Surgery and Healing in the Developing World - Dartmouth-Hitchcock

Outpatient Assessment of the Pregnant Patient
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Suction Curettage
This is a useful adjunct to sharp curettage. It is especially helpful for the surgeon
not experienced in the techniques of dilatation and curettage since it minimizes the
risk of perforation.
Curettage in the first and second trimester can be assisted by this procedure. The
procedure can be facilitated by use of soft malleable instrumentation rather than the
regular suction curettes which are metallic. Using a regular suction catheter after
dilatation, the uterine cavity can be partially evacuated. This reduces the time and
effort to complete the evacuation process.
The suction catheter can be substituted for using a large bore nasogastric tube by
simply creating additional openings at the distal end ~1/4-1/2 cm in diameter. A
solitary opening at the proximal end would facilitate the actual suctioning. In the
second trimester, particularly if the cervix is already dilated, an endotracheal tube
can also be used. This adds the benefit of removing large amounts of tissue and
reducing blood loss. In both circumstances, even in the hands of the inexperienced
surgeon, there is minimal risk of perforation. The uterus contracts more readily and
also aids completion of the “dilatation and curettage” by the sharp curette.
Suggested Reading
1. ACOG Practice Bulletin - Early Pregnancy Loss # 212 1995.
2. ACOG Practice Bulletin - Methods of Midtrimester Abortion #109 1987.
3. Bayer SR, Solo-Hunnicutt JA. Dilatation and curettage and cervical conization:
Operative gynaecology. WB Saunders, 1993.
4. Corson SL, Sedlacek TV, Hoffman JJ. Greenhill’s Surgical Gynaecology Year Book
Medical Publishers. 5th eds.
5. Jones IIIth HW, Wentz AC, Burnett LS. Novak’s Textbook of Gynaecology. 11th
ed.
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