|Clinical Management of Abortion Complications: A practical Guide (WHO - OMS, 1994, 86 p.)|
Carry out a general examination to check for anaemia and other diseases, followed by a detailed clinical (including vaginal) examination. Assess the size and position of the uterus and note the condition of the fornices. Check for ectopic or intrauterine pregnancy. Infection is a contraindication to dilatation and curettage, except in cases of septic incomplete abortion (when the patient must also be given antibiotics).
1. Give the patient a general anaesthetic or local anaesthesia (paracervical block).
2. Place her in the lithotomy position and clean and drape the area. Introduce a vaginal speculum, identify the anterior lip of the cervix, take hold of the lip with vulsellum forceps.
3. Sound the uterus by passing a uterine sound to assess the length and direction of the uterus. Then progressively dilate the cervix with dilators.
4. Introduce a small sponge holder (or polyp forceps) to check for polyps. Then gently curette each wall and angle of the uterus. All material obtained should be sent for histopathological examination, if required for diagnosis.
5. Apply a vaginal or gauze pad.
Possible complications include perforation of the uterus, injury to the bladder or bowel, cervical tear, extension of pre-existing infection, and rarely amenorrhoea due to trauma.