Two hundred twenty-two women undergoing incidental diagnostic dilation and curettage (D&C) at the time of elective laparoscopic tubal ligation were studied retrospectively to ascertain if the risks of a D&C were warranted in a group of young, healthy women with a low risk of endometrial pathology. The endometrial sampling was associated with five uterine perforations and one readmission for bleeding and did not uncover any significant pathology in women under 35. The endocervical curettings did yield pathology of some clinical significance in women of all ages. The risk of uterine perforation was significantly higher in women who were < 15 weeks postpartum. We conclude that in a population of asymptomatic women under the age of 35, a diagnostic D&C is not indicated at the time of elective laparoscopic tubal ligation.
PIP: The question of whether the significant risks associated with a dilatation and curettage (D&C) are warranted in a population of young, healthy women prompted a closer examination of performing an incidental diagnostic D&C routinely to detect asymptomatic endometrial pathology. All charts of patients undergoing elective laparoscopic tubal ligation (LTL) with an incidental D&C at Maine Medical Center in the years 1989 and 1990 were reviewed. Parameters examined were age, gravidity, and parity. The medical history was reviewed, noting any history of menstrual abnormalities, bleeding, or abnormal cytologic smears. 222 charts were reviewed. The mean age of the LTL/D&C patients was 33.3 years, mean gravidity was 2.7, and mean parity was 2.0. Five patients sustained uterine perforation at the time of D&C. Four of the 5 perforations occurred in women who were 15 weeks postpartum; only 17 of the 189 parous women without perforation (9%) were 15 weeks postpartum (relative risk, 33.0). These 4 women averaged 10.5 weeks postpartum (range, 7-15). One additional patient required hospital admission postoperatively for excessive bleeding. Pathologic findings of endometrial specimens were normal in 200 cases; the diagnosis was either proliferative, secretory, menstrual, or inactive endometrium. Endocervical curettage pathology was normal in 152: the findings were read as benign, squamous metaplasia, cervicitis, or squamous metaplasia with cervicitis. In 53 cases no endocervical specimen was sent. 17 patients had findings that could have been of clinical significance. 16 patients gave a history of an abnormal cytologic smear. Of the 129 women under the age of 35, only 2 had endometrial lesions of possible significance. All other endometrial lesions occurred in women over 35 years, thus sampling the endometrium may be warranted in them. A routinely performed D&C is not warranted in women less than 35 years old who have no history of abnormal vaginal bleeding. The results also indicate that the risk of uterine perforation appears to be markedly increased up to 15 weeks postpartum.