October 10, 2024 Aspiration / suction and uterine curettage are gynecological surgical procedures, in which tissues are removed from the interior of the uterus (uterine cavity). They are performed under general or locoregional anesthesia. The choice between curettage and suction depends, among other factors, on the problem and objective of the procedure. In uterine suction , a thin cannula is passed into the uterus, through the vagina and cervix, and a suction device is used to aspirate the endometrial contents. In the case of uterine curettage , a curette is introduced to scrape the cavity and internal uterine walls. In both procedures, it may be necessary to dilate the cervix to allow the insertions of instruments. Most common indications The most common indications for uterine suction and curettage are: Diagnostic objectives Abnormal vaginal bleeding to evaluate the endometrium (internal lining of the uterine cavity); Study of the endometrium in cases of infertility or recurrent pregnancy loss; Following abnormal cytology results (glandular changes) to study the endometrium. Treatment objectives Removal of endometrial tissue in cases of heavy uterine bleeding; Removal of ovular debris in the context of incomplete spontaneous abortion. Termination of pregnancy In situations of retained abortion. Depending on the reason why uterine curettage or suction indicated, there may be alternatives including: Medication Hormone therapy: in cases of bleeding due to endometrial hyperplasia, progestins can be tried to control it. Misoprostol: can be an alternative in situations of missed or incomplete abortion. Hysteroscopy It is not indicated in cases of recent retained or incomplete abortion, but it is the procedure of choice in late incomplete abortion. Preparation and care associated with uterine suction and curettage Performing a suction or curettage usually requires some preparation including: Fasting for 6-8 hours before the procedure, especially if performed under general anesthesia; Blood tests, like complete blood count, coagulation tests, blood group identification and indirect Coombs test; Medicines to dilate the cervix. After the procedure, all precautions provided by the clinical team must be strictly followed , including, for example, avoiding physical exertion and not using tampons. Pain and menstrual cramps are common after the procedure but are self-limited. Risks and complications of uterine suction and curettage Like any surgical procedure, uterine suction and curettage have associated risks. The risk of serious complications is very low (less than 1%), the most common of which are: Infection: the risk of uterine or pelvic infection is less than 1%. In cases where the procedure is performed due to a retained abortion or incomplete abortion, antibiotic prophylaxis is performed before the procedure; Uterine perforation: The risk of an instrument inadvertently perforates the wall of the uterus is 0.1%-0.4%, and this may require surgery to repair; Excessive vaginal bleeding: although very rare (less than 1% of procedures), significant bleeding may occur; Formation of scars inside the uterus may occur especially with curettage and it is estimated that the risk is 1.5% in cases of post-abortion curettage. This content was prepared by the Gynecology-Obstetrics team at Hospital da Luz. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
