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Vaginal Ultrasound


DILATION AND CURETTAGE -
is accomplished with a looped metal scraping tool and is usually done with Hysteroscopy (looking inside the uterus) to evaluate or manage abnormal bleeding in a non-pregnant woman.  

DILATION AND SUCTION CURETTAGE - uses a softer gentler instrument and is usually done to manage an inevitable miscarriage.

VAGINAL ULTRASOUND - Is mentioned first because it is done BEFORE endometrial biopsy,  which is usually done BEFORE Dilation and Curettage when abnormal bleeding is the problem.   If the transvaginal ultrasound clearly shows the uterine lining  ≤ 4mm thick then it excludes uterine cancer with an accuracy of 99%— even more accurate that endometrial biopsy.  If the lining is thicker or cannot be clearly seen then further evaluation is warranted.   The Vaginal Ultrasound can be enhanced by performing a Sonohysterogram (gently instilling sterile saline solution)  that will usually reveal the presence of small polyps which may be the source of bleeding.   This test is easy and relatively painless.   If the uterine lining is thickened then an endometrial biopsy is performed.

ENDOMETRIAL BIOPSY (EBx):  is a way to take a small sample of the lining of the uterus (endometrium).  Endometrial Biopsy is usually done BEFORE a Dilation and Curettage.  The sample is looked at under a microscope for abnormal cells.   It helps find problems in the lining of the uterus that may be causing an abnormal pap smear or heavy, prolonged, or irregular uterine bleeding.  It specifically looks for overgrowth of the lining (hyperplasia), or to check for cancer.  A vaginal ultrasound procedure is nearly always done before an endometrial biopsy.  Sometimes the ultrasound exam makes taking a biopsy unnecessary in the lining is thin (less than 5 mm).   This procedure is most commonly done in women over age 40.  A Dilation and Curettage is generally more thorough but requires anesthesia.

endometrial-biopsyDESCRIPTION OF EBx PROCEDURE:   During endometrial biopsy, you will be given a cover drape to place around your waist. You will then lie on your back on an examination table with your feet raised and supported by foot rests (stirrups).   A warmed and lubricated instrument with smooth, curved blades (speculum) will be gently placed into your upper vagina and the cervix.   A numbing spray is used on the cervix which is then cleansed with antiseptic and may be grasped and held in place with a clamp called a tenaculum.  A soft, very thin tube (pipette) to suction a small sample of lining from the uterus. This method is fast and usually not very painful.  Some women may choose to take a pain reliever, such as ibuprofen (Advil or Motrin), with a light snack 60 minutes before having the biopsy. This can help decrease the discomfort that can be caused by the biopsy.  Most women have moderate cramping during the endometrial biopsy which lasts 5 to 15 minutes.  Some women feel dizzy and sick to their stomachs. This is called a vasovagal reaction. This feeling will go away after the biopsy.  An endometrial biopsy usually causes some vaginal bleeding. You may use a pad for the bleeding or spotting.

DILATION AND CURETTAGE (D&C):  is usually done alone for miscarriage or together with hysteroscopy to clarify Gyn causes of bleeding.  It is done under anesthesia (you are asleep and feel nothing) In an outpatient surgery center.  After you have been well informed and consented to the procedure you will be given patient gown to change into.  An IV will be started, your history reviewed by several different people each providing overlapping safety.  After safety checklists are completed, you will be guided to the surgical room and then helped into a position on your back on an operating table.
  
DESCRIPTION OF D&C PROCEDURE:  An Anesthesology professional will carefully review your case and help you with a brief episode of general Anesthesia.  After you are asleep an instrument with smooth, curved blades (speculum) will be gently placed into your upper vagina and the cervix.  The cervix is then cleansed with antiseptic and is grasped and held in place with a clamp called a tenaculum.   Depending on the reason for the D&C a fiberoptic instrument called a hysteroscope may be used to look inside the uterus.   Next a small looped instrument called a curette is inserted through the cervix and into the uterus. The lining of the uterus is carefully and very gently scraped off and removed (along with any other tissue that looks abnormal) and sent for evaluation by a pathologist.  
 
RECOVERY:  After your general anesthesia, you will feel sleepy for a few hours.  You will be watched by a nurse in the recovery room until you are fully awake.   You can do most of your normal activities in a few days.  Do not lift anything heavy for a few days after the test.  Do not have sex, use tampons, or douche until the spotting stops.  You may experience mild cramping and some soreness in your vagina for a day or two.   Also,  some vaginal bleeding or discharge is normal for up to a week after a D&C or biopsy. You can use a sanitary pad for the bleeding. Do not do strenuous exercise or heavy lifting for one day after your biopsy.  You will be given instructions on your recovery.

RISKS:  Uncommonly occur but include Uterine Performation, Bleeding, Pelvic Infection.