New technique for reducing the risk of perforation of the uterus at the beginning of dilatation and curettage

The most critical part of dilatation and curettage (D&C) is blind dilatation of the cervix. A new technique is suggested to prevent perforation of the uterus when dilating a very narrow cervical canal. The external os is dilated only with a 2- to 7-mm Hegar dilator. Then a 7-mm rigid hysteroscope attached to a distending medium source is passed into the canal and, under hysteroscopic guidance, through the canal to the internal os. Thus the dilator is passed in the correct direction. When the smallest dilator cannot be passed after this maneuver, the internal os can be dilated using minigrasping forceps under hysteroscopic vision. We believe that this new technique will reduce the risk of perforating the uterus during D&C.