Scraping of the uterus
introduction
When scraping the uterus, also as Fractional abrasion or curettage is a small gynecological operation that can often be performed on an outpatient basis.
Indications for scraping the uterus are, for example, irregular and very heavy menstrual bleeding, sudden bleeding after the menopause, abnormalities in the transvaginal ultrasound, as part of the preventive medical check-ups or after a miscarriage.
The procedure can be performed under local anesthesia, but is usually performed under general anesthesia and usually takes no longer than ten to fifteen minutes.
When the uterus is scraped with the help of a sharp spoon (curette) The lining of the uterus is removed from the cervix and the body of the uterus and subsequently examined in the laboratory for pathological changes.
The uterine scraping thus serves both Diagnosis as well as the therapy. In this way, tissue can be obtained for histological examination and at the same time pathological changes, such as Polypsto be removed.
Indications for a uterine scraping
Reasons why a Uterine scraping should be performed are for example a Miscarriageif the fruit does not come off by itself and remains in the uterus, or after the birth of a child, if there are any remains of the placenta remained in the uterine cavity.
If the placenta is not completely removed, prolonged, very heavy bleeding can occur, which does not stop by itself and can be life-threatening.
Another indication for a uterine scraping is Heavy, irregular bleeding in premenopausethat cannot be treated with hormones.
Above all, however, the operation is in the event of sudden bleeding after the Menopause or noticeable Uterine lining changes indicated, which may stand out in the context of ultrasound checks during preventive care.
The scraping of the uterus plays an important role here, as pathological changes are quickly removed and tissue is obtained at the same time that is used for a histological examination in the laboratory and thus malignant or benign changes can be reliably determined.
Procedure of the procedure
The uterine scraping is usually done on an outpatient basis and under general anesthesia; this is often carried out in the form of short anesthesia with propofol. However, if the patient has other comorbidities that indicate an increased risk during and after the operation, an inpatient stay for one night is recommended for control. At the patient's request, the procedure can also be performed under local anesthesia, but general anesthesia is recommended due to the painful enlargement of the cervix.
After the anesthesia, the patient is positioned as if on a gynecological chair and the surgeon examines her vaginally again. Then the Specula (a gynecological instrument with two blades to unfold the vagina) inserted into the vagina and then under sight the Portio (Transition of the cervix into the vagina) is hooked and the cervical canal scraped off.
After that, the internal cervix is with the help of Hegar pens (small metal pins of different sizes) dilated to the desired width and a curette (a spoon with sharp edges) inserted and the uterine cavity scraped off.
Since the tissue is removed in two fractions and histologically examined separately from each other, one speaks of one fractional abrasion.
This has the advantage that, during the histological examination, it can be better differentiated from which part of the uterus the disease originates, whether from the cervix or the body of the uterus. This is particularly important for further therapy.
The scraping of the uterus, especially if a polyp or a malignant tumor is suspected, can also be carried out with a prior view, known as a hysteroscopy.
For this purpose, a small camera is inserted into the uterine cavity to show the pathological changes.
The surgeon can then visually remove the diseased tissue and then use the hysteroscope to ensure that everything has been removed. The procedure takes about ten minutes.
Most of the time, the bladder is emptied with a urinary catheter before the procedure.
Read more on the topic: Endoscopy
What do you have to consider after the procedure?
When the uterine scraping outpatient is done, the patient usually remains in the ward for monitoring for a few hours after the operation. If she feels well and if there are no complications, she can be discharged home on the same day.
It is important to note that you are after an anesthetic don't drive a car yourself may.
After the scraping, as after any operation, it is important to take some rest for a few days. Exercise should be avoided for the next one to two weeks.
Besides, you should also be on Warning symptoms how Fever, severe pain, heavy bleeding, or purulent discharge respect, think highly of.
If these signs occur, you should consult a gynecologist as soon as possible.
It is normal to have light bleeding that can last for up to several days and to delay the next menstruation.
By removing the lining of the uterus, it can up to eight weeks take until the mucous membrane has completely built up again and wound healing is complete. Therefore, this should not be a cause for uncertainty.
Complications
Possible complications are the same as with any surgical procedure Blood loss, up to the necessary transfer of foreign blood, with the associated risk for Intolerance reactions and the transmission of HIV and hepatitis.
Furthermore you can Infections, wound healing disorders, allergic reactions (with rash, itching, dizziness, vomiting, swelling ...) as well Injuries and Punctures (perforation) arise from neighboring structures and organs.
Here is above all the Injury to the wall of the uterus and fallopian tubes to mention what it is, among other things Adhesions and adhesions structure that can lead to menstrual changes, infertility and difficulty conceiving.
Also the Injury to the intestines and urinary bladder is possible, which can cause problems urinating or defecating, but this is very rare.
Another complication to emphasize, especially in young women, is this Injury to the cervix.
This can lead to a Cervical weakness come what the risk for subsequent births Premature births and miscarriages conceals.
To counteract this, it is important that the cervix is softened with medication beforehand in all women who want to have children in order to prevent injuries.
After the uterine scraping, there may also be a easy bleeding that lasts a few hours to days but is perfectly normal and shouldn't be a cause for concern.
If you have a fever, severe persistent pain or heavy bleeding, you should definitely consult a specialist!
Pregnancy and termination of pregnancy
During pregnancy, uterine scraping is only possible within the scope of Miscarriages indexed.
In most cases, a spontaneous departure of the fruit is waited for and medically supported with cervical-effective substances (for example prostaglandins).
If there is no spontaneous abortion, the uterus is scraped off.
It is important that the cervix is soft, what for example about the gift of Prostaglandins (active ingredients similar to the body that soften the cervix and promote labor) can be achieved.
After that, under general anesthetic expand the cervix and use a sharp spoon to remove the embryo (curette) scraped off.
The procedure takes about half an hour and is carried out on an outpatient basis so that the patient can be discharged home on the same day.
Another indication for uterine scraping is given if Placental remnants in the uterine cavity remain. They can lead to heavy, persistent bleeding, which in certain circumstances can be life-threatening.
For this purpose, the placenta is put on its placenta after the birth completeness checked. If it is torn open and not complete, the uterine cavity is scraped immediately after the birth under general anesthesia and the uterine cavity is scraped completely with the help of the curette.
A uterine scraping can also take place as part of a abortion be performed. A Termination of pregnancy is approved in Germany up to the 12th week if the pregnant woman has received advice at least three days beforehand and decides in favor of the procedure.
An abortion after the 12th week is only possible in special cases, for example after a rape, but only up to the 22nd week.
The most common abortion method in Germany is Suction method, about 80% of all abortions are performed with it. During the 6th-12th Week and is performed under general anesthesia.
Here, the cervix is first drawn with special pens (Hegar pens) and then a thin, flexible plastic tube is inserted into the uterine cavity.
The unborn child and placenta are then sucked out and removed by strong suction. Most of the time, the leftovers are scraped off again with a curette. Another method of abortion is that curettage (Curettage).
During the 7th-12th Week and is also carried out under general anesthesia. Here, too, the cervix is dilated beforehand with the Hegar pins and then the instruments are inserted to remove the unborn child from the uterine cavity. Finally, the remains are scraped off with a curette.
Menopause and polyps
Especially after menopause is the risk for morbid Changes in the lining of the uterus and the genital organs increased. Hence, it is important for women to continue after menopause regularly for check-ups go.
Means Ultrasonic can do this quickly Changes to the uterus or ovaries getting discovered.
Should be a thickened uterine lining be noticed, it should definitely be examined further with the help of a uterine scrape.
The uterine scraping has the advantage that the diseased tissue can be removed quickly and safely and then examined. In most cases, these are benign tumors of the uterine lining, so-called Polypswhich are harmless but can cause irregular and heavy bleeding even after the menopause.
Removal of the polyps quickly relieves symptoms. In some cases, however, a thickened uterine lining can also be a malignant tumor, especially Endometrial cancer, a hormone-dependent cancer of the uterine body.
The greatest risk of developing uterine body cancer is from ingestion Hormone replacement products (especially estrogens, without progestin protection). Other risk factors are one early menarche and a late menopause, few or no births, history of breast cancer, therapy with Tamoxifen, such as Obesity, Diabetes mellitus and high blood pressure.
Uterine body cancer expresses himself early on sudden, postmenopausal bleeding. Here, too, the uterine scraping is indicated in order to remove the diseased tissue and examine it more closely and initiate appropriate therapy. However, since this form of cancer is usually recognized very early, it can be treated well and usually has a good prognosis.
Fibroids
Fibroids are benign, estrogen-dependent tumors of the uterine muscles. They are completely harmless in themselves, but, depending on their location in the uterus and their size, Menstrual cycle disorders, menstrual cramps, pain and in rare cases too infertility cause.
The most common reason for fibroid removal is strong, irregular menstrual bleeding.
They are usually diagnosed using ultrasound.
Medicines can be taken therapeutically, for example progestogen-based contraceptives.
If that is not enough, myomas can also be surgically removed. Small fibroids that are attached to the lining of the uterus can be removed by scraping the uterus.
Another surgical option is this laparoscopic removal. Instruments and a special camera are introduced into the abdominal cavity by means of three small abdominal incisions, the abdomen is expanded with carbon dioxide and the fibroids are then cut out of the uterus under view.
However, fibroids have one high risk of recurrence and can always grow back in different places in the uterus.
However, after menopause they atrophy and no longer cause discomfort.
In very difficult cases and with very large fibroids, there is sometimes one Hysterectomy indexed.
Illustration of the uterus
- Uterus -
uterus - Uterine tip -
Fundus uteri - Uterine lining -
Tunica mucosa - Uterine cavity -
Cavitas uteri - Peritoneum cover -
Tunica serosa - Cervix -
Ostium uteri - Uterine body -
Corpus uteri - Uterine constriction -
Isthmus uteri - Sheath - vagina
- Cervix - Cervix uteri
- Ovary - Ovary
- Fallopian tubes - Tuba uterina
You can find an overview of all Dr-Gumpert images at: medical illustrations
- Uterus - uterus
- Uterine tip - Fundus uteri
- Uterine lining -
Tunica mucosa - Uterine cavity - Cavitas uteri
- Peritoneum cover - Tunica serosa
- Cervix - Ostium uteri
- Uterine body - Corpus uteri
- Uterine constriction - Isthmus uteri
- Sheath - vagina
- Pubic symphysis -
Pubic symphysis - Urinary bladder - Vesica urinaria
- Rectum - Rectum
Is a uterine scraping possible on an outpatient basis?
The uterine scraping is a small gynecological operation that usually only takes about ten minutes and is either in local anesthesia or in general anesthetic is carried out.
The uterine scraping is usually an outpatient procedure, which means that the patient remains in the ward for a few hours for monitoring after the operation, but can usually go home the same day.
Whether an operation can be carried out on an outpatient basis depends on the patient Age and the Comorbidities the patient.
Are heavy Cardiovascular diseases before, the patient is not stable enough for an outpatient procedure or the treating doctor suspects one increased intraoperative risk, a short inpatient stay is recommended.
Most of the time, the patients stay for one night in the hospital and go home the next day. Another reason for inpatient admission is the patient's express wish if she fears that she will not be able to cope on her own after the operation.
Should complications like during or after the operation profuse bleeding admission is also required. It is important to note that you are looking for a general anesthetic You are not allowed to drive independently for the next 24 hours and that after the uterine scraping you take care of yourself in the next few days, do not do any sport and open up Warning symptoms such as fever, severe pain, heavy bleeding, or purulent discharge and see a doctor as soon as possible if any of the above symptoms occur.
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