Scraping or curettage

Scraping or curettage is a procedure in which the cervix is dilated to remove part of the lining of the uterus (endometrium); a spoon-shaped instrument called a curette is used for this purpose.The procedure is performed for various reasons.

Why are gynaecological scrapings performed?

A scraping may be necessary in various cases:

• The therapeutic scraping is used to remove uterine tissue during or after a miscarriage or a medical or surgical termination of pregnancy or the removal of smaller parts of the placenta after birth. In this way, infections or heavy bleeding can be prevented. If the egg remains in the fallopian tube for at least 5-6 weeks during an ectopic pregnancy, laparoscopic surgery is necessary to remove the embryo and avoid serious complications.
• Bioptic scraping is used to diagnose or treat abnormal uterine bleeding.
  Scraping can help diagnose or treat fibroids, polyps, endometriosis, hormonal imbalances, or uterine cancer. The tissue sample taken is then examined under the microscope for abnormal cells.
  It can also be used in menopausal women.

Scraping is rarely used to treat other ailments, such as heavy menstrual bleeding, because more modern techniques are available that are more effective and less invasive.

How is the preparation done?

The scraping is carried out on an outpatient basis in the hospital, in a clinic or in the doctor’s office.
It is possible that the patient will remain under medical care for a few hours after the procedure.

Nothing should be eaten or drunk before the procedure, in this way the risk of vomiting and belching during surgery can be kept low.
The patient must be accompanied home, because the residual effect of the anesthesia could cause fatigue. After a few days, normal everyday activities can be resumed.
Sometimes the doctor begins dilation of the cervix as early as a few hours or even the day before scraping to ensure that the opening is gradual.

This procedure is usually performed when the cervix needs to be dilated, for example, for an abortion or for certain procedures of hysteroscopy.
In these cases, the doctor uses a special instrument that expands and absorbs the fluid in the cervix, which causes the dilation of the cervix.

How does a scraping work?

The type of anaesthesia depends on the procedure. Sometimes the procedure is performed under general anesthesia, in other cases peridural anesthesia (PDA) or spinal anesthesia is administered.

In most cases, widening and scraping are performed under general anesthesia, i.e. the patient sleeps and does not feel any pain or discomfort. However, the procedure can also be performed under local anesthesia, the affected region is then completely numb, but the patient remains awake.
In a PDA, the sensitivity of the lower half of the body is temporarily blocked.
The anesthesiologist must constantly monitor heart rate, blood pressure, breathing and oxygen saturation of the blood during the procedure.

Before the operation, the patient must empty the bladder, then a catheter is inserted.
The doctor inserts a dilator into the vagina to open the vaginal walls and make the cervix accessible.

How long does the procedure take?
A scraping usually takes about 10-15 minutes.

How is the procedure performed?
The operation is performed through the vagina and leaves no scars.
The cervix is dilated with the help of dilators and a small instrument called a “curette” is inserted into the uterus to gently scrape out the outer lining of the uterus (endometrium).
If the procedure is performed for diagnostic purposes, the tissue sample taken is sent to a laboratory for examination (biopsy).

The cervix can be cleaned with an antiseptic solution.
Using special forceps, the gynecologist keeps the cervix open during the procedure.
The cervical canal can be scraped out with a small curette (spoon shape) to examine the tissue of the cervix.

The cervix is dilated by inserting a series of thin dilators. Each dilator has a larger diameter than the previous one.
In this way, the opening of the cervix is gradually widened, so that finally the curette can be inserted.

The spoon-shaped curette is inserted into the uterus through the cervix and its sharp edges are used to scrape out the uterine lining.
In some cases, the tissue can also be suctioned; with local anesthesia, abdominal cramps may occur.

Finally, the instruments are removed.
The removed tissue can now be sent to the laboratory for examination.
With the tissue of a pregnancy, a culture can be created in the laboratory or tests for genetic or chromosomal changes can be performed.

After scraping

After the procedure of dilatation and scraping, one should not spend the next 24 hours alone, since after general anesthesia a certain disorientation is possible.

Driving a car or heavy machinery must be avoided until 24 hours after the procedure.
Recovery times are two to three days before everyday and professional activities can be resumed.

The first menstrual period after scraping can start punctually or late, there are no exact rules.
Usually, the first menstruation after scraping is characterized by heavy bleeding.

Scraping and re-pregnancy

After an unfinished pregnancy, it is necessary to wait until the hormone level of human chorionic gonadotropin (hCG) has dropped again.
This hormone is produced 7-8 days after fertilization and causes uterine changes to accommodate the embryo.

Undesirable side effects of scraping

Convulsions
Immediately after scraping, most women have cramps, similar to those of the menstrual cycle. These should stop within 24 hours after the procedure.
Painkillers, such as acetaminophen or ibuprofen, can help relieve the discomfort.

Nausea
After scraping, a feeling of malaise and nausea may appear. However, this is likely to take only a few hours.

Discharge
After the procedure, a slight bleeding from the vagina is quite normal, which first occurs in bright red, later in brownish coloring.
Physiological embryonic material can also escape.
Sanitary napkins should be used instead of tampons; tampons should be avoided until the next period because of the risk of infection.

The vaginal bleeding would have to stop within 5 to 10 days after the procedure.
In order to avoid infection, perfumed cosmetic products, swimming pool visits and bathing in the sea should be avoided during this time.

Sexual intercourse After a scraping, sexual intercourse
should not take place for some time. The exact duration depends on the individual situation and the reason for the procedure.
The doctor will give more precise instructions in this regard, but on average 10-14 days must pass.

Results
If a bioptic scraping is performed to diagnose a disease, the laboratory values (histological examination) should be available within 2 weeks.
The patient can discuss the written findings with her gynaecologist.

Recovery times The recovery times
are usually 2-3 days, after which everyday activities can be resumed.
The procedure has no consequences for fertility.

What complications can occur during scraping?

Scraping involves few risks and dangers.
Light bleeding and cramping in the days following the procedure are quite normal.
The most common complication of poorly completed scraping is perforation of the uterus by the dilators or curettes.
If this happens, but the internal organs (intestines, bladder and rectum) and large blood vessels are unharmed, the wound heals on its own without surgical intervention.

The risk of scraping is greater if there is a narrowing of the cervix (cervical stenosis) or anatomical changes.
The risk increases if there is an infection of the uterus or if a surgical procedure has recently been performed there, such as a caesarean section or myomectomy (removal of uterine fibroids).

Also, injury to the cervix is a possible complication. Cracks or wounds of the cervix can be treated to stop bleeding by applying pressure and local medications.
In rare cases, the cervix needs to be sutured.

Other complications include those of any surgical procedure, such as bleeding and infection. The bleeding is usually weak and subsides on its own. Infection is rare and is usually treated with oral antibiotics, but most scrapings do not involve taking antibiotics.
If the patient has heart problems, the doctor may prescribe antibiotics before and after the procedure to prevent vaginal bacteria from infecting the heart valves.

Alternative treatment options

Alternatives to scraping depend entirely on the cause. An abortion within the first three months usually provides for suction with scraping.

For menorrhagia (excessive menstrual bleeding), there are other diagnostic and treatment options:

• Tissue removal of the uterine lining with catheter for diagnostic purposes.
• Hysteroscopy is recommended for taking tissue samples from older women.
• Another diagnostic procedure is a transvaginal ultrasound. For this purpose, a narrow transducer is inserted into the vagina to represent the uterus.

Endometrial ablation
This procedure is performed using a small probe inserted into the uterus through the cervix.
With laser or microwaves, part of the uterine lining is removed.
However, this procedure is not possible for all women, for example, if there is an irregular uterine shape or if procedures have already been performed on the uterus. In these cases, scraping may be advisable.

• Hysteroscopy or uterine endoscopy
• Polyps of the uterus
• Inflammation of the uterine lining or endometritis