curettage

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Scraping is the surgical removal of the lining of the uterus. Doctors also call this procedure abrasio uteri or curettage. The scraping of the uterus is used, among other things, after a miscarriage, during abortions or for diagnostic purposes. Read all about the procedure, when it is done, and the risks involved.

What is a scraping?

Scraping is a surgical procedure in which the gynecologist removes all or part of the lining of the uterus. To do this, he uses a special instrument, a kind of metal loop with a blunt or sharp (cutting) edge, the curette. The procedure is also known as abrasion or curettage and is one of the most common gynecological interventions in Germany.

Fractional abrasion differs from normal scraping in that the doctor first removes the mucous membrane from the cervix and then from the body of the uterus. In this way, for example, a cancer diagnosis can be assigned more precisely to a specific location in the uterus.

During suction curettage, a device develops a slight suction through which the ablated tissue is sucked off after scraping. This technique is often used for abortions.

When do you carry out a scraping?

Obstetricians and gynecologists often perform an abrasion for diagnostic purposes. A pathologist then examines the mucous membrane microscopically after the uterus has been scraped and can thus detect any changes in the cells that may indicate cancer, for example.

The fractional abrasion, in which the mucous membranes of the individual uterine sections are examined separately, allows conclusions to be drawn about the exact location of a cell change - for example in the case of uterine lining cancer. The abrasion is then often combined with a hysteroscopy in order to further increase the informative value of the scraping.

Common reasons for scraping: miscarriage and fetal death

For various reasons, an embryo can die in the womb in early pregnancy. This so-called fetal death can lead to a birth with normal labor or it can be completely silent. In cases of miscarriage without scraping, dangerous complications can arise. Infection and bleeding are typical risks of an abortion. Abrasion and a simultaneous therapy with antibiotics help to prevent these serious secondary diseases.

Scraping after birth

After giving birth, parts of the mother cake or the membranes often remain in the uterus. If the uterus cannot contract properly, these remnants of tissue bleed. Usually certain medications help the uterus to contract again. However, if this does not work sufficiently, only curettage of the mucous membrane will help; in severe cases, the gynecologist must completely remove the uterus.

Irregular menstrual periods

Increased, heavier or irregular menstrual bleeding is often the reason for scraping. Menopause is a common time for these symptoms to appear. The cause is often benign cell changes in the uterine lining (e.g. polyps). Intermenstrual bleeding also makes abrasion necessary. These are often due to inflammation of the lining of the uterus (endometritis).

Termination of pregnancy

If a woman decides against a pregnancy, it can be terminated by a suction curettage. If there are no medical reasons such as endangering the mother that early scraping is necessary, an abortion in Germany is possible up to the twelfth week of pregnancy.

What do you do with a scraping?

A scraping is usually carried out under general anesthesia. If, for example, only tissue is removed from the cervix, this can also be done under local anesthesia.

Whether scraping takes place on an outpatient basis depends on the doctor's assessment and possible concomitant diseases of the woman, as well as the type of scraping. In general, gynecologists decide to carry out scraping on an outpatient basis whenever possible in order to keep the stress on the patient as low as possible.

The scraping: procedure and preparation

The procedure is performed on the gynecological chair, which is also used for preventive examinations.

After the surgeon has washed, disinfected and covered the legs and genital area with a sterile cloth, he places special instruments in the vagina and cervix in order to have a good view of the mucous membrane during the abrasion.

He then uses the curette to remove the mucous membrane in the body of the uterus and in the cervix. Using a special suction loop, he can suck off the removed tissue.

What are the risks of scraping?

Bleeding, infection, or pain are common after scraping. Treatment of these complications depends on their severity.

Profuse bleeding after scraping

The uterus is an organ with a lot of blood. There is therefore a risk of profuse bleeding after the mucous membranes have been scraped off. The reason can be either a cut that is too deep or remaining tissue. The gynecologist will decide whether another operation is necessary or whether hemostasis, for example with the help of medication (hemostatics), is sufficient. How long bleeding persists after scraping the uterus also depends on possible concomitant diseases, such as blood clotting disorders.

Infection and perforation of organs

As with other procedures, the risk of infection of the wound increases after an abrasion. This inflammation, in turn, can lead to blood poisoning, which the doctor then treats with antibiotics and circulatory drugs.

The use of pointed curettes increases the risk that the doctor accidentally punctures the uterus or other organs (perforation). Germs can enter the abdominal cavity through this wound channel and cause inflammation of the abdominal wall.

Cervical weakness

When the uterus is scraped, the connective tissue of the cervix can be so badly injured that it can no longer adequately support the weight of the child during a subsequent pregnancy (cervical weakness). This can trigger premature births or harm the child during delivery.

Changed menstruation after scraping

Scarring after scraping in the area of ​​the body of the uterus (synechiae) can lead to infertility if the fertilized egg cell no longer implants properly. Symptoms of these adhesions are a lack of or less frequent periods after the scraping of the mucous membrane as well as miscarriages in early pregnancy.

Pain after scraping

Pulling abdominal pain can occur after scraping the uterus, especially in the first few days. These are mostly similar to the well-known menstrual cramps. The doctor may give pain medication to aid recovery after the curettage.

What do I have to consider after a scraping?

If your scraping is done on an outpatient basis, you can usually go home on the same day after a few hours of monitoring. You are not allowed to drive a car under the influence of the anesthetic medication.

Be careful after scraping the uterus. Take a few days off to prevent complications and watch out for warning symptoms. These include suddenly onset and worsening pain, a tense abdominal wall, heavy bleeding, foul-smelling and purulent discharge as well as fever and weakness. If these signs occur, you should see your gynecologist as soon as possible.

With exercise after scraping the uterus, wait a week or two to reduce the risk of bleeding. Discuss with your gynecologist.

Cycle after scraping

Basically, both during abrasion and during normal menstrual bleeding, the lining of the uterus is removed. However, the procedure is more serious, which is why the first period after scraping the uterus can be up to eight weeks in coming. During this time, the mucous membrane slowly re-forms and wound healing is completed. Do not be alarmed by a delayed menstrual period after the tissue has been scraped off. If in doubt, ask your gynecologist.

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