Dilatation and Curettage
DILATATION and curettage, though one of the commonest of gynecologic operative procedures, is not done frequent enough and often is performed in a manner which makes its value dubious. Like so many other so-called minor procedures, it has suffered from being thus classified and has been utilized by the casual surgeon, with subsequent grave sequelae.
This procedure may be diagnostic or therapeutic and, on occasion, a combination of the two. It is in the diagnostic field that the greatest number of errors occur. When the procedure is properly carried out, tissue from the endocervix may be obtained separately from that in the uterine cavity (fractional curettage), thus making it possible to differentiate cervical from corpus abnormalities. The curet also permits a modified digital exploration of the uterine cavity which demonstrates irregularities. By careful gross examination of the tissue removed, it is often possible to obtain a clue as to the presence or absence of malignancy. Tissue removed should always be subjected to careful microscopic examination. Careful bimanual and rectovaginal examination should, of course, always be combined with dilatation and curettage. When a patient is under anesthesia, we are presented with an excellent opportunity for complete and thorough examination without the apprehension and fear of pain imposed by consciousness. Significant ovarian disease may also be found.
The commonest indication for diagnostic dilatation and curettage is bleeding. In the younger age group, so-called functional bleeding is the most frequent cause. Such a diagnosis, however, is not possible without a confirmatory dilatation. . .