Obstetrics and Gynecology - A.M. Gromova 2000

Induced Abortion
Artificial termination of pregnancy up to 12 weeks
Curettage of the pregnant uterine cavity

Curettage of the pregnant Uterus consists of 3 stages:

1. Straightening of the cervical canal.

2. Dilatation of the cervical canal.

3. Destruction and removal of the ovum, followed by curettage of the uterine cavity walls.

Step one: following a pelvic examination and visualization of the cervix using specula, the anterior lip of the cervix is grasped with bullet forceps and pulled toward the introitus. The uterine cavity is then gently probed without applying force to determine its length.

Step two: holding the bullet forceps in the left hand, Hegar dilators from No. 4 to No. 12-13 are sequentially introduced. The dilators should be held with only two fingers and inserted carefully, strictly past the internal os. Alternatively, Cervical Dilatation can be performed using a vibrodilator, which widens the cervical canal through mechanical vibrations of the tip at a frequency of 50Hz. This method makes dilatation less painful.

For faster and less painful dilatation of the cervical canal, topical anesthesia with decain is used. A tampon moistened with a decain solution is applied to the external os of the cervix for 30–40 seconds.

Step three involves the destruction and removal of the ovum using curettes (No. 6, 4, 1) and abortion forceps; however, the forceps are used only to retrieve fragments that have already separated and lie freely within the uterine cavity. The curette is carefully introduced to the uterine fundus, and working from the fundus toward the internal os, the anterior, right, posterior, and left walls of the uterus are successively curetted. Following the removal of the ovum, the Procedure concludes with the curettage of the uterine walls and the areas of the uterotubal junctions to remove the decidua.