Wednesday, March 24, 2010

Dilatation and Curettage

Mungkin orang pikir kalau ambik medic, mesti kene pandai..mesti kene tahan bau darah, mesti xpengsan kalau tgk darah membuak2, mesti cool kalau tgk jenazah org meninggal, mesti berani tdo dgn cadaver (eh ade ke? ehehhe)

Kalau nak diceritakan, last sem (sem7) belajar subjects Surgery, O&G, Opthalmology, ENT, Forensic, Public Health, and Anaestesiology.

Ingat lagik, kat VK Obgyen (ruang bersalin for phatology sahaja-pertolongan persalinan dgn kelainan/tidak normal/dgn penyakit2 tertentu yg berbahaya kpd ibu dan bayi), petang tu saya on-call so at 3pm till malam. Actually dah 3 hari demam and xbape sihat (tapi dah makan panadol so ingatkan tough laa that day).

Muke bersemangat nak belajar dgn resident/PPDS and kebetulan time tu Dr panggil kami suh tgk D&C (dilatation and curettage) kt room Gyne (nak bersihkan uterus after abortion. nak buang sume darah2 and sisa janin so xtinggal dlm uterus/rahim sebab nanti jadik bende asing dlm body si ibu). Punya la bersemangat nih nak tgk *sebab teringat auntie pnh spontaneous abortion dl* so nak tgk mcmne cara die. Mmg 1st time tgk mcm ngeri ibu pn ngerang kesakitan *of course la sakit plz dont try this at home/ bidan or org2 xpengalaman sebab bahaya infection, or tembus/robek rahim or emboli artery or xbersih scr aseptic*

Mule2 saya berdiri plg depan sbb nak tgk dgn clear mcmne Dr bwt (baru puas hati biar tgk jelas).Suddenly, rasa nausea and dizzy sebab bau darah tibe2 dtg (maybe sebab faktor demam xkebah lagi so mmg cepat rasa nk termuntah if bau mcm2). So, i moved back and tried nak keluar from room tu (room kecik tp rmai org) or duduk kt seat. Tapi rasa segan dgn Dr sebab saya kan student lgk (rasa xrespect kt Dr lak) jadi dgn tabahnyeh saye pn maintain cool and pura2 nothing happen. Jalanla slowly dkt patient si ibu tadik nak sambung tgk curette but suddenly black-out !! *mmg rasa nak termuntah, sejuk extremitas kaki ke kepala, peluh sejuk and muke pucat* trus lari ke sinki muntah !! *thanks to Thila yg tepuk2 belakang saya and bawak saya keluar fr that room ke kawasan lebih lapang* Duduk kejap kt bench luar and Thila sgt sweet ambikkan air aqua for me. Adela ibu2 (family patients yg tunggu kt luar) tanyer saye nampak mcm pitam je nih. *malu lak..dahla pkai lab coat..patut bukak je tdk..ahahhaa*

A few minutes later, saya pn masukla ruang VK after dh stabil and duduk atas bed patient (tempat ibu bersalin). Rmai Dr pn gelakkn sye ckp ade "patient" pitam nak kne bwt CPR laa ape tah lgk duk gurau senda (sebab bawah ruang VK nih is ER-emergency room.. so sape2 pengsan kt floor VK or Gynae leh campak je kebawah trus ke ER...hahaha) *punya laa malu time tu..tutup muka and tunduk je..muka mmg merah thn malu sebab sume duk gelakkan sye*

Memang kalau diingatkan balik, memang kelakar laaa peristiwa mcm nih..ala bkn sye xstrong, tapi sebab demam time tu, rasa loya and nk termuntah la sebab bau darah kan (byk je alasan) ahahaha..

Info about D&C: ~

Dilatation and curettage

A dilatation and curettage (D&C) is an operation performed on women to scrape away the womb lining. The cervix (neck) of the uterus (womb) is dilated using an instrument called a dilator. The endometrium (lining of the womb) is then lightly scraped off using a curette. This spoon-shaped instrument can be used to remove diseased tissue, treat abnormal bleeding or to obtain a specimen for diagnostic purposes.

Problems that may require D&C
D&C can be used as a diagnostic test or as a form of treatment for a range of conditions. Some of the problems that may require D&C include:

  • A history of abnormal menstrual bleeding, such as heavy bleeding (menorrhagia) or bleeding between periods
  • Polyps (small growths protruding from the mucous membrane of the uterus)
  • Uterine infection
  • Incomplete abortion (miscarriage)
  • Surgical abortion
  • Heavy bleeding after childbirth
  • Suspicion of uterine cancer
  • Investigations of female infertility.
Medical issues to consider
You will be advised to have nothing to eat or drink for at least six to eight hours before the surgery. In some cases, you are given an injection an hour before your operation to make you feel drowsy and help dry up internal fluids. Women younger than 35 years are generally advised against undergoing D&C, unless there is no other alternative.

Operation procedure
D&C is regarded as a relatively minor operation and can be done as day surgery but a general anaesthetic is usually given. The typical D&C procedure includes:
  • Once you are anaesthetised, your uterus is examined to determine its size and position.
  • The walls of the vagina are held apart by an instrument called a speculum (the same instrument used during a Pap test).
  • If you aren’t having general anaesthetic, an instrument is inserted to both position the cervix and administer local anaesthetic.
  • Rods (dilators) that increase in size are introduced into the cervix, one at a time, to gently widen the entrance of the cervix (os) to the right diameter.
  • The spoon-shaped curette is inserted through the dilated cervix and into the uterus.
  • The lining of the uterus (endometrium) is scraped off using the curette.
  • What happens next depends on the condition. For example, the scraping procedure concludes the surgical abortion, while tissue samples will be prepared and taken to a laboratory for investigation if the D&C was needed to help diagnose suspected uterine cancer.
Immediately after the procedure
After surgery you can expect:
  • Nurses to record your vital signs such as temperature, pulse and blood pressure.
  • You are observed for any vaginal bleeding.
  • You shouldn’t need pain relief after the operation, although some patients experience mild abdominal cramps. A light pain killing tablet may be suggested.
  • You should be able to get out of bed within a few hours and often are allowed home four to six hours after the operation if there is no vaginal bleeding.
  • If you have lost a lot of blood before the operation, you might be required to stay in hospital overnight.
  • Make arrangements for someone to come and collect you from the surgery or hospital, as you should not drive at least until the next day.
Possible complications
Some of the possible complications of D&C include:
  • Reactions to the medications used, such as allergic reactions to the general anaesthesia
  • Cervical damage due to dilation or the passage of instruments
  • Haemorrhage (bleeding)
  • Infection of the uterus or other pelvic organs
  • Scar tissue within the uterus, if the scraping was too vigorous
  • Puncture of the uterus.
Taking care of yourself at home
Be guided by your doctor or surgeon but general suggestions include:
  • Some cramping or mild abdominal discomfort is considered usual after a D&C. See your doctor if you are concerned or in pain.
  • You should take any medication as ordered by your doctor.
  • If you are taking antibiotics, make sure to take the whole course, even if you feel well.
  • You should not have sexual intercourse for a week or so if possible.
  • Avoid putting anything into your vagina, including tampons or douches, for at least one week or preferably two.
  • If you experience any signs of infection (such as fever, pain or discharge) see your doctor immediately.
Long term outlook
D&C is used to help diagnose certain conditions such as cancer of the uterus. Your doctor will let you know when the results of your laboratory tests are available. Treatment depends on the diagnosis. For example, if cancer is diagnosed, treatment options include hysterectomy (surgical removal of the uterus), radiotherapy, chemotherapy and hormone therapy.

Other forms of treatment
Alternatives to D&C depend on the condition. For menorrhagia, for example, other forms of diagnosis and treatment include:
  • Using a catheter (thin hollow tube) to take a sample of endometrial tissue for diagnostic purposes.
  • A hysteroscope (a type of slender telescopic device) is generally advised for taking tissue samples from older women.
  • Another diagnostic test is the vaginal ultrasound. This involves introducing a slender device into the vagina to take ‘sound pictures’ of the uterus.
  • The oral contraceptive pill can be used to treat menorrhagia.
  • An intrauterine device (IUD) that’s impregnated with the hormone progesterone can reduce heavy menstrual flow in some cases.
Where to get help
  • Your doctor
  • The Jean Hailes Foundation Tel. 1800 151 441
  • Australasian Menopause Society Tel. (03) 4642 1603
  • Family Planning Victoria Inc. Tel. (03) 9257 0100
Things to remember
  • A dilatation and curettage (D&C) is an operation performed on women to scrape away the womb lining.
  • D&C is a form of treatment for a range of conditions including incomplete miscarriage, polyps or unwanted pregnancy.
  • D&C can be used as a diagnostic test if, for example, cancer of the uterus is suspected.

No comments: