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D&E procedure
This document discusses different procedures for dilatation and evacuation (D&E). It describes both one-stage and two-stage D&E procedures. For one-stage, the dilatation of the cervix and evacuation occur in the same sitting under general or local anesthesia. For two-stage, the first phase involves slow dilatation of the cervix, followed by rapid dilatation and evacuation in the second phase. Preliminaries, instrumentation, complications, and post-abortion care are also outlined. Suction evacuation and menstrual regulation procedures are additionally summarized.
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D&E procedure
- 1. DILATATION AND EVACUATION NUR FARRANAJWA BINTI ABDUL AZIM 082015100035
- 4. TYPES ONE STAGES OPERATION Dilatation and evacuationdone in the same sittings TWO STAGED OPERATION 1st phase Slow dilatation of cervix 2nd phase Rapid dilatation of cervix and evacuation
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- 9. PRELIMINARIES • ANESTHESIA—either generalor local is used. In some cases, the operation may be performed with intravenous diazepam sedation. • LITHOTOMY position. • Full SURGICAL ASEPSIS is to be taken: – Surgical team is to wear sterile cap, mask, thorough hand wash and to wear gown and gloves – Vulva and vagina are to be swabbed with antiseptic solution – Cervix is cleaned with povidone-iodine solution – Leggings. • To empty the EMPTY THE BLADDER before she is placed on the table or catheterization • Vaginal examination is done
- 10. Cont. • Pudendal blockor perineal infiltration with 1% lignocaine is sufficient. • It may be applied even without anesthesia, especially in parous women. • The instrument should be assembled • The vacuum is tested prior to its application
- 12. POST ABORTION CARE •Emergency treatment of abortion complication • Family planning counselling and referral services • Involve male partners also
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- 20. MANAGEMENT OF UTERINE PERFORATION STOPALL PROCEDURE !! Don’t forgot to resuscitate and give antibiotics
- 21. SUCTION EVACUATION Procedure inwhich product of conception is sucked out from uterus with help of a cannula fitted to a suction device
- 22. INDICATION • MTP during1st trimester * • Inevitable abortion • Recent incomplete abortion • Hydatidiform mole
- 23. PROCEDURES Preliminaries: • As mentionedbefore • GA is usually not needed • If patient is apprehensive, • IV Diazepam 5-10 mg (conscious sedation) • Supplemented by paracervical block isquite effective • Patient is put on the table after bladder is emptied
- 32. MENSTRUAL REGULATION Aspiration ofthe endometrial cavity within 14 days of missed period in a woman with previous normal cycle
- 33. MENSTRUAL REGULATION EQUIPMENT -KARMANN CANNULA AND SYRINGE
- 34. PROCEDURE • Operation isdone as an out patient • Aseptic precautions • Sedation or paracervical block anesthesia may be employed • Introduction of posterior vaginal speculum & Allis forceps • Gentle dilatation of cervix using 4-5mm size dilators • Insertion of 5-6mm suction cannula (Karman’s) & attached to 50mL syringe • Cannula is rotated, pushed in & out with gentle strokes
- 35. Cont. • Operator shouldexamine the aspirated tissues by floating it in a clear plastic dish over a light source • Placenta tissue appears fluffy and feathery when floats in normal saline • Help to detect failed abortion, molar pregnancy or ectopic pregnancy
- 40. REFERENCES • Mudaliar andMenon’s Clinical Obstetrics, 11th edition, Sarala Gopalan and Vanita Jain, Ventouse • DC Dutta’s Textbook of Obstetrics, 9th edition, Hiralal Konar, Ventouse • Essential Of Obstrectric, Lakshmi Seshadri, Gita Arjun, Ventouse