Name of the Procedure:

Uterine Evacuation and Curettage for Hydatidiform Mole (also known as Dilation and Curettage, D&C)

Summary

Uterine evacuation and curettage is a surgical procedure used to treat a hydatidiform mole, which is an abnormal pregnancy in which a non-viable fertilized egg implants in the uterus and converts normal pregnancy processes into abnormal growths. The procedure involves dilating the cervix and removing tissue from the uterine lining.

Purpose

This procedure addresses the presence of a hydatidiform mole to prevent complications such as abnormal bleeding, infections, and the potential development of a rare cancer called choriocarcinoma. The goal is to remove all molar tissue from the uterus, thus resolving symptoms and preventing further complications.

Indications

• Diagnosis of a hydatidiform mole via ultrasound or HCG blood test.
• Abnormal uterine bleeding.
• Severe nausea and vomiting related to molar pregnancy.
• Rapid uterine growth inconsistent with a normal pregnancy.

Preparation

• Patients may be required to fast for 8-12 hours before the procedure.
• Blood tests and imaging studies, such as an ultrasound, are often conducted.
• Discussion of current medications and any necessary adjustments.
• Signing a consent form after receiving information about the procedure.

Procedure Description

1. Sedation/Anesthesia: General or regional anesthesia is administered.
2. Cervical Dilation: Surgical instruments or medication are used to gently dilate the cervix.
3. Evacuation: A suction device is inserted through the cervix to remove the molar tissue from the uterus.
4. Curettage: A curette, a spoon-shaped instrument, is used to scrape the uterine lining to ensure all abnormal tissue is removed.
5. Examination: The removed tissue is sent to a lab for further examination.

Tools: Suction device, curette, and sometimes ultrasound guidance.

Duration

The procedure typically takes about 20-30 minutes.

Setting

This procedure is usually performed in a hospital or outpatient surgical center.

Personnel

• Gynecologist or Obstetrician
• Anesthesiologist
• Surgical Nurse

Risks and Complications

• Infection
• Heavy bleeding
• Uterine perforation
• Scarring of the uterine lining (Asherman's syndrome)
• Risks related to anesthesia
• Incomplete removal of molar tissue, necessitating further treatment

Benefits

• Removal of abnormal tissue, preventing complications.
• Resolution of symptoms such as abnormal bleeding and severe nausea.
• Reduced risk of developing choriocarcinoma.

Recovery

• Patients can usually go home the same day.
• Instructions include rest, avoiding heavy lifting, and refraining from inserting anything into the vagina for a specified period.
• Mild cramping and spotting are normal for a few days to weeks.
• Follow-up appointments to monitor HCG levels and ensure all molar tissue has been removed.

Alternatives

• Medical management with medication (rare and less effective in cases of molar pregnancy).
• Close monitoring alone is generally not sufficient due to the risks associated with retained molar tissue.

Patient Experience

• Patients may experience some discomfort or cramping during recovery.
• Pain management includes prescribed medication and over-the-counter pain relievers.
• Emotional support may be beneficial due to the nature of the molar pregnancy diagnosis and procedure.