Introduction
The uterus abortion, also known as fractional abrasion or curettage, is a small gynaecological operation that can often be performed on an outpatient basis. Indications for a uterus abortion are, for example, irregular and very heavy menstrual periods, sudden bleeding after menopause, abnormalities in transvaginal ultrasound, in the context of preventive medical checkups or after a miscarriage. The procedure can be performed under local anaesthesia, but is more commonly performed under general anaesthesia and usually lasts no longer than ten to fifteen minutes.
In the case of uterine abortion, a sharp spoon (curette) is used to remove the lining of the uterus from the cervix and the body of the uterus, and then fine tissue is examined in the laboratory for pathological changes. The uterus scraping thus serves both for diagnosis and therapy. In this way, tissue can be obtained for histological examination and at the same time pathological changes, such as polyps, can be removed.
Indications for uterus scraping
Reasons why a uterus abortion should be performed are, for example, a miscarriage if the fruit does not come off on its own and remains in the uterus, or after the birth of a child if there are remains of the placenta in the uterine cavity. If the placenta is not removed completely, there can be long-lasting, very heavy bleeding which does not stop on its own and can be life-threatening. Another indication for a uterus scrape is heavy, irregular bleeding in the premenopause, which cannot be treated with hormones. Above all, however, the procedure is indicated in cases of sudden post-menopausal bleeding or conspicuous changes in the lining of the uterus, which may be noticed during ultrasound check-ups as part of preventive measures. Here, the uterus scraping plays an important role, as pathological changes are removed quickly and at the same time tissue is obtained which is used for histological examination in the laboratory and thus malignant or benign changes can be reliably detected.
Procedure of the intervention
The uterus is usually scraped out on an outpatient basis and under general anaesthesia, often in the form of a short anaesthetic with Propofol. However, if the patient has other concomitant diseases that indicate an increased risk during and after the operation, an inpatient stay for one night is recommended for control. At the patient’s request, the operation can also be performed under local anaesthesia, but general anaesthesia is recommended rather than local anaesthesia because of the painful dilation of the cervix.
After the anaesthesia, the patient is positioned as if on a gynaecological chair and the surgeon examines her vaginally once again. Then the specula (a gynaecological instrument with two blades to unfold the vagina) are inserted into the vagina and then the portio (transition of the cervix into the vagina) is hooked under visual control and the cervical canal is scraped out. The inner cervix is then dilated to the desired width using Hegar pins (small metal pins of various sizes), a curette (a spoon with sharp edges) is inserted and the cervix is scraped out.
As the tissue is removed in two fractions and histologically examined separately, this is also called fractional abrasion. This has the advantage that the fine tissue examination can then better differentiate from which part of the uterus the disease originates, whether from the cervix or the uterine body. This is particularly important for further therapy.
The uterus scraping, especially if a polyp or malignant tumour is suspected, can also be performed under previous visualisation, called hysteroscopy. For this purpose, a small camera is inserted into the uterine cavity to show the pathological changes. The surgeon can then remove the abnormal tissue under visual control and then use the hysteroscope to ensure that everything has been removed. The procedure takes about ten minutes. The bladder is usually emptied with a catheter before the procedure.