16.) Uterine Curettage And Douglass Pouch Puncture Indications Technique Instruments Flashcards
What is uterine curettage, and what is its purpose?
Uterine curettage involves scraping or removing the endometrial lining with a curette. It’s used therapeutically to clear retained tissue (e.g., after abortion or molar pregnancy) and diagnostically for conditions like endometrial cancer or abnormal bleeding.
What are the therapeutic indications for uterine curettage?
Therapeutic indications include removing retained products of conception, addressing hemodynamic instability due to severe bleeding, and treating molar pregnancies.
What are the diagnostic indications for uterine curettage?
Diagnostic uses include sampling endometrial tissue when there is suspicion of endometrial cancer, severe menstrual pain, or abnormally heavy bleeding, often in conjunction with hysteroscopy.
What are contraindications for uterine curettage?
Contraindications include active infection (e.g., endometritis), pregnancy, and post-menopausal status due to uterine fragility.
What are the different types of curettage procedures?
- Abrasio propatoria: Used in complete abortion with no active bleeding or residual fetal parts; may involve ultrasound observation. To prep uterine cavity for hysteroscopy etc
- Abrasio residorum: Used in progressing abortion (open cervix, some fetal parts expelled) or incomplete abortion with retained tissue and mild bleeding.
Describe the preoperative steps and positioning for uterine curettage.
Preoperative steps include anesthesia (paracervical block or general), positioning the patient in the dorsal lithotomy position, and visualizing the cervix with retractors.
How is the cervix prepared and dilated in curettage?
The anterior lip of the cervix is grasped with a tenaculum ( scissors like ) Cervical dilation is achieved using Hegar dilators, gradually increasing from smaller to larger sizes to reach the required dilation.
What types of curettes are used in curettage, and how are they applied?
- Blunt curette: Used for general scraping of anterior, lateral, and posterior walls.
- Sharp curette: Used for removing deeper or residual tissue. Both types can also collect samples for histopathology.
What is Douglas Pouch Puncture (Culdocentesis), and what is it used for?
Douglas Pouch Puncture, or culdocentesis, is a procedure that uses a long needle to access the rectouterine pouch via the posterior vaginal fornix. It’s used to diagnose hemoperitoneum, such as from a ruptured ectopic pregnancy.
Describe the technique and instruments used in Douglas Pouch Puncture.
The vagina is opened with retractors, the cervix is grasped with a tenaculum, and a long needle attached to an empty syringe is inserted through the posterior vaginal fornix to the cul-de-sac. Fluid (e.g., blood) is aspirated to evaluate for intra-abdominal bleeding.
