Special Surgical Procedures II
LESSON 2: Procedures in Gynecological and Obstetrical Surgery
Section Ii:
2-24
2-24. DILATATION OF THE CERVIX AND CURETTAGE
a. General. The dilatation of the cervix and curettage (D AND C) operation
involves the introduction of instruments through the vagina into the cervical canal and
then into the uterus and, in some cases, removal of substances and blood. It is done either for diagnostic purposes or as a form of therapy for a variety of pelvic conditions such as incomplete abortion, abnormal uterine bleeding, or primary dysmenorrhea. A D and C may be performed when carcinoma of the endometrium is suspected, in the study of infertility, or prior to amputation of the cervix or an operation for prolapse of the uterus.
b. Operative Procedure.
(1) A Kelly or Auvard retractor is placed posteriorly in the vagina. A Sims or Kelly retractor is placed anteriorly to expose the cervix. The anterior lip of the cervix is grasped with a tenaculum.
(2) The direction of the cervical canal and the depth of the uterine cavity are determined by means of a blunt probe or graduated pliable uterine sound.
(3) The cervix is gradually dilated by means of graduated Hegar or Hand dilators and a Goodell uterine dilator.
(4) Exploration for pedunculated polyps or myomas may be done, using a polyp forceps.
(5) The interior of the cervical canal and the cavity of the uterus are curetted to obtain either a fractional or a routine specimen. For specific identification of the site of specimens, the endocervix is scraped with the curette first, and the specimen is separated from the curettings of the uterine endometrium. In a routine curettage, all curettings are sent together for identification of tissue cells.
(6) Fragments of endometrium or other dislodged tissues are removed with warm, wet gauze sponges on holders.
(7) Multiple punch biopsies of the cervical circumference (at 12, 3, 6, and 9 o'clock) may be taken with the Gaylor biopsy forceps to supplement the diagnostic workup.
(8) Retractors are withdrawn; packing of iodoform or plain gauze secured to dressing forceps may be inserted into the cavity. The tenaculum is removed from the cervix. A perineal pad is applied.
