Department of Obstetrics and Gynaecology, Hospital Universitario ‘ 12 de Octubre’, Madrid, Spain.
J Perinat Med. 2013 May;41(3):267-71. doi: 10.1515/jpm-2012-0146.
To analyze the clinical situations that leads us to carry out curettage after cesarean section, the ultrasound prior surgery, intraoperative, and pathological findings.
A retrospective study of all cases of postpartum curettage after cesarean section in a level 3 maternity unit.
There were 42 curettages to women with cesarean sections (1.6% of all cesarean sections). The indications for curettage were: fever: 21, methrorraghia: 11, and residual trophoblastic tissue: 10. In the previous ultrasound, all indicated curettages for retained trophoblastic tissue showed it, and in a lower proportion those indicated for fever (66.6%) or methrorraghia (22.2%). A total of fourteen curettages (35%) were performed without suspect image of retained tissue, and in all cases the surgeon described to obtain small amount of tissue. From material submitted to pathologic evaluation trophoblastic tissue was found in 64.7%, and there were no differences as curettage indication.
When the previous ultrasound do not showed retained tissue, the surgeon did not remove retained material. When extracted there were always in small amounts. Therefore, it could be concluded that after cesarean section the curettage should be indicated only in the presence of evident ultrasound image of retained products.
分析导致我们在剖宫产术后进行刮宫的临床情况，包括术前超声、术中所见和病理结果。
对三级产科病房所有剖宫产术后刮宫病例进行回顾性研究。
共有 42 例剖宫产术后刮宫（占所有剖宫产术的 1.6%）。刮宫的指征为：发热 21 例，阴道出血 11 例，残留滋养层组织 10 例。术前超声均提示有残留滋养层组织，而提示发热（66.6%）或阴道出血（22.2%）的比例较低。共有 14 例（35%）刮宫术没有可疑的残留组织图像，所有情况下，外科医生均描述仅获取少量组织。从提交给病理评估的材料中发现有 64.7%的滋养层组织，刮宫指征没有差异。
当术前超声未显示有残留组织时，外科医生不会切除残留组织。当提取时，组织总是很少。因此，可以得出结论，剖宫产术后刮宫仅应在有明显超声图像提示有残留产物的情况下进行。
