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Emergency Treatment Module 2 - Session 4 Sharp Curettage

Emergency Treatment Module 2 - Session 4 Sharp Curettage. WHO recommends vacuum aspiration as the preferred method for uterine evacuation before 12 weeks of pregnancy. Module 2 - Session 4 Objectives. At the end of this session, participants will be able to:

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Emergency Treatment Module 2 - Session 4 Sharp Curettage

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  1. Emergency TreatmentModule2 - Session 4Sharp Curettage

  2. WHO recommends vacuum aspiration as the preferred method for uterine evacuation before 12 weeks of pregnancy.

  3. Module 2 - Session 4Objectives At the end of this session, participants will be able to: • Identify the instruments used for D&C and sharp curettage procedures • Explain the procedure for D&C and sharp curettage and demonstrate it on a model • Describe the post-procedure care

  4. Sharp Curettage: Also Known as Dilatation and Curettage (D&C) • Sharp curettage (SC) is an effective method for the treatment of incomplete abortion. • WHO recommends that sharp curettage be used only when vacuum aspiration (VA) is not available. • Reasons why many countries still rely on sharp curettage: • May experience difficulty in obtaining and maintaining VA supplies and equipment • Provider resistance to switching from sharp curettage • Providers may not have received training in VA • Some women presenting for PAC services are outside of the established criteria for VA use

  5. Sharp Curettage (2) When vacuum aspiration is not available (electric, foot pump or manual): • High-quality sharp curettage care must be ensured: • Periodic updating of skills is necessary as with any other surgical intervention. • Sharp curettage can be performed safely without general anesthesia. • Family planning counseling and services must be provided just as with clients receiving VA treatment.

  6. Instruments and Supplies for Sharp Curettage • Sterile equipment: • Retractor or speculum • Single-toothed tenaculum or vulsellum • Graduated dilators • Uterine sound • Curette or ring forceps • Local anesthesia • Antiseptic solution (e.g., Betadine) • Sterile gloves and infection prevention supplies/equipment

  7. Metal Curette Metal curette shown at front and side angles

  8. Steps for Sharp Curettage • Review indications for use: • Inevitable or incomplete abortion • VA not available for incomplete abortion up to 12 weeks gestation • Incomplete abortion >12 weeks gestation • Assess and determine treatment plan: • Greet and assess client. • Confirm the diagnosis and note any additional complications. • If needed, stabilize client and begin treatment of complications. • Assess pain management needs. • Discuss analgesia/anesthesia options. • Obtain any required informed consent before any medication or anesthesia is administered.

  9. Steps for Sharp Curettage (2) • Counsel the patient on the procedure, provide emotional support and encourage the patient throughout the procedure. • Organize the procedure area for SC: • Establish sterile field. • Organize instruments and equipment: • Forceps, speculum, tenaculum, sound, dilators, curettes of varying sizes if available • Other instruments according to anticipated need (e.g., for repair of cervical lacerations)

  10. Steps for Sharp Curettage (3) • Prepare patient for procedure: • Have patient empty her bladder and clean perineum if able to do so. • Give any prophylactic antibiotics (according to local protocol). • Assist into lithotomy position. • Perform a bimanual pelvic examination to assess the size and position of the uterus and the condition of the fornices • Administer any parenteral analgesic/anesthesia: • Give pethidine IM or IV for pain management. • Give oxytocin 10 units IM or ergometrine 0.2 mg before the procedure.

  11. Steps for Sharp Curettage (4) 8. Prepare the surgical team: • Scrub and apply appropriate attire and gloves. • Identify roles, including client monitor and circulator. • Drape the patient. • Gently insert a sterile (or high-level disinfected) speculum or retractor into the vagina. • Apply antiseptic solution to vagina and cervix (especially the os). • Check the cervix for tears or protruding POC: – If POC present in the vagina or cervix, remove using a ring or sponge forceps.

  12. Steps for Sharp Curettage (5) • Conduct careful, gentle uterine evacuation: • Gently grasp the anterior lip of the cervix with a tenaculum or forceps to straighten the uterine cavity. • Gently pass a uterine sound through the cervix to assess the length/direction of the uterus; compare with previous size estimate. • Dilate cervix (as needed) to introduce curette: • Dilatation is needed only in cases of missed abortion or when some retained POC have remained in the uterus for several days.

  13. Inserting the Retractor and Holding the Anterior Lip of the Cervix

  14. Steps for Sharp Curettage (6) • Curette all quadrants of the uterine cavity until there are signs of completion. • Quickly assess tissue for completeness and consistency with diagnosis.

  15. Curetting the Uterus

  16. Steps for Sharp Curettage: Caution! • Be careful! The uterus is very soft during pregnancy and can be easily injured during this procedure.

  17. Steps for Sharp Curettage—Post-Procedure Care • (Step 13 continued): • Transfer the patient to a comfortable, monitored recovery area when she is stable. • Give paracetamol 500 mg by mouth as needed. • Take vital signs and check for vaginal bleeding every 15 minutes for 1 hour before discharge from the facility. • Encourage the woman to eat, drink and walk about as she wishes. • Offer other health services, as available and appropriate, including tetanus or malaria prophylaxis. When the patient is fully awake and alert, inform her of the findings and implications for continued treatment. • Continue treatment and monitoring as appropriate to her condition.

  18. Steps for Sharp Curettage—Post-Procedure Counseling Provide counseling on the following: • Family planning and the importance of birth spacing or limiting • Discharge instructions • Any other appropriate counseling prior to discharge and follow-up care • Date for follow-up appointment

  19. Post-Procedure Care (2) • Provide FP counseling and the method of client’s choice (as appropriate) before discharge: • If full FP not offered at the site of emergency treatment, provide information and referral. Family planning uptake is highest when methods are available at the same time and in the same location as treatment. • Include counseling on return to fertility and birth spacing, especially for those clients who desire future pregnancies.

  20. Post-Procedure Care Integrating Counseling • With the client’s permission, include her partner in the counseling discussions. • Many women want their partners to be informed about their condition, treatment, follow-up care and family planning. • Men also desire to understand more about emergency treatment.

  21. Post-Procedure Care (3) • Discharge uncomplicated cases in 1–2 hours. • Post-procedure counseling to include: • Watch for signs and symptoms requiring immediate attention: • Prolonged cramping • Prolonged bleeding • Bleeding more than normal menstrual bleeding • Severe or increased pain • Fever, chills or malaise • Fainting

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