Curettage

What is curettage?

The curettage - or curettage - is a surgical procedure that uses the aid of a curette (a sort of sharp spoon) to remove a portion of the endometrium or an abnormal mass contained in the uterus. Curettage is done to diagnose or treat different morbid uterine conditions. It is a painful medical practice, which as such requires general (more often) or local (less frequently) anesthesia.

Scope

The scraping is performed for diagnostic or operational purposes.

DIAGNOSTIC SCRAPPING involves taking a sample from the uterine lining tissue (endometrium).Subsequently, the same sample is sent to the laboratory for a "careful cytological investigation, useful for providing very important diagnostic clues.
To ascertain or deny a presumed female genital pathology, diagnostic scraping can be performed in the following situations:

• Abnormal uterine bleeding (menorrhagia, metrorrhagia, hypermenorrhea, recurrent spotting)
• Uterine bleeding during the postmenopausal period
• Severe and abnormal uterine bleeding after vaginal delivery
• Fierce and unbearable menstrual pains
• Suspicion of cervical cancer
• Inability / difficulty with conception
• Detection of abnormal cells on Pap smear

The OPERATIVE SCRAPPING is instead performed to remove an abnormal mass grown along the endometrium and protruding into the uterine cavity. The scraping is also a surgical procedure for spontaneous abortion. Women can undergo curettage to voluntarily remove the product of an unwanted pregnancy no later than the 13th week of gestation.
In addition to this purpose, operative scraping is performed for the removal of:

• Some placental residues from the uterus after delivery
• Uterine (or endometrial) polyps
• Uterine fibroids
• Uterine cancer (total or partial removal)
• Excess endometrium (for women with polycystic ovary syndrome)

Before the intervention

Before proceeding with the curettage, the woman undergoes a scrupulous gynecological examination, often associated with cervico-vaginal swab and ultrasound of the uterus. Normally, blood tests are also required to examine any possible circulation disorders.
The patient must always inform the doctor in case of taking any particular medications or allergies (for example, allergy to nickel, allergy to latex, allergy to anesthetic drugs, etc.).
The patient must subsequently sign a form in which she declares to have been informed about the purposes, methods and possible risks of the intervention, giving her consent to the execution of the curettage.

During the surgery

As anticipated, uterine curettage involves the patient's narcosis (general anesthesia). Less often, the surgical procedure is done under local anesthesia.

The surgical procedure is performed in two steps:

1. Dilation of the cervical canal: normally induced a few hours before the operation. For voluntary interruptions of pregnancy, the dilation of the cervix must be gradual; therefore it is carried out in the 24 hours preceding the scraping. It is possible to dilate the cervix with specific drugs, or by introducing a special instrument called Hegar's graduated dilator into the cervix.
2. Curettage: A special spoon-shaped cutting instrument (curette) is inserted into the uterus through the dilated cervix. Next, the lining of the uterus is gently scraped to remove the abnormal mass or product of conception, or to take a sample cytological.

As an alternative to the curette, it is possible to remove the abnormal mass by vacuum aspiration or removal with surgical forceps.

Subsequently, the tissue mass is sent to the laboratory for further cytological investigations.

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In some cases, the scraping of the uterus is replaced by hysteroscopy, an examination that also allows to analyze the state of health of the uterine cavity, the cervical canal and the endometrium. Hysteroscopy is less risky than curettage, given that the intervention is facilitated by the virtual projection of the uterus on a monitor.
The woman can go home the same day as the curettage or, in case of complications, she can be hospitalized for a few days.

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