Diagnostic scraping of the walls of the uterus
Last reviewed: 17.04.2020
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Diagnostic scraping of the walls of the uterine cavity is an instrumental removal of the functional layer of the uterine lining of the uterus along with pathological formations that can originate from it. Diagnostic scraping of the walls of the uterine cavity should be performed only in a hospital setting with strict adherence to aseptic and antiseptic rules. Anesthetize local paracervical anesthesia with 0.25% solution of novocaine or mask anesthesia with nitrous oxide or intravenous anesthesia.
Diagnostic scraping of the walls of the uterine cavity is widely used in gynecological practice mainly for the detection of the state of the endometrium. After probing the uterus, the channel of the cervix is dilated with Gegar dilators (usually up to No. 8). Then the middle curette is scraped out by the mucous membrane of the anterior and posterior walls of the uterus, its bottom and the tube corners.
If necessary, separate diagnostic scraping of the mucosa of the canal and the uterine cavity.
Scrapings are separately sent for histological examination.
[Indications for diagnostic curettage of the walls of the uterus are uterine bleeding, dysfunctional disorders of the menstrual cycle, suspicion of malignant tumors of the uterus, placental and decidual polyps, hyperplasia and polyposis of the mucous membrane of the uterine cavity, incomplete miscarriage, etc. In polyps, hyperplasia and incomplete miscarriages, with a diagnostic purpose, but also with a therapeutic one.
After the disinfection of the external genitalia and vagina, the cervix is exposed with mirrors, treated with alcohol and seized by the foreleg with bullet forceps. If the uterus is retroflection, then it is better to grab the cervix by the back lip. Proceed with probing the uterine cavity and widening the neck channel with Gegar dilators up to No. 9-10. Expanders are introduced, starting with small numbers, only by the strength of the fingers of the hand, and not by the whole hand. The expander is not brought to the bottom of the uterus, it is enough to hold it for the inner pharynx. Each expander must be left in the channel for a few seconds; If the following expander enters with great difficulty, then you must re-enter the previous expander. After dilating the canal, the cervix begins to scrape the walls of the uterine cavity, using sharp curettes of different sizes for this purpose. The curette should be kept free, without resting on the handle. In the uterus cavity, it is gently injected to the bottom of the uterus, then press the curette handle so that its loop slides along the wall of the uterus and is taken from the top down to the inner throat. For scraping the posterior wall, without removing the curette from the uterine cavity, turn it gently to 180 °. Scraping is performed in a certain order: first scrape the front wall, then the left lateral, posterior, right lateral and corners of the uterus. Soskob carefully collected in a jar with 10% formalin solution and sent for histological examination.
When scraping the uterus, there are certain characteristics that depend on the nature of the pathological process. Uneven, tuberous surface of the uterine cavity can be with interstitial or submucous myoma, so if this is found, scraping should be done carefully, so as not to damage the capsule of the myomatous node. Damage to the capsule of the myomatous node can cause bleeding, necrosis of the node and its infection. Soskob can look like a crumbly mass, characteristic for decaying malignant tumors. In such cases, do not perform a complete scraping to not perforate the wall of the uterus, altered by the tumor. In all cases of suspected malignant tumor, separate diagnostic scraping of the uterine cavity should be performed.
Separate diagnostic curettage is that first produce a scraping of the mucous membrane of the cervical canal, without going for the internal pharynx. Scraping is collected in a separate test tube. Then, the uterine cavity is scraped and this scraping is placed in another tube. In the directions for histological examination, it is noted from which part of the uterus the scraping is obtained.