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Stree evam Prastuti Tantra

Surgical Procedures (Gynaecology), Thermal cautery, D+C

Common Gynaecology day surgery cases-
◾Dilatation and curettage
◾Termination of pregnancy (D and E)
◾Biopsy procedures
◾Examination under anaesthesia
◾ Endoscopic procedures like

  • Diagnostic hysteroscopy, laparoscopy
  • Laproscopic sterilisation operation
  • Ovarian drilling diathermy
  • Transcervical resection / ablation of endometrium

Thermal Cauterisation

Operation whereby the eroded area of the cervix is destroyed either by thermocoagulation or red hot cauterisation.

Procedure- superficial cauterisation can be done without anaesthesia.

extensive cauterisation is done with general anaesthesia.

  1. Lower part of the cervical canal is dilated by 1 or 2 small Dilators.
  2. Whole eroded area is cauterised by cauterised by cautery point giving linear radial strokes, starting from inside of the cervical canal to over eroded area.
  3. Area is smeared with antibiotic ointment.

Healing – 2-3 weeks for sloughing of the burn area.

Indications-

  1. Cervicitis
  2. Cyst
  3. Lesions
  4. Cervical ectopy with troublesome discharge

Contraindications-

  • Vaginitis
  • Pregnancy
  • Acute pelvic inflammatory diseases
  • Carcinoma of cervix

Dilatation and Curettage (D and C)

Operative procedure whereby Dilatation (opening) of cervical canal followed by Uterine Curettage is done

Procedure-

  1. Empty the bladder prior to operation (patient)
  2. Done under general anaesthesia or under diazepam sedation.
  3. Patient should be in lithotomy position.
  4. Local antiseptic cleaning
  5. Bimanual examination
  6. Posterior vaginal speculum is introduced.
  7. Anterior lip of cervix is grasped.
  8. Uterine sound is introduced to know the position.
  9. Cervical canal is dilator with graduated Dilators.
  10. When dilator is introduced, cervix is made steady by traction of Vulsellum.
  11. After desired Dilatation, uterine cavity is curetted with a curette either in clockwise or anticlockwise direction, starting from fundus down to internal os.
  12. Vulsellum and the speculum are removed.

◾Curetted material is preserved in 10% formol saline, labelled properly and sent for histological examination.

Indications-

  • Infertility
  • DUB
  • Pathologic amenorrhoea
  • Endometrial TB
  • Endometrial carcinoma
  • Postmenopausal bleeding

Therapeutic-

  • DUB
  • Removal of IUD
  • Endometrial polyp
    • Incomplete abortion

Contraindications-

  • Viable desired intrauterine pregnancy
  • Inability to visualise cervical os.
  • Obstructed vagina
  • Patient has problem with clotting mechanism.

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