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HOWTO: Perform the Dilation & Curettage Surgical Procedure

By ti dave in Science
Wed Mar 24, 2004 at 10:40:02 PM EST
Tags: Science (all tags)
Science

This procedure involves opening of the cervix and scraping away of the endometrium, or inner lining of the uterus.

Disclaimer:
You should seek supervised practice, prior to attempting the procedure yourself.
Never forcefully perform this procedure. Uterine perforation can easily result.
Always use sterile equipment.

Dilation & Curettage is indicated for abnormal, or post-menarchal bleeding, spontaneous (incomplete) abortions, or therapeutic abortions under an oppressive regime.
Contraindications include normal, desired intrauterine pregnancy, acute cervicitis, endometriosis, or pelvic inflammatory disease.


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The procedure may be performed under general anaesthesia, spinal (level of L3-L4 spine, inject 10-15 cc. of 0.25% Marcaine carefully), paracervical block (0.25% Marcaine injected just inside the vaginal mucosa, next to the cervix on each side, 5 cc.) or 50-75 mg. Demerol IV slow drip while monitoring the patient's vital signs carefully.

    Perform the Dilation & Curettage Procedure:

  • Insert a comfortably warm, sterile speculum into the vagina. Ask the patient, if conscious, to relax and bear down.
  • While carefully spreading the labia with a gloved hand, insert the speculum blades slowly downward and inward, watching the insertion closely.
  • As the cervix is approached, slowly open the blades and allow the blades to straddle the cervix between them. Lock the screw lock of the speculum.
  • Wipe the entire cervical stump three times, in a circular fashion outward, with antiseptic sponges on transfer forceps.
  • Discard the swabs and forceps.
  • Bend the uterine sound to the estimated angle of the uterine position.
  • Grasp the cervix with a tenaculum forcep at the six o' clock position and gently insert the sound until resistance is met. Here, you will again try to note any lesions or growths, as you insert the sound. Read the depth of the uterine cavity by noting the level of the mucous or blood on the sound, as you would the oil level on a dipstick.
  • Make a mental note of the depth of the uterine cavity.
  • Starting with the smallest Hegar dilator, insert the dilator into the cervix, to the dilator lip.
  • Proceed to the next larger size, until the cervix is at least as open as the loop of the largest curette, probably a #8 Hegar.
  • Start with a small, sharp curette by scraping the entire diameter of the cervical canal with an in and out motion.
  • Repeat the four-quadrant scraping of the uterus by going to the depth of the uterus and scraping outward all along the uterine walls, in deep, even strokes, so as to obtain long strips of endometrium. Ensure that all endometrial tissue is removed from the inner surface of the uterus.
  • Curette the top of the uterus in an up-and-down fashion and remove all endometrial tissue.
  • Insert a dry, sterile sponge on a uterine forcep and swab the uterine cavity, using a twisting motion as you withdraw the forceps.
  • Re-insert uterine polyp forceps and grasp for masses.
  • Withdraw the forceps and observe for bleeding.

    Post-Operative Care:

  • Replace the uterus, by removing the tenaculum and speculum and using both hands, push the uterus gently, but firmly, upward.
  • Place patient on bed rest for 3 days and limit the patient's activity for at least 7 days.
  • Excessive bleeding may require packing the uterine cavity with long, continuous sterile roller gauze and observing for shock, until the patient is out of danger and hemostasis is achieved.
  • Monitor patient for any signs of infection during the recovery period.
  • Tend to patient's emotional needs and concerns during the recovery period.

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Related Links
o scraping away
o menarchal
o Contraindi cations
o mucosa
o cervix
o Marcaine
o Demerol
o Transfer forceps
o Tenaculum forceps
o Hegar dilators [various sizes]
o Curettes
o Uterine polyp forceps
o hemostasis
o signs of infection
o Also by ti dave


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HOWTO: Perform the Dilation & Curettage Surgical Procedure | 357 comments (245 topical, 112 editorial, 0 hidden)
Questions: (2.46 / 13) (#1)
by maynard on Mon Mar 22, 2004 at 09:11:44 PM EST

Are you a physician?

Do you think the general K5 community could use this information toward any purpose?

While this appears factually informative (I'm not competent to say), does it offer contrasting opinion leading toward a conclusion like a traditional essay?

Do you think this submission offers real discussion potential?

Cheers,
--Maynard


Read The Proxies, a short crime thriller.

THANKS DAVE (2.60 / 25) (#3)
by Tex Bigballs on Mon Mar 22, 2004 at 09:18:12 PM EST

WHO NEEDS EXPENSIVE MEDICAL INSURANCE WHEN ANYONE CAN BE QUALIFIED FOR GINER SURGERY WITH JUST THIS HANDY DANDY GUIDE

Seeing as most of K5's membership is male ... (2.93 / 16) (#5)
by pyramid termite on Mon Mar 22, 2004 at 09:37:52 PM EST

... wouldn't instructions for a do-it-yourself vasectomy be more appropriate?

On the Internet, anyone can accuse you of being a dog.
Now this is the kind of article I like to see! (2.60 / 10) (#7)
by ninja rmg on Mon Mar 22, 2004 at 10:09:30 PM EST

It's this do-it-yourself type of format that initially attracted me to Kuro5hin. Fermented beverages, fermented bread products, and now this! Fantastic!

While my beer, mead, and sourdough bread may still be works in progress, this is a procedure I can complete in just one sitting. Instant Gratification! +1 FP, enthusiastically!



Good. (2.91 / 12) (#8)
by Paulsweblog on Mon Mar 22, 2004 at 10:17:18 PM EST

How about a guide to liposuction and things more relevant to the lives of most of these geeks? Some instructions on how to build a liposuction machine. Whatever it is.

I'm sure there're plenty of women here who would never do this manually but have the process relevant to them some point in their life. The problem is that it's rare and they're a tiny minority. A liposuction howto would apply to about 4 out of 5 users here, instead of 1 in 25,000.

--
Blood for blood and death for death.

ATTENTION KUROBOTS (2.00 / 11) (#16)
by mutualaid on Tue Mar 23, 2004 at 12:21:56 AM EST

"Dilation & Curettage Surgical Procedure" == first trimester abortion

Apparently not many of you are medically-saavy.

If abortion was illegal in your country... (2.70 / 17) (#18)
by lucifer666 on Tue Mar 23, 2004 at 12:38:52 AM EST

I was thinking this article, while seemingly a little off putting, could be an invaluable resource in a country where abortion is illegal.

In Britan in the 40's before the birth control pill, coathanger abortions were everywhere. Many, many women died as a result of undergoing these operations. Possibly even worse, many more women were left baren after irreperable damage was caused.

Regardless of your political or moral viewpoint on abortion being right or wrong, there is still the plain fact that if it's illegal, it's still going to happen. In fact, there's a very good case to say that when it's illegal, a woman is much more likely to be injured or killed as the result of a botched backyard procedure. A bit like pot or speeding, very illegal, but it happens a lot.

Given this fact, even if we say abortion is wrong, it is even more wrong to put peoples lives in danger.

An informative article such as this could in fact be used by a medical professional, in a country that didn't have the procedure in it's text books. There is somewhere a doctor doing abortions wrong, because he's never been shown how to do it properly due to the law in his country. While I can gain little from it in terms of applyable information, I hope he or she reads it.

beats a rusty coathanger in an alley (2.70 / 17) (#25)
by circletimessquare on Tue Mar 23, 2004 at 03:46:27 AM EST

which is where abortions will be performed (and as they are performed in countries with their heads up their asses) if those who do not see women as in control of their own bodies continue in their stubborn childish immoral ways

The tigers of wrath are wiser than the horses of instruction.

Wow.... (2.75 / 16) (#36)
by starX on Tue Mar 23, 2004 at 05:30:06 AM EST

On the one hand, I'm fairly speechless that we now have an Abortion HOW-TO.  On the other, I have to question its significance.  Are you a doctor?  Have you actually performed this procedure?  If you are/have, than this is probably one of the most subversive HOW-TOs ever.  Undercutting the possibility that the so called "right to lifers" would ever get legislation that made such procedures illegal is the information that would, in the hands of a competent physician (who one would hope that however underground their facilities may be, would observe the standards of modern medical practice), allow said physician to perform such a procedure.  If you're not, than this is an interesting social protest that could have untoward consquences, and you ought to take pains to make sure that there is no chance that anyone reading it would ever think that you were a doctor with practical experiencein these matters.

If you are not a physician and have never before performed this procedure, than how can you personally confirm the accuracy of these instructions?  You lack sources, so you're pretty well asking us to take it on faith that you are an authority on this procedure.  If you are not, than I would certainly hope you would at least say so (your disclaimer about performing it in the pressence of someone who has the experience doing so aside).  If you have not synthesized this knowledge from practical experience, than where did you get it?  

Yes, bravo, you have touched a taboo, but consider that you are addressing a very serious issue here (and by that I mean performaing a surgical procedure in general), and you should be willing to say whether or not you are personally experienced in performing this procedure, and where you got your information from.  

"I like you starX, you disagree without sounding like a fanatic from a rock-solid point of view. Highfive." --WonderJoust

I wish you had posted this 4 months ago (nt) (2.76 / 13) (#44)
by j1mmy on Tue Mar 23, 2004 at 07:43:53 AM EST



I suggest adding a disclaimer (1.68 / 29) (#45)
by Adam Rightmann on Tue Mar 23, 2004 at 08:35:36 AM EST

Following this procedure to kill a baby growing inside a woman may result in prison and eternal Damnation.

You forgot (2.44 / 9) (#57)
by minerboy on Tue Mar 23, 2004 at 12:51:43 PM EST

Sterilization procedure - difficult without an autoclave. Where to obtain the Drugs - all will have to be obtained black market in the US - you may get some anti-biotics in Mexico. Which anti-biotics are recommended ? The procedure will not be appropriuate for any stage of pregnancy - which stages is it appropriate for ?

On second thought - I will have to vote -1 , on the of chance that some distraught 8th grader will see it and try it. Wouldn't you feel terrible ?



-1 (1.35 / 17) (#58)
by ljj on Tue Mar 23, 2004 at 01:11:36 PM EST

With the contempt it deserves.

Why ti dave, why?

--
ljj

In the SF medical handbook eh (2.62 / 8) (#65)
by IlIlIIllIIlllIII on Tue Mar 23, 2004 at 02:06:28 PM EST

in case you need to perform a battlefield abortion? I don't get it though.

What do I do now? (2.71 / 21) (#78)
by the on Tue Mar 23, 2004 at 07:02:31 PM EST

So I got to the stage where you start scraping with the curette. All was going fine but suddenly the patient has started serious hemorrhaging. The blood loss is pretty dramatic and we don't have any blood or plasma on hand as your article didn't mention that this might be important. Anyway, if you get a chance to reply in the next few minutes please tell me what to do next. If you can't reply that quickly maybe you could write an article on What To Do When You Suddenly Have A Corpse On Your Hands.

--
The Definite Article
ouchy (2.50 / 8) (#79)
by livus on Tue Mar 23, 2004 at 07:06:51 PM EST

I actually know someone who used to participate in DIY abortions in the 1950s when it was illegal. The poor woman had to go to lots of them because no one but her knew what they were doing, so they'd phone her up at the knitting needle stage and ask her to come along to look through the gore and check that they "got it out".

No one should have to go through this. At the same time, as the boy scouts say, "be prepared".

 

---
HIREZ substitute.
be concrete asshole, or shut up. - CTS
I guess I skipped school or something to drink on the internet? - lonelyhobo
I'd like to hope that any impression you got about us from internet forums was incorrect. - debillitatus
I consider myself trolled more or less just by visiting the site. HollyHopDrive

Dammit (2.15 / 13) (#96)
by yayaya on Tue Mar 23, 2004 at 08:24:28 PM EST

Someone should have done this to kitten's mom back in the day.

Such a bad a idea.. (2.62 / 8) (#97)
by sudog on Tue Mar 23, 2004 at 08:25:23 PM EST

.. on so many levels.

What, you think so much of yourself that even an untrained, unwashed idiot can follow your instructions successfully?

What an ego! :-)

I learned everything I needed to know from (2.37 / 8) (#103)
by Real World Stuff on Tue Mar 23, 2004 at 09:22:40 PM EST

The Cider House Rules.

Nothing a swift kick to the abdomen won't fix.

~RWS
2 B 1 ask 1

This can't be factual! (2.77 / 9) (#138)
by bigchris on Wed Mar 24, 2004 at 03:04:36 AM EST

I didn't once read a "stat" in the entire piece.

---
I Hate Jesus: -1: Bible thumper
kpaul: YAAT. YHL. HAND. btw, YAHWEH wins ;) [mt]
Why did you write this up? (2.10 / 10) (#148)
by mami on Wed Mar 24, 2004 at 07:49:01 AM EST

Well, it's a good idea to ban men from dealing with the inner lining of our valued female uterus in any shape or form anyway. No woman with some brains needs your "Passion of the Uterus"-kind of article.

+1, information wants to be free [nt] (2.85 / 14) (#160)
by pb on Wed Mar 24, 2004 at 11:45:42 AM EST


---
"See what the drooling, ravening, flesh-eating hordes^W^W^W^WKuro5hin.org readers have to say."
-- pwhysall
Please withdraw this story (1.75 / 12) (#162)
by hatshepsut on Wed Mar 24, 2004 at 12:34:58 PM EST

unless you have actually done this. Posting a How-To on something you haven't actually done is worse than useless.

If I want to learn about medical procedures, I will ask a doctor, read a book (or article) written by a doctor, or go to medical school.

Hellooooo, Sellison. Where are you? (1.63 / 11) (#185)
by Dphitz on Wed Mar 24, 2004 at 03:02:27 PM EST

I would have expected some good trolling from him on this one, right up there with the Fundie Adam Rightmann.  

Oh well.  -1 on this because . . . who fucking cares?  Although well written and concise no one here will ever use this information to any practical extent.  Unless I get my mistress pregnant that is.  Then it's time to go shopping!


God, please save me . . . from your followers

I don't want a surgical HOW-TO... (2.55 / 9) (#187)
by CodeWright on Wed Mar 24, 2004 at 03:08:39 PM EST

...unless it tells me how to install my Ono-Sendai 7 cyberdeck neural implant.

--
A: Because it destroys the flow of conversation.
Q: Why is top posting dumb? --clover_kicker

Excellent work, ti dave. (2.33 / 6) (#207)
by ninja rmg on Wed Mar 24, 2004 at 10:42:46 PM EST

Through your efforts, this site has just become a great deal more punk rock.

I salute you.



Most excellent work, if ti dave gets pregnant next (1.50 / 6) (#226)
by mami on Thu Mar 25, 2004 at 02:54:01 AM EST

time, I am well prepared to offer him my services to perform the procedure on him.

Prevention is better than cure (none / 2) (#276)
by Big Dogs Cock on Fri Mar 26, 2004 at 06:56:51 AM EST

Fuck them up the arse instead.
People say that anal sex is unhealthy. Well it cured my hiccups.
A Note for Latecomers: (none / 2) (#291)
by ti dave on Fri Mar 26, 2004 at 12:18:58 PM EST

I recommend that you also read the interesting Editorial comments attached to this story.
"If you dial," Iran said, eyes open and watching, "for greater venom, then I'll dial the same."

the operation will not be televised.nt (none / 1) (#309)
by Russell Dovey on Sun Mar 28, 2004 at 08:07:12 AM EST


"Blessed are the cracked, for they let in the light." - Spike Milligan

male-dominated kuro5hin (2.33 / 3) (#351)
by alifare on Wed Mar 31, 2004 at 11:00:01 AM EST

i have to say, this is actually one post i enjoyed. it made me smile. usally kuro5hin is full of female put-down, but this one was done with good humor.

Surgury HOW-TO (3.00 / 2) (#353)
by A55M0NKEY on Thu Apr 01, 2004 at 10:56:59 AM EST

That was really cool.

Now don't get me wrong, I am all for abortions of all types. I think most everyone should get an abortion, and believe they should be legal until at least the 400th trimester.

But.. Isn't posting this info illegal in the US? Isn't there some medieval US law against posting info on how to get an abortion?

Having said that, I also wanted to say that I appreciate having medical info like this available. Not that I plan to be performing any do-it-yourself abortions but who knows, maybe some chick will get knocked up by Brundle-Fly and need to do this to herself...

Does know of any sources for medical knowlege such as how to use/prescribe prescription drugs, perform minor or major surgeries ( appendix removals, gall-bladder removals, bullet/stick/arrow/whatever removals, amputations, stitches ) how to diagnose and treat common diseases. I realise that it is unwise not to take advantage of the expert medical care that is available in industrialized countries when it is in fact available, but the survivalist in me want to know how to best remove my arm with a jacknife should it become pinned under a boulder in the middle of nowhere. What if society should collapse or if I should become stranded as a beggar in a third world country and become infested with Bot flies. I wanna know how to cut one out and stitch myself back up. I want to know how to inject pain numbing drugs so as not to feel it and also not die of the drugs. I want to know how to tell which antibiotic to steal from the pharmacy should it be Mad Max world and I get a crossbow bolt infection.

I almost did buy a big ass bottle of Neomycin for 12 bucks from the farm store. It's the active ingredient in Neosporin which costs like 6 bucks a tube and is much less concentrated. I could dilute it into some vaseline and have the equivalent of like a gallon of the antibiotic ointment. ( Neomycin, I read will make you permanently deaf and also unable to balance should it be ingested internally )

I buy and use on myself an animal medical product, Bag-Balm from the Farm Store ( they also sell it in the Grocery store ) which is meant for cows udders. It works for human chapped hands and lips too.

There really ought to be a large gradiation of levels between regular person and doctor. One of the reasons medical costs are so high is that you have to go to a full fledged doctor to get any treatment. I bet 99 % of doctor appointments made for earaches, colds, etc could be handled as effectively by someone with much less training who could escalate the tough cases to the next level of doctorness. Also, I bet people could learn much of that stuff themselves.

The only reason I see why you wouldn't want the general public to be able to perform do-it-yourself medicine is addictive drugs and antibiotic resistance. You will get morons that will take amoxicillin like a daily vitamin in the mistaken belief that it will prevent them from getting ill, and you will get people high on morphine all the time. Those kinds of drugs should probably only be able to be prescribed by someone with a license and even then addictive ones not prescribed to ones self.

With something like morphine, you might very well need morphine after open heart surgury and you might even get slightly addicted to it during treatment but this is not a problem when it will no longer be available when the prescription runs out. I bet habit forming drugs would be prescribed much less if it were commonly available because of the danger of addiction.

A doctor has put so much effort into obtaining the training neccessary to be able to practice medicine legally that they are unlikely to accept an extra $50.00 from an addict to get an Oxycontin prescription. But if some levels of medical license could be obtained with just a 12 week course then someone like that wouldn't be as afraid of losing their medical qualification.

How much security do antibiotics need? Since many are sold for veterinary purposes it seems the would be abusers aren't that intent on getting them. These could probably be prescribed by a practitioner with less invested in their license.

What about morphine? If you are on a battlefield with your leg blown off, then a first-aid medic is liable to tie on a bandage and stick you with some morphine. This person is qualified to make the decision as to whether morphine is indicated. Highly trained medical professionals are not necessarily needed to prescribe it. Why should they be drug-security-guards? Why should any medical professional be a security guard for drugs?

Maybe what we need is to have a database that keeps track of what gets prescribed to who and what prescriptions actually get filled. We could then trust people with less invested in their licenses to practice medicine to practice medicine at the level they are qualified to practice at regardless of how 'dangerous' the drugs they use. If someone filled too many 'suspicious prescriptions' they could be automatically flagged for an investigation by a highly qualified board, and there by rescued from their own doctor shopping.

My opinion.... (none / 1) (#357)
by The Amazing Idiot on Thu Sep 23, 2004 at 01:05:26 AM EST

I am a Catholic, and very PRO-life.

My very religion says that all life is sacred, and should be cherished.

However, bypassing even my religion, is my understanding of the sciences. D&C IS a part of medical procedures, and for those trying to understand these, explanations like there are invaluable. D&C procedures are also valuable for removing uterine polyps, cancer growths, or other ABNORMAL groths, along with abortion.

The fact that TI Dave tried to best explain what this procedure entails gives value to it, and this community. Perhaps even this information JUST MIGHT save some ladies life from realizing that a doctor's doing a part of the procedure wrong..

Ahhh kuro5hin (none / 1) (#358)
by lukestuts on Fri Oct 01, 2004 at 02:07:55 PM EST

Just come back after a few months of Slashdot - I'd forgotten what gets posted here. Good to be back.

HOWTO: Perform the Dilation & Curettage Surgical Procedure | 357 comments (245 topical, 112 editorial, 0 hidden)
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