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Dilation and curettage (D&C)
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Dilation and evacuation (D&E)
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It is a process of opening and dilating the cervix using a series of graduated dilators followed by curettage, or scraping of the uterine lining It is a procedure used It is used in pregnancy termination in the second semester to remove the products of conception by
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It is a diagnostic procedure to check for abnormal fluid Blood fluid may indicate a ruptured ectopic pregnancy; pus-filled fluid indicates acute infection; ascetic fluid may indicate cancer It may be used to take an endometrial biopsy, remove polyps, other tumors, or excess endometrial lining, or to treat cases of incomplete spontaneous abortion
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Minimal risk Inexpensive Not as useful for and generally effective, treating changes in although not as precise the upper cervix; as laser ablation a cone biopsy is recommended instead There is a slight risk of Not as commonly puncturing any mass performed today or uterine wall with advances in ultrasound technology If done roughly, uterine perforation may occur or scarring could develop leading to infertility It is generally performed under local or general anesthetic in the operating room
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Mild bleeding, cramping There is also slight risk of uterine perforation and scarring
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D&E is the most common and safest
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first dilating the cervix and then using destructive grasping forceps Vacuum aspiration may also be used to facilitate the removal Fern test for Cervical mucus is ovulation spread on a clean, dry slide and allowed to dry in the air A fern-frond pattern is seen under the microscope when ovulation has failed to occur A nonfrond-like pattern is seen when ovulation has occurred Genital tract biopsy It is the removal of tissue from lesions of the vulva, vagina, cervix, and endometrial cavity
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procedure used (95% of the time) for an abortion in the second trimester
To determine the presence or absence of ovulation at the ovulatory time of cycle
Allows for histopathologic assessment of the specimen to evaluate any malignancy and may also serve to fully excise small lesions
Minimal risk
A fern-frond pattern is induced by unopposed estrogen Progesterone inhibits the effects of estrogen on ferning and makes the mucus thick and cellular (seen in ovulation) See Figure 2-2, page 22 Usually performed in the office and requires only local anesthetic
(Continued)
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Common Gynecologic Procedures (Continued )
Procedure Hysterectomy Description Indications/Contraindications Benefits/Risks Advantages include the elimination of future pregnancies, cessation of menses, and possibility of uterine and cervical cancer Comments There are different types of hysterectomy: Total: removal of all of the uterus and not the fallopian tubes or ovaries Subtotal or supracervical: body of the uterus is removed near the level of the internal cervical os, leaving the cervix in place Radical: is a cancer surgery procedure where the uterus is removed with wide margins of surrounding tissues
It is the removal of the It may be indicated for patients uterus It can be with benign or malignant changes performed by entering in the uterine wall or cavity, for the abdomen menstrual disturbances or (abdominal abnormal bleeding, endometriosis, hysterectomy) or uterine prolapse, or chronic extracting the uterus pelvic pain through the vagina It is not recommended for the sole (vaginal hysterectomy) purpose of sterilization
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Hysterosalpingography
Hysteroscopy
It is an x-ray of the It is useful to assess the size, shape, uterus, fallopian tubes, and anatomy of the uterine and abdominopelvic cavity for evaluation of infertility cavity that involves or genital anomalies the injection of dye through the cervix It is a small endoscope It is used for evaluation of bleeding which has a built-in or structural abnormalities which viewing camera that may cause infertility, or location of allows direct missing intrauterine devices; it is visualization of the also used for therapeutic reasons endocervix and (ie, polypectomy, endometrial endometrial cavity ablation, removal of the uterine septum) It is a new minimally invasive technique used to visualize the uterine cavity by use of ultrasound and slow infusion of sterile saline It is used to evaluate abnormal growths inside the uterus; abnormalities of the tissue lining the uterus (the endometrium); or disorders affecting deeper tissue layers
There is a risk of infection of the uterus or pelvis, bleeding, pain, and allergic reaction to the dye Mild bleeding, cramping
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