RFE in gynecology. What is it, on what day of the cycle to do, how it is carried out, indications, reviews of the procedure

The WFD procedure (separate diagnostic curettage) is carried out when other methods for determining pathology do not give visible results. In this case in gynecology are used other techniques. One of them is the RFE.

This procedure can cause unpleasant emotions, but do not underestimate its effectiveness. Operation and research requires proper preparation and preliminary delivery of the necessary tests.

More about the WFD procedure

The procedure for diagnostic curettage consists in the fact that during the event, the doctor makes a fence of the epithelium, or rather its surface, which lines the uterus, as well as the cervical canal. It is these tissues that are sent for further analysis.

The procedure is performed a few days before the start of your period (there are certain exceptions). This is due to the fact that the doctor wants to minimize the risk of possible bleeding, which may be triggered by the actions of sampling.

In fact, the upper layer of the epithelium is not necessary for the normal functioning of a woman's body. It is this part of the epithelium that is rejected by the body during menstruation, so the procedure cannot be harmful. After scraping, a standard process begins, during which the mucous membrane is renewed and begins to grow again. The same thing happens with menstruation.

RVD is performed in several stages, one of which is the introduction of anesthesia. Medicines are selected individually. The doctor must take into account the age of the patient and the pathology from which she suffers. After that, a specialist examines the uterine cavity.

If he does not see any damage that interferes with the safe conduct of the RVD, then scraping is performed. All this takes about 20 minutes. After that, the patient must visit the doctor several times and undergo a so-called control examination. After that, it will be possible to make a more accurate diagnosis and prescribe treatment.

The goal of the WFD

First of all, this procedure is carried out for diagnosis. When using ultrasound to assess the state of the pelvic organs, of course, it is possible to identify a lot of pathologies.

But ultrasound does not allow you to get an image of the internal organs in order to better assess at what stage the neoplasm is. Therefore, during the application of ultrasound, WFD is often performed.

Curettage of this is an effective method for diagnosing sarcoma and other oncological pathologies. In addition, WFD is often used to treat a patient. During the procedure, the doctor removes the formed seals and tumors. Thus, we can say that RFE is a therapeutic and diagnostic measure that allows you to get rid of diseases that cannot be cured by conservative methods.

Indications

WFD in gynecology is a procedure that a doctor prescribes for:

• Bleeding in the uterus. The cause of bleeding is difficult to determine. In this case, there is a risk of anemia. To minimize the danger, doctors perform a separate scraping.
• Problems caused by a previous abortion. If in the process of removing the fetus by the medical staff, mistakes were made, then in this case it is recommended to perform scraping.
• Synechia. This is a condition when the walls of the uterus, located opposite to each other, begin to grow together. In this case, partial curettage of the uterus is carried out in order to remove the top layer of overgrown cells. Such pathological conditions are not so common in medical practice.

What diseases can be detected?

There are several pathologies that can be identified by the WFD procedure.

Pathology name	Peculiarities
Endometritis	It is characterized by inflammatory processes in the lining of the uterus. Usually, this disease is treated with medication, and WFD is used exclusively as a diagnostic measure.
Hyperplasia	The patient is diagnosed with a thickening of the endometrium. In such a situation, WFD is used not only for examination, but also for treatment. After performing curettage, the patient is checked for dysfunction, and if it is, then additional treatments are prescribed.
Polyps	Formations are distinguished by their uneven and irregular shape. They can occur on the mucous membrane as a result of a variety of pathological processes occurring in the female body. With the help of medical therapeutic measures, it is impossible to get rid of this type of formations. Therefore, the only effective method is scraping the uterine cavity, that is, RFE.
Adenomatous hyperplasia	Pathology of the preatal type. In this case, the so-called atypical cells are formed in the uterus, which in their structure are very similar to the particles from which a tumor is formed.
Endometrial cancer	With the disease, no pathognomic signs are detected. As a rule, endometrial cancer is most often diagnosed in older women, after menopause.
Cervical cancer	A tumor of a malignant type, which in medical practice occurs much more often than endometrial cancer. This pathology requires rapid treatment, before the spread of the tumor. Therefore, the diagnosis of WFD is the most effective way to detect the disease.
Endometriosis	Characterized by the rapid proliferation of tissues, which in their structure are almost identical to the endometrium itself.

On what day of the menstrual cycle do they do?

WFD in gynecology is a procedure that is performed on a specific day of the menstrual cycle. Only in this case the received data will be as informative as possible. However, the exact day or period of the WFD depends on the risk of complications and the pathology that the doctor suspects. Symptoms are also taken into account.

For example, if a patient has uterine bleeding, then diagnostic and therapeutic measures begin immediately, regardless of the day of the menstrual cycle. If there is a suspicion of menstrual dysfunction, then a study of this type is recommended to be carried out in the period from 5 to 10 days of the cycle.

Also, the menstrual cycle can proceed without ovulation. In this case, the WFD is carried out 2-3 days before the onset of menstruation itself.

If there is a suspicion of the development of a tumor, then, as a rule, curettage is performed as quickly as possible. Doctors prefer not to wait for a certain day of the cycle, but to start treatment as soon as possible.

Narcosis

The RFE procedure is quite painful, therefore, general anesthesia is used during the procedure. Local anesthesia is rarely allowed if standard anesthesia cannot be used. With local anesthesia, pain cannot be completely ruled out.

Spinal anesthesia is sometimes used. In this case, the patient remains conscious during WFD, but her lower torso is devoid of sensitivity. However, this method of using anesthesia is associated with certain risks, therefore, if possible, doctors do not recommend using this method of immobilization and dulling of sensitivity.

Before the introduction of anesthesia, the patient must sign the appropriate consent.

How do I prepare for the procedure?

After undergoing a gynecological examination, the patient receives a referral from the doctor for the procedure. If a few days before RFE the patient begins to have vaginal discharge, then this may indicate thrush. It is imperative that you notify your doctor about this fact.

There are several important rules for preparing for the procedure:

• 6 hours before the RFE, provided that intravenous anesthesia is administered, it is necessary to completely exclude the intake of milk and any fermented milk products. Juices should not be consumed, especially with pulp.
• 4 hours before the procedure, you must refuse any drink, including water.
• Food should not be eaten 10-12 hours before the diagnostic and therapeutic examination. If this rule is violated, mechanical asphyxia can be provoked during the procedure.
• For 2 weeks, you need to exclude taking medications. If there are drugs that need to be taken in a course, or a woman cannot refuse drugs for health reasons, it is imperative to notify the gynecologist.
• Before the RFE, you must not dye your hair, extend your nails and do any cosmetic procedures using chemicals. It is also recommended to stop using decorative cosmetics.
• In the morning, on the day of surgery, you need to remove hair from the pubic area, perform a cleansing enema and carry out standard hygiene measures.

You cannot come to the procedure by driving a motor vehicle yourself. In the process of RFE, drugs are injected into the patient's body, which will greatly inhibit the reaction. Therefore, the next day you can not get behind the wheel.

Some anesthetists ask you to purchase special compression stockings for the procedure. Therefore, it is worthwhile to first clarify this issue with a doctor.

The first few hours after scraping, a woman should rest in a hospital environment, so it is worth taking a book with you and charging a mobile phone. It is recommended to lay a special absorbent film on the bed. Often, after performing the procedure, a woman has mild bleeding.

Analyzes

WFD in gynecology is an extremely effective procedure that requires serious preparation. This is not only the correct diet and certain restrictions.

An important stage in the preparatory activities is the delivery of the necessary tests:

• Ultrasound. The procedure is aimed at examining the organs located in the small pelvis. As a rule, it is ultrasound that becomes the basis for curettage.
• General analyzes of urine and blood.
• Coalograms (complex type analysis).
• Additional blood tests. The doctor must be sure that the patient does not suffer from hepatitis, HIV, syphilis. It is also required to clarify the group and Rh factor of the patient's blood.
• You need to take a vaginal swab. It determines the degree of purity of the environment.

If there is a need for an urgent curettage, then only those tests are performed that allow us to assess the general condition of the patient. This means that it is required to clarify the Rh factor and blood group, conduct an analysis for blood sugar, as well as a study of the OAC and OAM.

Execution technique

When using anesthesia, a woman does not experience pain. However, the doctor should tell you how the WFD will be administered. It is important that the patient, before the procedure, tells about all recent illnesses.

It even matters whether she suffered from certain symptoms, for example, frequent headaches, nausea, discharge from the genitals.

Tools

In the process of scraping, special gynecological instruments are used. The operating room should contain all the necessary anesthetic and resuscitation equipment.

The following tools should be prepared:

• Curette. This is a tool with a special loop on one edge. It is directly used in the scraping procedure. Curette loops come in a variety of shapes and sizes. They are selected depending on what the scraping is for and in what volumes.
• Expander Gegara. They are a metal rod with a rounded tip. The length of the appliance is approximately 20 cm. This instrument is necessary in order to expand the cervix mechanically. This will allow the doctor to enter the uterus and use the curette.
• Bullet forceps. Musot forceps can also be used. It is a tool that is made up of long clamps. They are needed in order to grip and fix tissue.
• Probe. It is a straight or curved rod. There are special divisions on its surface. A probe is used to measure the length of the uterus.
• Gynecological mirror. This is another tool that is used during vaginal enlargement.

Technique

WFD in gynecology is a procedure that is performed in a prepared sterile operating room. Scraping takes about 20-30 minutes. Anesthesia is usually given by the intravenous route.

Before starting WFD, the patient is asked to empty the bladder. After that, she goes to the ward, where she needs to undress (it is allowed to leave only a nightgown or special clothes for the procedure from her clothes).

At the next stage, the woman goes to the operating room, where at the entrance they put a hat on her head and shoe covers on her legs. After that, the patient lies down on a special chair, she is injected with anesthesia.

In order to eliminate the risk of infection, immediately before entering the uterus, the doctor treats her cervix and vulva with an alcohol solution and a liquid that contains iodine.

After that:

1. The doctor should expose the cervix with the help of a gynecological mirror and fix it with forceps.
2. After that, he inserts a probe into the cervix and measures the length. Only then can the expansion procedure be performed using the Heger expander. In this case, the doctor first uses a small expander, gradually increasing its size.
3. When the cervical canal reaches the required size, a curette is sent into it and the curettage procedure begins.
4. First, curettage of the cervical canal is performed. In this case, penetration into the internal cavities does not occur. Only at the second stage of the operation, the doctor begins to scrape the internal cavity of the uterus.

During the operation, instruments of different sizes are used.

During the procedure, hysteroscopy can be performed. In this case, at the stage of expansion of the cervical canal of the uterus, a special device, a hysteroscope, is introduced into it. It allows you to better inspect all surfaces and identify possible additional problems.

The doctor can remove most of the neoplasms directly during the WFD. At the same time, it is possible to successfully get rid of even fibroids that have grown to 4 cm. After completing the procedure, the woman almost immediately comes to her senses and is sent back to the ward. There she must spend a few more hours. Feelings of weakness and headaches are considered normal.

Consequences and complications

WFD in gynecology is a procedure that requires monitoring after it has been performed. For this purpose, additional examinations are carried out. The doctor should assess how evenly the areas of the uterine cavities were treated.

Very often, after curettage, women complain of pulling pains in the lower abdomen. This is the norm. But sometimes the pain is too strong. In such a situation, the doctor may allow the use of an anesthetic. It can be in tablet or liquid form. Then the injection is performed.

For the next 3-4 days, the patient may complain of a small volume of blood discharge. This suggests that there is a process of blood accumulation in the uterine cavity. In this case, the patient may experience a slight increase in temperature. However, if the body temperature indicators exceed 37.2-37.5⁰, it is imperative to inform your doctor about this.

After a few weeks, the woman's condition is completely restored. For some, this process may take less time.

Complications can arise due to the fact that during the procedure, doctors made mistakes. This happens very rarely.

After RDI, some patients were diagnosed with:

• Injury or rupture of the cervix. This can happen due to a sharp, rather than sequential, expansion of the uterus during the procedure.
• Perforation of the cervix. In this case, injuries are caused by careless use of gynecological instruments. The risk of such damage increases if WFD is performed immediately after an abortion, childbirth, or if the uterus itself does not develop properly. Such injuries are detected immediately, so doctors can immediately take all the necessary measures to exclude subsequent, more serious complications.
• Infections. Such complications are detected in the rarest cases. Usually, this condition is provoked by inflammatory processes in the uterus, during which RVD is performed. However, thanks to preliminary analyzes, it is almost always possible to exclude infection.

How is rehabilitation going?

After the procedure, the woman is in the hospital, where she is periodically examined by a doctor. If necessary, medication is prescribed. It is recommended to spend the first days after the WFD at home, to rest as much as possible.

Some patients say that they returned to their usual way of life immediately after being discharged from the hospital. Discharge is usually carried out the day after the curettage is performed, regardless of how well the patient feels.

But there are some limitations. For example, you cannot return to sexual activity for at least 2 weeks after surgery. In some cases, the doctor recommends waiting up to 1 month.

For 5-10 days, discharge may be observed, but every day there will be less and less of them. The postoperative rehabilitation period does not involve taking antibiotics. However, if a woman's temperature rises, she may be prescribed anti-inflammatories. Antibiotic therapy is used only in the rarest of cases.

During the first 3 days, the patients are in the status of disabled. Therefore, at this time it is strongly discouraged to go to work and engage in physical labor. As a rule, the menstrual cycle is fully restored one month after the WFD procedure.

If in the first month there is a strong discharge, the volume of which increases daily, you should immediately consult a doctor. You also need to monitor your body temperature. If it increases the permissible level, you should not try to be treated with folk methods or independently prescribe medication for yourself. This condition can lead to hospitalization.

However, most often the recovery period passes without any complications if the woman adheres to all postoperative recommendations.

Such a procedure as RFE in gynecology is an effective method not only for diagnosis, but also for the treatment of many dangerous pathologies. Thanks to scraping, it is possible to timely identify benign and malignant neoplasms and, if necessary, remove them.

The success of the operation depends both on the skill of the doctor and on how well the patient prepared for the upcoming procedure. This is a modern diagnostic method, which is often preferred when determining whether a woman is suffering from cancerous tumors and other lesions of the reproductive system.

Video about WFD

About separate diagnostic curettage of the uterus: