Name of the Procedure:

Curettage, postpartum
Common name(s): D&C (Dilation and Curettage)

Summary

Curettage, postpartum is a medical procedure where the lining of the uterus is scraped or suctioned to remove any remaining tissue after childbirth. This procedure is often performed to prevent or manage complications such as excessive bleeding or infection.

Purpose

The primary purpose of postpartum curettage is to clear residual placental or fetal tissue from the uterus following delivery to prevent heavy bleeding (hemorrhage), infection, and other complications.

Indications

• Retained placental fragments
• Heavy postpartum bleeding (hemorrhage)
• Uterine infection
• Incomplete miscarriage
• Uterine abnormalities detected via ultrasound

Preparation

• Patients may be advised to fast for several hours before the procedure.
• Necessary blood tests, including complete blood count (CBC) and coagulation profiles, may be performed.
• A pre-procedure ultrasound might be conducted to assess the uterine contents.
• Medication adjustments, such as stopping blood thinners, might be recommended.

Procedure Description

1. Anesthesia: Administered to ensure the patient is comfortable, usually local, regional, or general anesthesia.
2. Dilation: The cervix is gently dilated using special instruments.
3. Curettage: A curette (a surgical instrument) or vacuum aspiration device is used to scrape or suction the uterine lining to remove any remaining tissue.
4. Inspection: The healthcare provider ensures all tissue has been removed and checks for any complications.
5. Completion: The instruments are removed, and the patient is monitored for a short period post-procedure.

Duration

The procedure typically takes about 15 to 30 minutes.

Setting

Curettage, postpartum, is usually performed in a hospital or an outpatient surgical center.

Personnel

• Obstetrician-gynecologist (OB-GYN) or a specialized surgeon
• Anesthesiologist or nurse anesthetist
• Nurses and surgical technicians for assistance

Risks and Complications

• Common risks: Mild pain, cramping, and light bleeding
• Rare risks: Uterine perforation, infection, excessive blood loss, adverse reactions to anesthesia
• Management: Antibiotics for infection, blood transfusions for severe bleeding, surgical repair if necessary

Benefits

• Immediate cessation of heavy bleeding
• Reduced risk of infection
• Prevention of complications from retained tissue

Recovery

• Patients are monitored for a few hours post-procedure.
• Instructions for rest, avoiding heavy lifting, and monitoring symptoms are provided.
• Pain relief medications may be prescribed.
• Follow-up appointment is scheduled to ensure complete recovery.

Alternatives

• Expectant management (waiting for tissue to pass naturally)
• Medication to encourage the expulsion of uterine contents
• Each option's pros and cons should be discussed with a healthcare provider.

Patient Experience

• During the procedure: Little to no pain should be felt due to anesthesia.
• After the procedure: Cramping and light bleeding similar to menstrual periods can be expected.
• Pain management: Prescribed medications can help manage discomfort. Comfort measures like heating pads may be recommended.