OG37.4-5 | D and C with EA-ECC Observation — Summary & Reflection

KEY TAKEAWAYS

D&C (OG37.4) and EA-ECC (OG37.5) are minor gynaecological procedures requiring precise anatomical knowledge and careful technique. D&C indications include AUB investigation, postmenopausal bleeding assessment, and ERPC for incomplete abortion. EA with pipelle or Karman cannula samples the endometrial cavity with minimal dilatation; sensitivity for endometrial carcinoma ~85–90%. ECC scrapes the endocervical canal with a Kevorkian curette — used in cervical cancer staging and when endocervical pathology is suspected. Fractional curettage order is CRITICAL: ECC first, then endometrial sampling — reversed order contaminates the ECC specimen. D&C steps: EUA → bimanual assessment → speculum → tenaculum → sound (confirm depth) → Hegar dilatation (sequential, no force) → sharp curette (systematic: anterior, posterior, lateral walls, fundus) → specimen collection. Uterine position determines sounding direction: anteverted = anteriorly; retroverted = posteriorly. Key complication: perforation — recognised by instrument advancing beyond confirmed depth with no resistance; STOP immediately. Asherman syndrome (intrauterine adhesions): late complication of aggressive curettage, especially in post-abortal or post-infective settings.

REFLECT

After observing a D&C or EA-ECC, take 10 minutes to answer these reflective questions: (1) At which step in the procedure did the surgeon pause or slow down — what anatomical or clinical finding prompted that pause? (2) Were separate specimen jars used and correctly labelled? If not, what clinical risk would that create? (3) Did you observe any sign of discomfort to the uterus (colour change, brisk bleeding, sudden instrument advance) that might represent an early warning of a complication? What would you do differently if you were the operator? Reflective practice after minor procedures builds the careful, attentive habits that reduce complications in surgical training.