Surgery and Healing in the Developing World - Dartmouth-Hitchcock

14
114 Surgery and Healing in the Developing World
Figure 1. Dilatation and curettage. The anterior lip of the cervix is grasped.
Figure 2. Single toother tenaculum.
Complications
The main complications arising from dilatation and curettage are:
1. Hemorrhage
2. Uterine perforation
3. Infection
4. Miscellaneous—Asherman’s syndrome, infertility
Anticipating excessive blood loss is critical in keeping this to a minimum. The
evacuation of the uterus after an incomplete first trimester miscarriage is different
from an incomplete second trimester loss. The latter is notorious for hemorrhage,
which can easily lead to hypovolemic shock. An intravenous line with an ergotoxic
agent (pitocin or ergometrine) readily available is imperative with second trimester
evacuation. This is even more important in the presence of a septic uterus, a situation
that renders the contractile ability of the myometrium reduced.
Furthermore, the surgeon must always be prepared to perform a bimanual massage
of the uterus as an adjunct to facilitate uterine contraction and subsequent