Postcurettage (synonym: postcurettage; curettage, curettage) or night palpation is the scraping of the uterus performed after complete or incomplete expulsion of a pregnancy.
Indications (areas of application)
- Night palpation for incomplete placenta (placenta) post partum (after birth)/manual placental abruption.
- Increased bleeding post partum
- Atonic uterus (uterine atony or atonic postpartum hemorrhage) – contraction weakness of the uterus, that is, the lack or insufficient ability of the uterine muscles to contract after the birth of the child and the incompletely or completely born placenta (placenta). This contraction weakness results in severe to life-threatening hemorrhage that requires immediate intervention. Uterine atony is among the most common causes of maternal mortality (mortality).
The surgical procedures
Before the procedure, the urinary bladder is generally emptied by means of a catheter. Night palpation or night palpation is the name given to the removal of a placental remnant (the remainder of the placenta) after birth. Originally, this was done manually, later also with a special curette, the so-called Bumm`sche Curette (it is a blunt, according to the size of the uterus so to speak oversized, Curette).For night palpation, one hand goes into the uterus and feels with the finger the inner surface to detach the remaining residue of the placenta (the placenta) with the finger. The outer hand grasps the uterus over the abdominal wall and pushes it toward the inner hand. This procedure can also be done with the Bumm`sche curette. Some use both procedures in one session. This procedure is performed under anesthesia. Manual placenta detachment is necessary when the placenta does not detach spontaneously or after administration of contraceptives or other manual procedures (e.g., compression of the uterus using the so-called Credé handle). Under general or peridural anesthesia, one hand enters the uterine cavity and looks for an area where the placenta has already detached. This is the right layer between the placenta and the uterine wall. From there, you begin to detach the rest of the placenta with your finger. The outer hand grasps the uterus over the abdominal wall and pushes it toward the inner hand. Once the placenta is detached, it is embraced and delivered through the vagina. It is then palpated manually or with the Bumm curette.
Bleeding post partum
Bleeding post partum (postpartum hemorrhage, bleeding after the child is born, bleeding in the postpartum period).
The period after the birth of the baby is divided into the so-called placental period (the time when the placenta, the placenta, detaches from the uterus and is born) and the post placental period (this is the time until two hours after the placenta is fully delivered). Heavy, even life-threatening, bleeding can occur during both periods. According to experience, after two hours have passed, unexpectedly heavy bleeding usually does not occur. For this reason, more or less intensive monitoring of the newly delivered has been limited to this period. There is no clear definition of what is still considered normal and when one speaks of increased or heavy bleeding. In order to control the intensity of bleeding, the patient is placed in a special position, the Fritsch position. The patient lies in a supine position. After the buttocks are pushed down, the legs are placed one over the other. This gives the possibility to control the blood loss, with repeated control of the strength of contraction of the uterus. Causes of increased bleeding can be soft tissue injuries in the area of the perineum, vaginal entrance, vagina, cervix or injuries of the uterus (rupture), or they are caused by increased placental solution bleeding. Atonic postpartum hemorrhage (atonic uterus, uterine atony, atony)If the placenta is detached and complete with the membranes and injuries to the soft tissues are excluded, these are the so-called atonic postpartum hemorrhages, which can very quickly lead to massive blood loss and are not infrequently life-threatening. It is a contraction weakness of the uterus, that is, the lack or insufficient ability of the uterine muscles to contract after the birth of the child and the incompletely or completely born placenta (placenta).It often occurs after an excessively long duration of labor or when the uterine muscles are overstretched, e.g., in the case of a very large child, multiples, or hydramnios, i.e., excessive amniotic fluid. This contraction weakness results in severe to life-threatening hemorrhage that requires immediate intervention. Uterine atony is among the most common causes of maternal mortality (maternal death rate). The bleeding is usually episodic because the blood first collects in the uterus and then is expelled all at once. Therapeutic action must be taken quickly to prevent maternal shock:
- The administration of contraceptives intravenously, possibly additionally intramuscularly (oxytocin, syntometrine). If the effect is insufficient, prostaglandins are then used, which can be applied intravenously, intramurally (into the uterine muscles) or intracavitarily (into the uterine cavity).
- Simultaneous adequate volume substitution is indicated, possibly the administration of blood.
- Emptying the uterus and simultaneously preventing it from filling with blood again. This involves mechanical compression of the uterus from the abdominal wall and simultaneously from the vagina by means of special handles (according to Fritsch and Zweifel). If these measures do not lead to success, it is necessary to look for injuries in the birth canal and possibly perform a palpation of the uterus (see above).
These procedures are generally performed under anesthesia. It is also important to check the blood clotting as soon as possible by laboratory.
Possible complications
- Injury or perforation (piercing) of the uterine wall with the instruments, possibly with damage to adjacent organs (bowel, urinary bladder) is rare.
- Light bleeding after hours or days is normal.
- Retained placental remnant may occur. This then usually leads to prolonged bleeding and in the process, the tissue remnants are expelled.
- Infections or wound healing disorders (very rare).
- Adhesions of the cervix, cervical canal, uterine cavity as a result of infection is possible. This can lead to menstrual disorders (cycle disorders) and / or conception difficulties (difficulties conceiving), possibly to sterility (infertility) (very rare).
- Hypersensitivity or allergies (e.g., anesthetics/anesthetics, medications, etc.) may temporarily cause the following symptoms: Swelling, rash, itching, sneezing, watery eyes, dizziness or vomiting.
