ASSISTING WITH
GYNECOLOGICAL
PROCEDURES
Submitted to, Submitted by
Mrs.Justy Joy Sukanya V
Assistant professor Titty Scaria
JMCON Vismaya Maliekal
IVth year Bsc(N)
Submitted on : 04-01-2021
DILATATION AND CURRETAGE
Defenition
A dilation and curettage, also called a D and C, is a minor
surgery that involves dilating or opening the cervix, which is the
opening to the uterus or womb. After dilating the cervix, a
spoon-shaped object called a curette is used to remove tissue
from the inner lining of the uterus.
Purposes
The main purposes for D and C include:
to determine reason for heavy bleeding during or
between menstrual periods
to remove non-cancerous tumors, or fibroids
to remove and examine potentially cancerous tumors
to remove infected tissue, which is often caused by a
sexually transmitted disease called pelvic inflammatory
disease (PID)
to remove tissue left behind in the womb after miscarriage
or childbirth
to perform an elective abortion
to remove an intrauterine device (IUD), which is a form of
birth control.
Materialsrequired
Thesetconsistsof:
8pcsdilatorset.
Uterinesound.
Uterinecurette.
Cuscovaginalspeculum.
Spongeholdingforcep.
Vulsullemforcep.
Ovumforcep.
Simsvaginalspeculum.
Procedure
The actual procedure is done in a sterile environment
such as an operating room, either in a hospital, a surgical
center, or in a specially designated room in a physician's office.
PROCEDURE RATIONALE
Administer anesthesia and This ensures a good view of
then the patient's legs are the genital area for the
parted and flexed and surgeon or gynecologist to
comfortably put up on a
stirrup in 'lithotomy' position. operate.
The vagina and cervix are Helps to avoid chances of
scrubbed with an antibacterial infection
solution that maybe iodine or
alcohol based.
The cervix is visualized using This helps both in stabilizing
an instrument called the and bringing the cervix down
speculum and its upper lip towards the vaginal opening to
with a special curved forceps ease with rest of the
called the 'Vulsellum procedure.
Dilatation is next done using To enhance visualisation and
sequential metal round the ease of the procedure.
tapered dilators and the
opening to the uterus is
gradually widened to about
the size of a large pencil.
Once this dilatation has been To obtain tissue for
completed, the spoon like examination.
curette is inserted into the
uterine cavity and is used to
gently scrape the lining of the
uterus.
Scraping is to be done deep Obtain appropriate tissue for
enough to sample the tissue the best results.
adequately, until the gritty
layer of cells just above the the
muscle of the uterus is felt.
This scraping is done To avoid chances of misleading
throughout the uterus and the results.
tissue removed is send for
microscopic examination.
Depending on the indication Procedure is carried out only
for the procedure the surgeon based on the necessity.
terminates the procedure once
enough tissue has been
obtained, or that the entire
cavity has been sampled or
scrapped.
Complications
This is a very low-risk procedure because it’s minimally
invasive. However, any surgical procedure has some potential
dangers. These may include:
anesthesia-related problems with the heart and lungs,
which are rare
infection
blood clots related to staying in bed and not moving
around, which are rare if you follow your doctor’s
instructions about getting up regularly
damage to the uterus or cervix
These may be a sign of damage to your uterus or cervix:
heavy bleeding
foul-smelling discharge
severe pain
fever
chills
Reference
Dutta textbook of textbook of gynecology, Jaypee
brothers publication, sixth edition.
Checklist
PROCEDURE YES NO
Sterile handwashing and aseptic techniques
are followed.
Put on gloves .
Provide lithotomy position.
Clean the area with antibacterial solution.
Assist in administration of general
anaesthesia.
Provide speculum and vulsellum for
visualisation.
Assist in dilatation of cervix.
Provide curette for scraping the tissue.
Label and send the collected tissue for
microscopic examination.
Provide sterile perineal pad .
Assist patient to move to recovery unit.
Monitor vital signs hourly.
Observe for bleeding, cramping and
spotting at the site.
Observe for nausea and vomiting.
Instruct to avoid putting anything like
tampons inside vagina for a few weeks.
Call physician if there's a fever, cramps for
more than 48 hours, increasing pain, heavy
bleeding or foul smelling vaginal discharge.
Record the findings in nurse's record.
PAP SMEAR
Definition:
The pap smear test is a method of cervical screening used to
detect potentially precancerous and cancerous processes in the
cervix .It is obtaining sample of exfoliated cells and simple test
to look at cervical cells.
Purpose:
To detect early cancer of cervix.
To determine estrogen activity related to menopause or
endocrine abnormalities.
Timing of doing pap smear:
Start within 3 years of onset of sexual activity or by age of
21.
After initial screening, have annually or biannually.
Yearly done until three consecutive normal pap smears,
then may decrease frequency to every 2-3 years.
Materials required:
Vulva swabbing set
Vaginal speculum
Perianal drapes
Sterile gloves
KY jelly
Cytobrush and cervical spatula
Torch light
Liquid based cytology container or glass slide and
fixative
Swab sticks for HVS
Preparation before taking pap smear:
Patient must be advised to make an appointment other
than during menstruation.
Before appointment :
o Avoid intercourse for 2 days
o Refrain from douching for 1 day
o Cease the use of vaginal medication for
at least 48 hours
Procedure:
Steps Rationale
Insert speculum into vagina in To visualize the cervix.
such a way that speculum
holds the vaginal wall apart.
Insert the longer end of Ayre’s To obtain a samples of
spatula in cervical canal to exocervix and squamo-
obtain sample from exocervix. columnar junction.
Spread the material obtained
on to pap smear slide.
Insert cytobrush 2 cm into To obtain endocervical cells
cervical canal and rotate 180 and may sample cells from the
degrees. Roll the brush on pap squamocolumnar junction, If it
smear slide. is high in canal.
Immediately spray the slide To prevent drying and decay of
with fixative, or if a thin prep, cells due to exposure of lights.
swirl the brush and spatula in
the solution.
Send the sample to laboratory For examining sample under
Steps Rationale
with pathology request form. microscopy.
Reference:
DC Dutta textbook of textbook of gynecology, Jaypee
brothers publication, sixth edition.
https://www.slideshare.net/hanasheque/pap-smear-
14847745
Checklist:
Procedure Yes No
Explained procedure to patient.
Obtained consent from patient.
Encouraged patient to void.
Provided privacy to patient.
Positioned patient in lithotomy
position.
Draped patient with perianal
drapes.
Procedure Yes No
Encouraged patient to take deep
breath while insertion.
Given support to patient during
procedure.
Helped to focus torch light in
perineal area.
Observe any discharge from vagina.
Performed perineal care.
Assisted patient to change from
lithotomy position to supine
position.
Document the procedure in nurses
record.
Complete the pathology request
form.
Send the specimen to laboratory
with request form.
