long time i'm not wrote here...
hurmmmmmmmmmmmmmmmmm.... 7 months after my marriage...
i found that i'm pregnant...
such a wonderfull moment...
but its not so long...
7 weeks pregnancy doc ask me to go to the hospital 4 d&c..
all my dreams to become a mommy just go like that...
on April 13...my baby not with me anymore....
now aku kena berpantang..
masa aku taip nih...br 10 ari berpantang...kehilangan ank sgt menyakitkan... sbb dh lama aku nantikan kehadirannya dalam hidup aku...
tQ ALLAH sebab sudi pinjamkan even sekejap sgt dlm rahimku ini...
now,,,lets check it out,,
what is d&c
Dilation and curettage
From Wikipedia, the free encyclopedia
| Background | |
| Abortion type | Surgical |
| First use | Late 19th century |
| Gestation | 4-12 weeks |
| Usage | |
| WHO recommends only when manual vacuum aspiration is unavailable | |
| United States | 1.7% (2003) |
| Medical notes | |
| Undertaken under heavy sedation or general anesthesia. Risk of perforation. Day-case procedure | |
| Infobox references | |
Dilation (or
dilatation) and curettage (D&C) refers to the dilation
(widening/opening) of the cervix and
surgical removal of part of the lining of the uterus and/or contents of the uterus by scraping and
scooping (curettage). It is a
therapeutic gynecological procedure as well as a rarely used
method of first trimester abortion.[1][2]
D&C normally refers
to a procedure involving a curette,
also called sharp curettage.[1] However,
some sources use the term D&C to refer more generally to any procedure that
involves the processes of dilation and removal of uterine contents, which
includes the more common suction curettage procedures of manual and
electric vacuum
aspiration.[3]
Contents[hide] |
[edit] Procedure
The first step in a
D&C is to dilate the cervix, usually
done a few hours before the surgery. The woman is usually put under general anesthesia before the procedure
begins. A curette, a metal rod with a handle on one end and a sharp loop on the
other, is inserted into the uterus through the dilated cervix. The curette is
used to gently scrape the lining of the uterus and remove the tissue in the
uterus. This tissue is examined for completeness (in the case of abortion or miscarriage treatment) or pathologically for abnormalities (in
the case of treatment for abnormal bleeding).[1]
[edit] Clinical uses
D&Cs are commonly
performed for the diagnosis of gynecological conditions leading to 'abnormal
uterine bleeding';[4] to
resolve abnormal uterine bleeding (too much, too often or too heavy a menstrual flow);[2] to remove
the excess uterine lining in women who have conditions such as polycystic ovary syndrome (which
cause a prolonged buildup of tissue with no natural period to remove it);[citation
needed] to remove tissue in the uterus that may be causing
abnormal vaginal bleeding,[1]
including postpartum retained placenta;[5] to
remove retained tissue (also known as retained POC or retained products of
conception) in the case of a missed or incomplete miscarriage;[3] and as
a method of abortion that is now
uncommon.[1] In
contrast, D&C remains 'standard care' for missed and incomplete miscarriage
in many countries despite the existence of alternatives currently used for
abortions.
Because medical and
non-invasive methods of abortion now exist, and because D&C requires heavy
sedation or general anesthesia and has higher risks of complication, the
procedure has been declining as a method of abortion. The World
Health Organization recommends D&C as a method of surgical abortion only
when manual vacuum
aspiration is unavailable.[6]
According to the Centers for Disease
Control and Prevention, D&C only accounted for 2.4% of abortions in the
United States in the
year 2002,[7]
down from 23.4% in 1972.[8]
Most D&Cs are now carried out for miscarriage management and other
indications such as diagnosis.
Hysteroscopy is a valid alternative to D&C for
many surgical indications from diagnosis of uterine pathology to the removal of
fibroids and even retained products of conception. It poses less risk because
the doctor has a view inside the uterus during surgery, unlike with blind
D&C.
Medical management of
miscarriage and medical abortion using drugs such as misoprostol and mifepristone are safe, non-invasive and cheaper
alternatives to D&C.
[edit] Complications
Complications may arise
from either the introduction or spreading of infection, adverse reaction to
general anesthesia required during the surgery or from instrumentation itself,
if the procedure is performed blindly (without the use of any imaging technique
such as ultrasound or hysteroscopy).
One risk of sharp
curettage is uterine perforation. Although normally no
treatment is required for uterine perforation, a laparoscopy may be done to verify that bleeding has
stopped on its own. Infection of the uterus or fallopian tubes is also a
possible complication, especially if the woman has an untreated sexually transmitted
infection.[1]
Another risk is
intrauterine adhesions, or Asherman's syndrome. One study found that
in women who had one or two sharp curettage procedures for miscarriage, 14-16%
developed some adhesions.[9] Women who
underwent three sharp curettage procedures for miscarriage had a 32% risk of
developing adhesions.[9] The risk of
Asherman's syndrome was found to be 30.9% in women who had D&C following a
missed miscarriage,[10] and 25%
in those who had a D&C 1–4 weeks postpartum.[11][12][13] Untreated
Asherman's syndrome, especially if severe, also increases the risk of
complications in future pregnancies, such as ectopic pregnancy, miscarriage, and abnormal placentation (e.g.placenta
previa and placenta accreta).[1]
According to recent case reports, use of vacuum aspiration can also lead to
intrauterine adhesions.[14]
[edit] See also
[edit] References
- ^ a b c d e f g "Dilation and sharp curettage (D&C) for abortion". Women's Health. WebMD. 2004-10-07. Retrieved 2007-04-29.
- ^ a b Hayden,
Merrill (2006-02-22). "Dilation and curettage (D&C) for dysfunctional uterine
bleeding". Healthwise. WebMD.
Retrieved 2007-04-29.
Nissl, Jan (2005-01-18). "Dilation and curettage (D&C) for bleeding during menopause". Healthwise. WebMD. Retrieved 2007-04-29. - ^ a b "What Every Pregnant Woman Needs to Know About Pregnancy Loss and Neonatal Death". The Unofficial Guide to Having a Baby. WebMD. 2004-10-07. Retrieved 2007-04-29.
- ^ Anastasiadis PG, Koutlaki NG, Skaphida PG, Galazios GC, Tsikouras PN, Liberis VA. (2000). "Endometrial polyps: prevalence, detection, and malignant potential in women with abnormal uterine bleeding.". Eur J Gynaecol Oncol. 21 (2): 180–183. PMID 10843481.
- ^ Wolman I, Altman E, Fait G, Har-Toov J, Gull I, Amster R, Jaffa A. (2009). "Evacuating retained products of conception in the setting of an ultrasound unit.". Fertil Steril. 91 ((4 Suppl)): 1586–88. doi:10.1016/j.fertnstert.2008.10.032. PMID 19064261.
- ^ "Dilatation and curettage". A-Z Managing Complications in Pregnancy and Childbirth by WHO. Retrieved February 20, 2006.
- ^ "Abortion Surveillance --- United States, 2002". MMWR Surveillance Summaries. Retrieved February 20, 2006.
- ^ "Abortion Surveillance -- United States, 1990". MMWR Surveillance Summaries. Retrieved February 20, 2006.
- ^ a b Friedler S, Margalioth EJ, Kafka I, Yaffe H (1993). "Incidence of post-abortion intra-uterine adhesions evaluated by hysteroscopy--a prospective study". Hum. Reprod. 8 (3): 442–4. PMID 8473464.
- ^ Schenker JG, Margalioth EJ (1982). "Intra-uterine adhesions: an updated appraisal.". Fertility Sterility 37 (5): 593–610. PMID 6281085.
- ^ Kodaman P, Arici A (2007). "Intrauterine adhesions and fertility outcome:how to optimize success?". Curr Opin Obstet Gynecol 19 (3): 207–214. doi:10.1097/GCO.0b013e32814a6473. PMID 17495635.
- ^ Rochet Y, Dargent D, Bremond A et al. (1979). "The obstetrical outcome of women with surgically treated uterine synechiae (in French).". J Gynecol Obstet Biol Reprod 8 (8): 723–726. PMID 553931.
- ^ Buttram VC, Turati G (1977). "Uterine synechiae: variations in severity and some conditions which may be conducive to severe adhesions". Int. J. Fertil. 22 (2): 98–103. PMID 20418.
- ^ Dalton VK, Saunders NA, Harris LH, Williams JA, Lebovic DI (2006). "Intrauterine adhesions after manual vacuum aspiration for early pregnancy failure.". Fertil. Steril. 85 (6): 1823.e1–3. doi:10.1016/j.fertnstert.2005.11.065. PMID 16674955.
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