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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