It may be called for when the endometrium is congested and œdematous from such conditions as displacements of the uterus and chronic subinvolution.
It is better not to curette for a purulent uterine discharge; extension of the infection may be caused and give rise to pyosalpinx.
(iii) Sterility. Curetting should follow dilatation, in the hope that the new endometrium formed may afford a better nidus for the ovum.
(iv) Frequent abortion in the early months. Curetting often cures this by removing the diseased endometrium.
(v) Inoperable carcinoma of the cervix. Removal of the redundant portions of the growth by the curette, followed by cauterization or other measures, relieves the hæmorrhage and foul discharge. Great caution must be exercised, lest the peritoneum or bladder be opened into by the curette and the sufferings of the patient thereby increased. Cells of the disease may also be pushed into the pelvic lymphatics; considerable febrile disturbance may also follow the operation. In this condition a blunt curette ([Fig. 60], B) may be gently used; the same instrument is safest in abortion up to the eighth week of pregnancy; after this date it is better to use the fingers only.
Fragments removed by the curette are subjected to microscopical examination for diagnostic purposes. The various conditions which may have to be diagnosed are:—
1. Carcinoma of the body of the uterus.
2. Retained products of conception.
3. Tuberculosis of the endometrium.