Dilation And Curettage (D&C)

Definition with Rationale

The gradual enlargement of the cervical os and the curetting
(scraping) of endometrial or endocervical tissue for histologic
study.
Hysteroscopy is the visual inspection of the interior of the
uterus through an endoscope. This procedure has not een found to e
reliale in the diagnosis of tual pathologic conditions.
Discussion
The procedure is usually performed to!
1 To
diagnosed cervical or uterine malignancy.
2 To control dysfunctional uterine leeding.
3 To complete an incomplete aortion.
4 To aid in evaluating infertility.
5 To relieve dysmenorrheal.
"ractional D&C procedures can assist in differentiating etween
endocervical and endometrial lesions.
#ositioning
$ithotomy% arms may e e&tended on armoards.
#ac's( Drapes
)ynecologic pac'
*nstrumentation
D&C tray
+upplies( ,-uipment
#added stirrups
Telfa
#erineal pad
+uction
$uricant
#rocedure .verview
6 A weightened speculum is placed in the vaginal vault.
7 The cervi& is grasped with a tenaculum.
8 A graduated sound is passed through the cervical canal into the
uterine cavity to determine its depth and angulation.
9 /sing Hegar or Han' dilators0 the surgeon egins to dilate the
cervical opening0 increasing the si1e of each dilator.
10 A Telfa sponge is placed over the ill of the weighted speculum0
and the uterus is gently curetted0 allowing the tissue specimen to
collect on the Telfa sponge.
11 The small serrated curette is used to scrape the uterine walls
again or when the D&C is performed to remove retained placental
tissue0 while the large0 lunt curette and forceps are used to remove
the tissue.
12 *f a fractional D&C is performed0 endocervical curettings are
otained efore the uterus is sounded0 to avoid ringing endometrial
cells into the cervical os.
13 The weighted speculum is removed0 and the perineum is dressed with
a perineal pad.
#erioperative 2ursing Considerations
14 +tirrups should e padded0 and a coccygeal support placed on the
tale to protect the lower sacral area.
15 Raise and lower the legs together and slowly to prevent
disturances caused y rapid alterations in venous return and( or
in3ury to the rotator hip 3oint.
16 *nstruments are set up on the lac' tale in order of usage0 a
scru person may not e necessary during the procedure.
*f a fractional D&C is performed0 multiple specimens may e
otained. They should e placed in separate containers0 and laeled
accordingly.
Dilatation and Curettage 4 #ost .perative Care
Postoperative care involves the precautions that we need to follow after
a Dilatation and Curettage (D&C) procedure.
The precautions that need to followed after the surgery are!
+ome cramping or mild adominal discomfort is considered usual after a
D&C0 consult the doctor if the pain is severe.
5edications should e ta'en as per the prescription of the doctor.
,nsure to ta'e the entire course of antiiotic.
Refrain from the use of internal tampons and se&ual intercourse for
aout a wee' or as advised y your doctor.
/se sanitary nap'ins during this time period.
*f there are any signs of infection such as fever0 pain or discharge
consult the doctor immediately.
Read more: Dilatation and Curettage - Post Operative Care | Medindia
http://www.medindia.net/surgicalprocedures/dilatation_curettage_postoperativecare.htm
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Dilation (or dilatation) and curettage (D&C) is a gynaecological
procedure done y widening or opening the cervical canal and surgical
removal of the uterine lining or uterine contents y scooping and
scrapping (with the use of sharp curette) or suctioning (suction
curettage) .
*t is a minor surgery done in amulatory or outpatient surgery clinics
or hospital. D&C is considered to e either a diagnostic or therapeutic
procedure depending on cases. *t can e diagnostic if it pertains to
determination for gynaecological prolems or malignancy (iopsy).
.therwise0 it may e therapeutic if it used to halt leeding from
endometrial hyperplasia0 endometrial polyps or myomas and sometimes
ecause of first trimester aortions.
A physician may refer a client for D&C if she complains of menorrhagia
'nown as e&cessive amount or duration of cyclic menstrual leeding0
metrorrhagia0 termed as uterine leeding etween menstrual period and
most especially if she may e&perience the so called postmenopausal
leeding. These manifestations could e a symptom for several
conditions which should not e ignored0 li'e polyps0 myoma (enign
neoplasm of the uterus)0 or in some0 endometrial cancer . Thus0 this minor
procedure is often used in line with hysteroscopy in order for the
physician to view the uterus for presence of some anormal growths.
Dilation and curettage is performed with anesthesia. Depending on case
to case asis0 local0 spinal or general anaesthesias are used to allow
the client to e unaware of pain involved during the procedure.
The physician and the nurse oth have an important role for providing
health teachings on the preparation prior to procedure and the things
that will happen during it. *t is est to provide comfort and support to
the client to relieve her fears aout D&C and its results. The
following preparations are made prior to D&C!
Assessment of other medical conditions li'e cardiopulmonary
diseases0 pelvic infection and leeding tendencies.
The client will undergo various tests li'e urinalysis0 routine
lood analysis and other diagnostic tests to ma'e sure that the
client has no other illnesses that could hinder or complicate the
procedure.
Days prior to D&C0 the client is advised not to ta'e any
unnecessary medications li'e aspirins0 or ta'e some alcohol.
+he is also advised not to ta'e food or fluids 6 to 7 hours
prior to procedure to avoid aspiration of gastrointestinal contents
while under anesthesia.
An informed consent is properly otained to ensure that the client
understood and familiari1ed herself of the entire process and the
things she would e&pect from the procedure.
*t is performed in an operating room with strict maintenance of asepsis.
The client is given the anesthesia and positioned with ac' lying and
oth legs fle&ed (li'e the position for #ap smear). The client is then
prepped and draped properly. *f the client is under general anesthesia0
her vitals are eing monitored y an anesthesiologist or an anesthesia
nurse. During the procedure0 the cervical canal is eing dilated0 y
which aftermath is eing hold open y a speculum. Curettage ta'es place
y introducing a sharp curette to scrape or scoop the endometrial lining
or uterine contents.
D&C would only last for more or less 89 to :9 minutes and after the
procedure the client may e&pect to e&perience some discomforts li'e
cramping sensations and light leeding which could last from half an
hour to a day or days in some. &nalgesics li'e 2+A*Ds are usually
administered to relieve pain and the client is still eing monitored and
placed in a recovery room after it for an hour until she may ale to
move her lower e&tremities or until she is stale. +ince this procedure
is done as an outpatient surgery0 the client may e allowed to go home
the ne&t day if no untoward reactions occur. .n the other hand0 if the
client e discharged0 she will e not allowed to drive within 8; hours
ecause drowsiness may still ensue due to anesthetic effects.
Despite eing a safe gynaecological method0 some complications may
e encountered.
*ntroduction or spread of infection especially for client with
pelvic infection which could e spread y the instruments used to
other reproductive organs.
/terine perforationwhich could e detected y hemorrhage. This is
due sometimes to the use of the sharp curette.
*ntrauterine adhesionswhich could e referred to as Asherman<s
syndrome4 rarely it happens due to e&cessive scrapping of the uterine
lining leading to formation of scars. *f this will not e treated0
the possiility for more ris's in future pregnancies may happen% for
instance0 miscarriages0 anormal placental presentations0 and ectopic
pregnancy.
2owadays0 this dilation and curettage is less li'ely used and
recommended ecause of the availaility of non invasive diagnostic
imaging procedures li'e ultrasound and hysteroscopy. The =H. even
recommends this method only if manual vacuum aspiration is unavailale.
This procedure may e lin'ed to aortions ut let it e 'nown for
management of aortion complications.
)ursing care plan may involve nursing prolems li'e fear0
'nowledge deficit0 health see'ing ehavior0 volume fluid deficit and
pain. *t is very helpful to educate0 too0 the client to watch out for
anormal symptoms after the procedure0 li'e!
17 "ever
18 "oul smelling discharge from the vagina
19 ,&cessive leeding which may e prolonged in duration
20 ,&cessive and persistent pain which is not relieved y any pain
medications

References!
>tasnice? >tanice title@ABA? )lic'man0 C. C. (DEEF). #hatom 2otes
2ursing! 5aternal4 2eworn Dst ,dition. *nfo Access & Distriution #te
$td. Gagins'i0 $. (8997). Dilation and Curettage. Retrieved last Culy
8:0 89D8 from www.medicinenet.com +toopler0 5. & Davis0 C. Dilation and
Curettage (D&C). Retrieved last Culy 890 89D8 from
http!((www.emedicinehealth.com >(tanice? >(tasnice?
4 +ee more at! http!((rnspea'.com(maternal4child4nursing(dilation4and4
curettage(Hsthash.+h5I-d.dpuf