Managing Complications in Pregnancy and Childbirth: - IAWG

DILATATION AND CURETTAGE P-61The preferred method of evacuation of the uterus is by manual vacuumaspiration (page P-65). Dilatation and curettage should be used only ifmanual vacuum aspiration is not available.• Review for indications (page P-65).• Review general care principles (page C-17).• Provide emotional support and encouragement and give pethidineIM or IV before the procedure. If necessary, use a paracervicalblock (page P-1).• Administer oxytocin 10 units IM or ergometrine 0.2 mg IM beforethe procedure to make the myometrium firmer and reduce the risk ofperforation.• Perform a bimanual pelvic examination to assess the size andposition of the uterus and the condition of the fornices.• Apply antiseptic solution to the vagina and cervix (especially theos) (page C-22).• Check the cervix for tears or protruding products of conception. Ifproducts of conception are present in the vagina or cervix, removethem using ring (or sponge) forceps.• Gently grasp the anterior lip of the cervix with a vulsellum or singletoothedtenaculum (Fig P-32, page P-62).Note: With incomplete abortion, a ring (sponge) forceps ispreferable as it is less likely than the tenaculum to tear the cervixwith traction and does not require the use of lignocaine forplacement.• If using a tenaculum to grasp the cervix, first inject 1 mL of 0.5%lignocaine solution into the anterior or posterior lip of the cervixwhich has been exposed by the speculum (the 10 o’clock or 12o’clock position is usually used).• Dilatation is needed only in cases of missed abortion or when someretained products of conception have remained in the uterus forseveral days:- Gently introduce the widest gauge cannula or curette;- Use graduated dilators only if the cannula or curette will notpass. Begin with the smallest dilator and end with the largestdilator that ensures adequate dilatation (usually 10–12 mm)(Fig P-33, page P-62);