Praxis Medical Insights

Pre-Procedure and Intraoperative Considerations

Endoscopists performing fewer than 500 procedures are four times more likely to cause uterine perforation, highlighting the importance of experience in minimizing complications 1, 2

The National Comprehensive Cancer Network recommends inspecting curetted material for completeness and sending it for histopathologic examination to ensure accurate diagnosis 3
Estimating blood loss is crucial during and immediately after the procedure to monitor for excessive bleeding 4
Post-procedure infection, characterized by fever and pelvic pain, can occur, especially with retained products and prolonged procedure time, emphasizing the need for careful patient monitoring 1, 4
Excessive bleeding, defined as soaking through more than one pad per hour for 2 consecutive hours, requires immediate evaluation and intervention 1, 4

For fertility-sparing evaluation in young women with grade 1 endometrial cancer or atypical hyperplasia, D&C with or without hysteroscopy is required for definitive histologic diagnosis, as recommended by the European Society for Medical Oncology and the National Comprehensive Cancer Network 5, 3, 2
D&C is superior to office biopsy for accurate tumor grading, despite office methods having high sensitivity for detecting carcinoma, according to the American College of Obstetricians and Gynecologists 2
Office biopsy has a 10% false-negative rate, and a negative result in symptomatic patients requires fractional D&C under anesthesia to ensure accurate diagnosis 1, 2
Hysteroscopy can be used as an adjunct to evaluate focal lesions like polyps in patients with persistent undiagnosed bleeding, as suggested by the American Association of Gynecologic Laparoscopists 1