
The first signs by which it can be assumed that a woman has a uterine bend may be a violation of the regularity of menstruation, increased pain during menstruation and during sexual contact. In addition, if the uterus is tilted forward, there is a frequent urge to urinate.
A symptom of the occurrence of a bend can be an increase in the intensity of menstrual flow, the formation of coagulated blood clots in them. The duration of menstruation increases due to spotting. There may be delays caused by a violation of the patency of the neck due to bending.
When the uterus is bent, leucorrhoea of a yellowish or greenish color with an unpleasant odor often occurs. Their appearance indicates stagnation of mucus and the presence of a bacterial infection.
Compression of the intestine when a bend occurs leads to constipation and gas incontinence. Urination becomes more frequent.
Possible complications with the bend of the uterus
With the formation of a bend in the uterus, the consequences are associated both with a violation of its functioning, and with an impact on neighboring organs of the small pelvis.
Possible menstrual disorders (changes in the duration and nature of menstruation). The danger of pathologies (inflammatory processes, endometrial hyperplasia) is increasing.
Due to the bending of the uterus forward or backward, the rectum or bladder is squeezed, which affects the work of these organs, complicates defecation or urination.
Curvature of the uterus and pregnancy
With a slight bend of a congenital or acquired nature, there are usually no problems with the onset of conception if there are no other pathologies. During pregnancy, the uterus stretches, its position becomes more natural. Changes in shape and size can lead to the disappearance of pathology after childbirth.
If there is a significant bend, then the opening of the cervix rests against the wall of the vagina, which makes it difficult or impossible for sperm to penetrate into it. The result is a woman's infertility. The same complication occurs if there is an inflection at the base of the body of the uterus. In this case, after sexual intercourse, the sperm lingers in the vagina.
In many cases, the onset of pregnancy in the presence of a uterine bend in a woman becomes possible due to the partial or complete restoration of her position relative to the vagina. A woman’s choice of the correct posture during sexual intercourse, the elimination of the bend with the help of a special massage, and other measures recommended by the doctor can help conceive.
If pregnancy has occurred, then complications are most likely to occur if the uterus is tilted back. In this case, spontaneous abortion is possible. During childbirth, the opening of the cervix and the passage of the child through the birth canal are difficult, which threatens with fetal hypoxia and the appearance of injuries. In some cases, the birth of a child is possible only through a caesarean section.
Pregnant women who have a pathology such as bending are recommended to practice yoga and therapeutic exercises to strengthen the ligaments and muscles of the pelvis. Exercise often helps to correct the position of the uterus if there are no adhesions in the abdominal cavity. The presence of adhesions greatly complicates the course of pregnancy, since the growth of the fetus causes displacement of other organs. There is a so-called "infringement" of the uterus, which often ends in a miscarriage.
Video: The possibility of pregnancy when the uterus is bent. Flow features
Methods of diagnosis and treatment
The bend is often diagnosed already during a routine gynecological examination. To clarify the nature and degree of deviations, ultrasound of the pelvic organs is used, as well as hysterosalpingography (x-ray of the uterus using a contrast solution), which allows you to detect the cause of obstruction of the fallopian tubes.
To determine the cause of the bend of the uterus and assess possible complications are used laboratory methods blood tests and smears from the vagina, biopsy (taking tissue samples for microscopic examination), as well as colposcopy.
The following kink removal methods are used:
- drug treatment to accelerate the resorption of adhesions;
- elimination of diseases that caused the organ to deviate from its normal position (hormonal therapy, anti-inflammatory treatment, physiotherapy);
- carrying out activities that help strengthen muscles and ligaments (physiotherapy exercises, Pilates classes);
- general strengthening treatment with vitamins.
A special gynecological massage allows you to correct the position of the organ.
In some cases, surgical methods of treatment are used. For example, adhesions are removed by laparoscopy.
Often, the uterus is fixed by installing a pessary (a special ring that fixes it in the correct position). It is set for a certain time and after the elimination of the slope is removed.
Sometimes a method is used in which the doctor manually corrects the position of the organ. This uses general anesthesia.
They boil down to the fact that women should not lift weights, be in a standing position for a long time. It is harmful to engage in certain sports associated with tension in the pelvic muscles (strength exercises, prolonged cycling).
You can not endure the urge to urinate and empty the intestines for a long time. It is good to sleep on your stomach. It is recommended to perform special exercises to strengthen the muscles of the pelvic floor, perineum and vagina.
Genital organs should be carefully looked after to avoid infection. It is necessary to treat gynecological diseases in a timely manner, undergo regular preventive examinations.
Video: Kegel exercises to strengthen the muscles of the pelvic floor
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- weakness of the ligaments that hold the uterus;
- frequent containment of the urge to defecate and empty the bladder;
- constipation;
- difficult childbirth complicated by muscle rupture;
- adhesions that developed after inflammatory diseases;
- ovarian cysts, tumors of the bladder, large intestine;
- abortions resulting in inflammation;
- heavy physical labor, excessive physical activity in a fitness club;
- endometriosis;
- uterine tumors (myoma, fibromyoma, leiomyoma).
- violations of the menstrual cycle, which are expressed in the appearance of severe pain, heavy bleeding and prolonged spotting before menstruation;
- discomfort during intercourse;
- constipation (the bend of the uterus can compress the rectum and interfere with its emptying);
- miscarriage;
- infertility.
- taking medications;
- gynecological massage, which increases the elasticity of adhesions, if any, and normalizes blood circulation in the pelvis;
- physiotherapy exercises for training intimate muscles;
- vitamin therapy;
- phytotherapy;
- physiotherapy procedures.
- subacute and acute pathologies of the genital organs;
- common infectious diseases;
- diseases of the kidneys, heart and liver in the acute stage;
- the presence of suspicions of a violation of the integrity of the uterine wall.
- HIV tests ( AIDS virus);
- Analyzes for RW ( syphilis is a chronic sexually transmitted disease of an infectious nature, accompanied by damage to the mucous membranes, skin, bones, internal organs and nervous system);
- Group hepatitis tests AT, FROM;
- Complete blood count with interpretation;
- A smear from the vagina to exclude the presence of inflammatory processes;
- Coagulogram ( one type of blood test) to determine its coagulability.
- loss of a large amount of blood;
- severe pain;
- greater dilation of the cervix;
- incomplete cleansing of the uterine cavity;
- general anesthesia.
- peritonitis ( inflammation of the peritoneum);
- heavy bleeding;
- disorders of the blood coagulation system;
- accumulation of blood clots in the uterine cavity;
- abdominal trauma.
- lymphorrhea ( liquid watery vaginal discharge);
- bloody issues;
- cramping pain;
- mucus and blood in the stool;
- increase in body temperature;
- an increase in the volume of the uterus;
- uremia ( self-poisoning of the body due to impaired kidney function).
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In fact, both sides are right. Slight bending of the uterus is not dangerous and does not require treatment. If the deviation from the normal position of the uterus is serious, it can cause problems that require medical attention.
A similar pathology is more often observed in young women with an asthenic physique. The main thing if you suspect a bend of the uterus is to contact an experienced gynecologist in time and, if necessary, undergo a course of treatment.
What is the bend of the uterus and where does it come from
In a normal position, the body and cervix form an obtuse angle directed forward. In this case, a deviation in any direction can be observed: back, forward, left and right.
Approximately every fifth woman faces the problem of improper position of the uterus. Most often, in about 70% of cases, there is a bend of this organ forward or backward.
Among the most common causes of a tilted uterus are:
Also, the bend can be congenital and accompanied by underdevelopment of the uterus.
Symptoms of the bend of the uterus
Sometimes the bend of the uterus does not make itself felt. But in some cases, it manifests itself with the following symptoms:
Particularly acute pain can be felt with a combination of bending and rotation (twisting of the uterus), which causes compression of the fallopian tubes. In this case, the pain can be aching, dull, or vice versa - sharp, radiating to the rectum or lower back.
When the uterus is bent, pain can also be caused by long walking, standing or a sharp change in body position - for example, when rising from a chair after a working day.
All women who want to have a normal sex life and plan to give birth to a healthy baby need to undergo a gynecological examination and exclude the presence of a uterine bend. Given the frequent asymptomatic nature of this pathology, it does not interfere with being checked even in the absence of complaints!
Diagnostics
The bend of the uterus is detected during an examination by a gynecologist and is confirmed by an ultrasound examination of the pelvic organs. On an individual basis, the patient may be assigned an extended colposcopy, cytological and microscopic examination of scrapings from the cervix and cervical canal.
Treatment of the bend of the uterus
The following treatments are also used:
In especially severe cases, they resort to surgical intervention to dissect adhesions and fix the uterus in the correct position.
How to get pregnant with a tilted uterus
For conception, the gynecologist will recommend sexual positions in which sperm is most likely to penetrate the vagina. It will not be possible to choose such positions on your own, following the advice of loved ones or comments on the Internet, because you need to know in which direction the uterus is deviated. Only an experienced gynecologist will be able to examine the bend and determine in which positions it is easiest to get pregnant in each case.
The site provides reference information for informational purposes only. Diagnosis and treatment of diseases should be carried out under the supervision of a specialist. All drugs have contraindications. Expert advice is required!
Any surgical intervention is a very unpleasant and risky procedure. However, there are situations when you really cannot do without the help of a surgeon. There are many types of surgical interventions today. Their list includes scraping of the uterine cavity or curettage- one of the gynecological surgical interventions used for both diagnostic and therapeutic purposes. Especially often, such an operation is performed for the purpose of diagnosing and treating female oncological pathologies.What is being scraped off?
The uterus is a muscular organ, which with all its appearance resembles a “pear”. Inside this organ there is a cavity that is in contact with the external environment through the cervix. The cervix, in turn, is located in the vagina. The uterine cavity is a place intended for the development of the fetus during pregnancy. This place is lined with endometrium, i.e. mucous membrane. Throughout the menstrual cycle, the endometrium tends to thicken. In the absence of pregnancy during menstruation, it is regularly rejected. If pregnancy occurs, then the endometrium attaches a fertilized egg to itself and gives it the opportunity to develop. When carrying out curettage, the specialist removes the endometrium directly, or rather its functional ( surface) layer. The cervical canal is also subjected to curettage, namely the place where the entrance to the uterus is located.Deciphering the basic concepts
Scraping - This is the main action during the procedure, but the procedure itself has various names.WFD – separate diagnostic curettage sometimes also used for medicinal purposes. During the WFD, the cervical canal is initially scraped, and then the cavity of this organ. In all cases, the resulting scraping undergoes a histological examination to make an accurate diagnosis. Histological examination is a study of tissues, during which their composition is studied, as well as the presence or absence of pathological cells in them. Often, this study is also carried out to assess the general condition of the removed organ. For medicinal purposes, this procedure is carried out in order to extract a particular formation. It could be like a polyp painful growth on the mucous membrane) and hyperplasia ( enlarged tissue resulting from cell growth).
RDV + GS – separate diagnostic curettage under hysteroscopy control. Hysteroscopy is an examination of the uterine cavity using an optical system, namely a thin tube, inside which an optical fiber is located. This tube, 5 mm thick, is inserted through the vagina into the cervix. With its help, it is possible to examine the walls of the cavity, identify the existing pathology, carry out all the necessary manipulations, and then check the work done. Without a doubt, this approach is more effective.
Indications for this procedure
Curettage is carried out for two purposes, namely therapeutic and diagnostic. In the first case, one or another pathological condition is removed, but in the second, a final diagnosis is made.Therapeutic goal
1.
Uterine bleeding
- different in nature and etiology of bleeding from the uterus. In this case, the true cause of their occurrence may not be clear. This procedure is carried out in order to stop bleeding. 2.
Synechia
- are adhesions of the walls of the uterine cavity. This procedure is necessary in order to dissect the existing adhesions. It is performed using a hysteroscope ( an instrument designed for the diagnosis and treatment of intrauterine pathologies) and other special mechanisms.
3.
Mucosal polyps
- polypous growths of the uterine mucosa. It is impossible to get rid of them with the help of medicines, which is why this procedure is carried out.
4. endometritis are inflammation of the lining of the uterus. In order for the course of treatment to be complete, it is initially necessary to scrape off the endometrium.
5. Hyperplasia or hyperplastic process of the endometrium - Excessive thickening of the lining of the uterus. This procedure is the only method for both diagnosis and therapy of this pathological condition. After carrying out all the necessary manipulations, patients are prescribed special medications to consolidate the result.
6. Remains of embryonic tissues or fetal membranes - all these are complications of abortion, which this procedure will help get rid of.
Diagnostic purpose
1. Suspicious changes in the cervix;2. Suspicious changes in the uterine mucosa;
3. Prolonged profuse menstruation with clots;
4. infertility;
5. Preparation for planned gynecological surgery;
6. Preparation for manipulations for uterine fibroids;
7. Intermenstrual bleeding from the vagina of unknown etiology.
Contraindications for this procedure
What are the steps involved in preparing for surgery?
1. Refusal of food on the day of the procedure and the night before;2. Taking a shower;
3. Performing a cleansing enema a procedure in which water or other liquids or drug solutions are injected through the anus into the rectum);
4. Shaving the hairline located on the external genitalia;
5. Anesthesiologist's consultation;
6. General examination using mirrors by an obstetrician-gynecologist;
List of tests to be done before the procedure
Procedure steps
1. Treatment of the external genitalia and vagina;2. Exposing the cervix using mirrors;
3. Fixing the neck with bullet forceps - a surgical instrument, which is a cremal clamp with straight pointed hooks;
4. Cervical canal dilatation ( cervical canal of the uterus);
5. Curettage of the mucous membrane with a curette ( a tool with a working body in the form of a sharp or blunt metal loop);
6. Treatment of the cervix with tincture of iodine;
7. Removing tools.
Surgical technique
As soon as the bladder is completely emptied, the patient is placed on a gynecological chair, after which a two-handed examination is performed ( examination with two hands) vagina. Such an examination is necessary to establish both the size and position of the uterus. Then the external genitalia and vagina are treated with alcohol, as well as iodine tincture. This is followed by exposure of the cervix using spoon-shaped mirrors. Using two pairs of bullet forceps, the cervix is lowered to the entrance of the vagina. Uterine probe ( thin metal smoothly curved tool) makes it possible to establish the length and direction of the uterine cavity. Most often, the uterus is located in the position anteflexio version, i.e. in a position that is anatomical norm, without any deviations. In such cases, all the necessary instruments are introduced into this organ with a forward concavity. If the uterus is in position retroflexio uteri, i.e. her body in the area of the internal pharynx bends back, then the instruments are guided backward by concavity, which makes it possible to avoid injury. Sometimes you can’t do without Gegar’s metal expanders ( metal rods), which help to expand the cervical canal to the size of the largest curette. The dilators should be inserted very slowly and effortlessly, and should initially be the smallest dilator. As soon as the cervical canal is expanded to the required size, the surgeon picks up the curette. Move the curette forward very carefully. Each time it should reach the bottom of the uterus. As for the reverse movements, they are performed more vigorously and with effort, so that the mucous membrane is captured. The whole process is sequential. First, the front wall is scraped, then the back and side walls. At the end, the corners of the uterus are also cleaned. The procedure lasts until the uterine walls become smooth to the touch. Typically, the operation takes 15 to 25 minutes.
Features of the procedure are determined by the nature of the disease. So, for example, with submucosal myoma ( benign tumor of the muscular layer of the uterus, which is located under the endometrium) the uterine cavity has a bumpy surface, which is why the whole procedure is carried out very carefully so as not to damage the capsule of the myomatous node. During pregnancy, all manipulations are carried out especially carefully so as not to damage the neuromuscular apparatus, etc.
Immediately after the procedure, the bullet forceps are removed, after which the neck is treated with tincture of iodine, and the mirrors are removed. Scraping is collected in a special container with a 10% formalin solution, after which the material is sent for histological examination. If there is a suspicion of a malignant neoplasm, then scrapings are taken from the mucous membrane of both the cervical canal and the uterine cavity. Each scraping is placed in a separate test tube.
Traditional curettage
Traditional curettage is a surgical intervention for artificial termination of pregnancy using a sharp metal curette. To date, such an operation is carried out infrequently, since it has numerous disadvantages:Other possible complications include:
Curettage in the diagnosis of uterine fibroids
Carrying out this procedure for the diagnosis of uterine fibroids plays a very important role, as it makes it possible to obtain larger tissue samples for further research. It is especially important to carry out such a diagnosis in the case of submucosal fibroids, which are not so easy to identify. The use of a sharp curette makes it possible to confirm the destruction of the uterine cavity against the background of intramural myomas ( fibroids, which are located in the thickness of the muscular layer of the uterus). If during the procedure it is possible to remove the submucous myoma on the leg, then the manipulations performed are also therapeutic, since they eliminate the source of pain and bleeding.Curettage for suspected uterine cancer
Cancer of the body of the uterus is considered to be the most common malignant tumor of the small pelvis in women. Most often, this ailment begins to develop in postmenopause, i.e. in the absence of menstruation for more than 12 months. The symptoms of this disease are:
If cancer is suspected, the procedure is recommended to be carried out very carefully so as not to pierce the place eaten away by the tumor. And it is very easy to break it, especially if the process lasts a long time. It is impossible to scrape in the same place for a long time. In this case, the procedure is not carried out to empty the uterus, as in the case of miscarriages, but to obtain the necessary material for its further examination.
Curettage for missed pregnancy
In this case, all manipulations are aimed at removing the surface layer of the mucous membrane. As for the germ layer, it is left for the growth of a new mucous membrane. With a frozen pregnancy, the cervical canal of the uterus is also subjected to curettage. The scraping taken is mandatory sent for research. The results obtained make it possible to establish the true cause that led to premature termination of pregnancy. If, after the manipulations, the woman is not bothered by abdominal pain and her body temperature is normal, she is allowed to go home. If a woman complains of pain and high temperature, then a second operation is performed, during which all remaining remnants of the membranes are removed.Period after surgery
Immediately after the procedure, special attention should be paid to body temperature and vaginal discharge. If during the first 3-10 days after the procedure only spotting spotting is noted, then there is no reason for concern. If there is no discharge, but there are abdominal pains, then you need to sound the alarm. Such pain is the first sign of hematometra ( accumulation of menstrual blood in the uterine cavity due to a violation of its outflow). This phenomenon most often occurs against the background of spasm of the cervical canal. In such cases, you need to seek help from a doctor who will refer you to an ultrasound examination to confirm or refute the alleged diagnosis. In order to prevent hematometra during the first 3-4 days after the procedure, you should take 1 tablet of no-shpy 2-3 times a day. It is quite possible to use some antibiotics, but only as prescribed by a doctor. Such drugs will help prevent the development of various inflammatory complications. The external genitalia should be regularly washed with antiseptic solutions that have an antimicrobial effect. After 10 days, it will be possible to collect the results of the histological examination and discuss them with the attending physician.Complications caused by the operation
1.
Infection and development of inflammatory pathologies of the genital organs:
these complications arise if the procedure was performed against the background of an inflammatory process or if the specialists did not follow all the rules of septic and antiseptic. Treatment involves the use of antibiotics.
2. Perforation (violation of integrity) of the uterine wall: You can break the integrity of the walls with any surgical instrument. The most common causes of their violation are very strong friability of the walls and poor expansion of the cervix. Treatment: if the violations are minor, then nothing needs to be done, since they heal on their own. If we are talking about severe perforation, then an operation is performed, during which sutures are applied.
3.
Mucosal injury:
is the result of excessive curettage, as a result of which the growth layer of the endometrium is damaged. In such cases, the mucous membrane no longer grows.
Treatment: all therapeutic measures are ineffective.
4.
Asherman Syndrome:
a condition characterized by a violation of the reproductive function and the menstrual cycle. Often it becomes the cause of the development of synechia.
Treatment provides for physiotherapeutic procedures and the use of antibacterial and hormonal drugs. If synechia occurs, hysteroscopy is performed.
5.
Hematometer:
accumulation of blood in the uterine cavity.
Treatment: removal of spasm, taking special medications.
