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DILATION AND CURETTAGE
A dilation and curettage (D & C) may be diagnostic (identifies the cause of irregular bleeding) or therapeutic (often temporarily stops irregular bleeding). The cervical canal is widened with a dilator and the uterine endometrium is scraped with a curette. The purpose of the procedure is to secure endometrial or endo-cervical tissue for cytologic examination, to control abnormal uterine bleeding, and as a therapeutic measure for incomplete abortion.
Because this procedure is usually carried out under anesthesia and requires surgical asepsis, it is usually performed in the oper-ating room. However, it may take place in the outpatient setting with the patient receiving a local anesthetic supplemented with diazepam (Valium), midazolam (Versed), or meperidine (De-merol). The patient who receives these medications is carefully monitored until she has fully recovered.
The nurse provides an explanation of the procedure as well as physical and psychological preparation, informing the patient about what the procedure involves and what to expect in terms of postoperative discomfort and bleeding. The perineum is not shaved, but the patient is instructed to void before the procedure. The patient is placed in the lithotomy position, the cervix is di-lated with a dilating instrument, and endometrial scrapings are obtained by a curette. A perineal pad is placed over the perineum after the procedure, and excessive bleeding is reported. No re-strictions are placed on dietary intake. If pelvic discomfort or low back pain occurs, mild analgesics usually provide relief. The physician indicates when sexual intercourse may be safely re-sumed. To reduce the risk of infection and bleeding, most physi-cians advise no vaginal penetration or use of tampons for 2 weeks.
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