Dilation and Curettage
Dilation and curettage or D&C is a procedure that involves widening of the cervix and removing of the uterine lining and contents by scraping and scooping. Dilation and curettage is used as a diagnostic procedure for fibroids or uterine cancer and often as an abortion procedure during the first trimester. A hysteroscope is used to look inside the womb for abnormalities such as fibroids or polyps. D&C is also done when there is endometrial abnormality or menstrual bleeding irregularity. D&C is done under anesthesia. The procedure doesn't take much time but the woman needs to rest for the day. A D&C is not done on women who have an infection of the uterus or fallopian tubes.
Asherman's syndrome refers to the formation of adhesions or scar tissues on the endometrium (uterine lining). Most often endometrial scarring occurs as a result of scraping of tissue from the uterine wall while performing dilation and curettage (D& C). Though D&C is mainly responsible for adhesions, uterine surgery and severe infections of the endometrium such as genital tuberculosis are some of the other factors that cause Asherman's syndrome. Normally, Asherman's syndrome shows up with decreased menstrual flow or even amenorrhea, cramping, abdominal pain and is even associated with infertility and recurrent miscarriages.
Causes of Asherman's syndrome
D&C procedure is performed for miscarriages, excess bleeding, elective abortion or to remove the retained products of conception. Some gynecological disorders call for uterine surgery. Sometimes trauma occurs to the uterine lining while performing D&C procedure or other surgery. In case of damage, the wound begins to heal and in the process, fuses with the affected portion causing adhesions. The risk of Asherman's syndrome increases with repeated D&Cs.
Diagnosis and treatment of Asherman's syndrome
Hysteroscopy is the widely used method to diagnose the Asherman's syndrome as it allows the doctor to have a complete view of the uterus directly. However other methods such as sonohysterography (SHG), hysterosalpingogram (HSG) and transvaginal ultrasound examination are also used to evaluate adhesions. Blood tests are done to detect tuberculosis or schistosomiasis.
Asherman's syndrome is normally treated with surgery to remove the adhesions or scar tissue. The surgery involves hysteroscopy procedure wherein scar tissue is removed by using small instruments, micro scissors and a camera. Once the scar tissue is removed, an intra uterine balloon is placed inside the uterus to keep the uterine cavity open. This procedure aids the healing process and prevents adhesions from returning. Patient may also be prescribed oral estrogen medications for promoting growth of regular uterine lining. Patient may be called in for review hysteroscopy after two weeks of the procedure to make sure that there is no reformation of adhesions.
Pelvic Inflammatory Disease
Nearly 1 million women in the US alone suffer from pelvic inflammatory disease or PID each year; PID is an infection in the reproductive organs of a woman. It is essential to treat the symptoms of Pelvic Inflammatory Disease immediately when noticed. Failure to do so may lead to complications such as infertility and even can be life threatening. Sexually transmitted diseases (STD) such as chlamydia or gonorrhea are often the cause for pelvic inflammatory disease. Women who have multiple sexual partners or partners with symptoms of chlamydia or gonorrhea infections are at a higher risk for PID. Some forms of contraception such as IUDs may put a woman at increased risk of PID. Surgical procedures such as D and C (Dilation and Curettage), insertion of IUD or treatment of an abnormal Pap smear can lead to pelvic inflammatory. Usually the cervix prevents the spread of bacteria into the internal organs. But when the cervix gets infected with an STD (Sexually Transmitted Disease), disease-causing bacteria travel up the internal organs and damage the uterus, fallopian tubes, ovaries and abdomen. Bacteria present in the vagina and cervix can also have a precipitating effect on the Pelvic Inflammation. Usually multiple organisms are responsible for a bout of PID. Spreading of the infection can lead to further inflammation and scarring.
Women suffering from PID experience high fever and chills. Dull pain in the lower abdomen and lower back are typical symptoms of pelvic inflammatory disease. A woman suffering from pelvic inflammatory disease may also experience fever and irregular menstrual bleeding. Other symptoms of Pelvic Inflammatory Disease are pain during intercourse and urination. Some women do not experience any symptoms at all. Laboratory tests for chlamydia, gonorrhea and urinary tract infection are conducted on a patient who might be suffering from PID. A pelvic ultrasound helps in looking for any abnormalities in the pelvic area or fallopian tubes. Pelvic Inflammatory Disease can also be diagnosed with falloposcopy - a visual study of the inside of the fallopian tubes.
Treatment for pelvic inflammatory disease is based on pelvic examination and examination of the woman's sexual and menstrual history. Antibiotic therapy of Floxin is used as oral medication for PID. This is the first FDA approved oral therapy for PID. Other drugs used in combination for treatment of Pelvic Inflammatory Disease are Cefoxitin, Oflaxocin, Clindamycin. If left untreated, pelvic inflammatory disease can lead to severe and permanent damage of the reproductive organs.
Bibliography / Reference
Collection of Pages - Last revised Date: July 16, 2018