History of Uterine Curettage
Endometrial biopsy is the insertion of a thin cannula through the cervical
os to obtain a sample of the lining of the uterus. An endometrial biopsy
can usually be performed in a physician's office with no anesthesia or
with a local anesthetic.
Instrumentation of the female genital tract can be traced to antiquity.
Vaginal speculums have been recovered from the ruins of Pompeii.
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Ancient speculum recovered from Pompeii. From Leonardo RA: History
of gynecology, Plate II, New York, 1944, Theo. Gaus' & Sons,
Inc.
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In the fifth century BC, Greek physicians dilated the cervical os with pieces of wood in an effort to relieve obstruction of menstrual flow.
The nineteenth century saw the introduction of several innovative gynecologic instruments. In 1828, Samuel Lair used a stylet or silver sound to explore the uterine fundus. In 1832, John Mackintosh treated dysmenorrhea by dilating the cervix with graduated metal rods.
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Nineteenth century curette. Leonardo RA: History of gynecology,
Plate XXV, New York, 1944, Theo. Gaus' & Sons, Inc.
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J.C.A. Récamier, in 1843, used a curette—a small scoop attached
to a long blade—to scrape off fungal growths from uterine mucosa.
So that a curette could be passed through a rigid, closed cervix, the
cervix was dilated with sponge tents or packed with iodoform gauze.
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To preserve modesty, vaginal examinations in the 1800s were at times performed with the patient clothed and standing. From Doane: Magriet's
midwifery illustrated, New York, George Gregory, 1853.
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In the 1800s, examination of the female genitalia was viewed as immodest and immoral. At the beginning of the nineteenth century, vaginal examinations were performed with the patient standing.
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Uterine perforation by sponge tent. From Kelly HA: Gynecology,
New York, 1928, D. Appleton & Co.
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Dilatation and curettage (D&C) was felt by some to be hazardous and
barbaric. Either the curette or sponge tent could perforate the uterine
fundus. Aseptic technique and the introduction in 1895 of a curette with a blunt safety point led to the gradual acceptance of D&C.
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Dilateria—dried seaweed that expands slowly in the cervical
os to dilate the opening. From Milex Products Inc. catalog, 1997.
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In 1878, C. Ruge and J. Veit suggested that curettage could be used as
a diagnostic procedure. Curettage was first used to remove retained products
of conception in 1886. Graduated metal rods became the method of choice
to dilate the cervix, although it is still possible to purchase sponge
tents.
At the beginning of the twentieth century, women were often hospitalized for a day or two for a D&C. In 1924, Howard Atwood Kelly advocated performing D&C in the office, sometimes without anesthetic or cervical dilation (Kelly). In 1935, Emil Novak described his method of suction curettage in the office (Novak).
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Novak currette—A narrow metal cannula with a serrated edge.
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From Noval E: A suction-curet apparatus for endometrial biopsy,
JAMA 104;1497-1498, 1935. Copyright 35, American Medical
Association.
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A Vabra aspirator. From Jensen JG: Vacuum curettage: out-patient curettage without anesthesia, Danish Medical Bulletin 17(7):199,
Aug 1970.
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Pipelle, a narrow, flexible plastic tube with internal suction.
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Usually he was able to insert the curette without dilating the cervix
or using sedation. Novak used a narrow metal curette with a serrated edge attached to a water pump. L. M. Randall also introduced a metal curette
in 1935 (Randall). In 1970, Jensen reported his results from 350 outpatient suction curettages of the uterus without anesthesia (Jensen). Jensen used a disposable metal cannula, 3 mm in external diameter, attached to a plastic aspiration chamber. This device, the Vabra aspirator, was connected to an external suction pump. A narrow, flexible plastic tube with internal suction, the Pipelle, was introduced by Cornier in France in 1982 (Cornier)
and approved for use in the United States by the Food and Drug Administration
in 1986.
At present, endometrial aspiration is easily performed in the office.
Suction curettage is used for abortion and diagnostic evaluation. Hysteroscopy
has added to our ability to explore the uterine cavity. D&C under
anesthesia continues to be employed (Ricci,
Kelly).
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