D & C

 Arif Pauzi: Homework:

Alif -
Q : Preparation before D n C procedure?

A : 1.Some pt will need to have blood testing before D and C ( such as blood count or tests of clotting factor), although this is not always necessary. Pt should not eat or drink anything starting the night before the procedure. Pt will need someone to accompany they home because it is not safe to drive after receiving anesthesia, which cause sedation.

2. Know the contraindication for D n C.

Absolute contraindications to dilation and curettage include the following:
-Viable desired intrauterine pregnancy
-Inability to visualize the cervical os
-Obstructed vagina

Relative contraindications to dilation and curettage include the following:
-Severe cervical stenosis
-Cervical/uterine anomalies
-Prior endometrial ablation
-Bleeding disorder
-Acute pelvic infection (except to remove infected endometrial contents)
-Obstructing cervical lesion

3. Equipment

-A Graves speculum may be used to visualize the cervix. Alternatively, a weighted speculum with one or more vaginal retractors in the anterior and lateral vaginal fornices may be used.
-Several types of cervical dilators are commonly used. A dilator has a tapered end. Common dilator types include the Pratt, Hegar, and Hank dilators.
-currete and forceps(ring, Randall or packing forceps)

Patient preparation

Anesthesia

Office procedures may require no formal preoperative preparation if a need for cervical dilation is absent or minimal and a small-caliber endometrial sampling device or suction device is employed.

Some providers suggest patients undergoing cervical or paracervical instillation of local anesthetic be instructed to have an empty stomach. Manipulation of the cervix and placement of the curette may induce a vasovagal response with secondary nausea and vomiting.

Patients may be instructed to abstain from oral intake of solid foods for 6–8 hours and oral intake of clear liquids for 2 or more hours, even in the office setting. A preoperative over-the-counter pain medication, such as a nonsteroidal anti-inflammatory medication, may be taken with a sip of water at home prior to the procedure to assist with comfort during and after the dilation and curettage.

Procedures involving conscious sedation or regional or general  anesthesia should follow the American Society of Anesthesiology guidelines for abstaining from clear liquids and oral consumption prior to surgical procedures. The current recommendations are no solid food for 8 hours preprocedure and no clear liquids for 4 hours preprocedure.

Positioning

The procedure is typically performed in the dorsal lithotomy position. Care should be taken to prevent pressure injuries and excess abduction of the hip joint. Patients with orthopedic limitations may need to be positioned before sedation or general anesthesia is employed.


Dr Shaiful Ehsan: Additional info for D&C...
Consent and explanation...
Explain risk of procedures including early (eg uterine perforation) & late complications
Insert CBD / to empty bladder...

The rest are acceptable...tq



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 Ili Dalia: Salam doctor, if patient missed misscarriage admitted to the ward for d&c or erpoc whar was the suitable chief complaint.. if i just said puan j, 23 yrs old malay lady g3p2 at 10 week poa admitted to htaa for surgical intervention in view of her misscarrige. Boleh ke?

 Dr Shaiful Ehsan: Waalaikumsalam Ili, 23, G3P2 at 10 weeks poa, electiveley admietted for further management of her absence progress of pregnancy / no progress of gestational sac / fetus parameters on scan....tq