Gynaecological Operations

Dilatation And Curettage (D&C)

Indication:

Miscarriage.
Endometrial sample.
Assessment of ovulation.
IUCD removal.

Instrument:

Uterine curette
Uterine sound
Sims speculum.
Hegar dilators.
Tenaculum.

Instruments Used in Gynaecological Examinations

Metallic Catheter
Cusco’s Speculum (Duck’s Speculum)
Sim’s Speculum
Sim’s Uterine Sound
Tenaculum
Hegar’s Uterine Dilator
Uterine Curette

Steps Involved in Dilatation and Curettage

The technique is outlined in a numbered list:

Evacuate the bladder
Anesthesia
Vaginal speculum & grasp the cervix
Sounding
Dilate the cervix
Curette

Complications of D&C

Cervical lacerations.
Cervical incompetence (recurrent miscarriage).
Asherman’s syndrome (infertility).
Uterine perforation.
Infections.
Haemorrhage.
Risk of anaesthesia.
Risk of blood transfusion.
Metallic catheter insertion
- For urinary drainage (urine).
Speculum insertion (OSCE)
- Technique: insert with blades closed, twist while advancing until fully inserted, then open gently until the cervix is visualized.
- Use a controlled, gentle motion; lubricate if indicated.
Tenaculum
- Apply to hold the cervix steady when required (eg. for sounding, instrumentation).
Uterine sound
- Purpose: measure the length and direction of the uterus.
- Insert slowly and gently; confirm direction before advancing other instruments.
Hegar dilators (progressive dilatation)
- Insert sequentially from smaller to larger sizes to achieve the required dilatation.
- Purpose: allow passage of instruments or evacuation; proceed gradually to reduce cervical trauma.
Ovum forceps
- Used to grasp tissue (eg. products of conception or retained material) or remove specimens as indicated.
- Apply gently and confirm secure hold before traction.
Curettage (uterine curretage)
- Systematic scraping: anterior wall → lateral walls → posterior wall → contralateral lateral wall.
- Continue until the desired clinical endpoint is reached (eg. bleeding reduces or tissue removal is adequate).
- Perform cautiously to minimize trauma and monitor bleeding.

remove all instruments and unbind speculum

finally send products to histopathology

complications

perforation
lacerations

Myomectomy

Indications: Removal of symptomatic fibroid in those who do not complete their families.
Types:

Abdominal
Vaginal
Hysteroscopic: submucous <5cm
Laparoscopic: Pedunculated subserous

Complications:
- Bleeding.
- Hysterectomy.

Hysterectomy

Removal of uterus.

Complication:

Infertility.
Depression.

Gynaecological Indications for Hysterectomy

Fibroid.
Advanced endometriosis.
Adenomyosis.
Malignant tumors of the cervix, body, tubes or ovary.
Recurrent DUB not responding to conservative treatment.
Prolapse.
Postmenopausal bleeding.
Sterilization.

Obstetric Indications for Hysterectomy

Uncontrolled postpartum haemorrhage.
Rupture uterus.
Placenta accreta.
Invasive mole.
Couvelaire uterus.

Types of Hysterectomy

Abdominal
Vaginal
Laparoscopic
Assisted Vaginal Hysterectomy (vaginal + laparoscope).
Caesarean hysterectomy. Types of Abdominal Hysterectomy

Subtotal: removal of the uterus with preservation of the cervix
Total: removal of the uterus & cervix
Radical: removal of the uterus, cervix, parametrial tissue, endopelvic fascia, uterosacral ligaments & pelvic lymph nodes

Caesarean Hysterectomy Removal of the uterus after C.S due to

Atonic uterus.
Postpartum haemorrhage.
Placenta accreta.

Cervical Cerclage

Indications

(1) Prophylactic (elective). Suspected cervical incompetence. Cerclage at 14 weeks {early miscarriage caused by other factors}.
(2) Urgent (therapeutic) Asymptomatic women with sonographic evidence of cervical shortening and/or funnelling.

Contraindications

Uterine contractions.
Uterine bleeding
Chorioamnionitis
Premature rupture of membranes
Fetal anomaly incompatible with life

Types of Cervical Cerclage

Mc Donald. Shirodkar. Transabdominal.

Ovarian Cystectomy

Indication:
- Ovarian cyst.
Complication:
- Rupture of ovarian cyst.
- Bleeding.
- Adhesion.
- Bladder injury.
- Bowel injury.

Pap Smear

Indication: Screening for cervical cancer.
Complication:
- Infection.
- Failure.

Colposcopy

Indication:

Abnormal pap smear
Punch biopsy.

Cone Biopsy

Indication:

Under anaesthesia The dye we use in biopsy:

Acetowhite test:
Acetic acid, abnormal cell will absorb so take the biopsy from the white cell.
Iodine test:
Lugol solution normal cell absorb and become brown because it contains glycogen so take biopsy from non-absorbed cells.