DILATATION AND CURETTAGE INFORMATION & INFORMED CONSENT DOCUMENT

Op. Dr . Mesut BAYRAKTAR Private Clinic

In accordance with the “Article 70 of the Law No. 1219, dated 11 April 1928, on the Practice of Medicine and Medical Sciences” and in accordance with: It is the consent document that must be obtained from patients before medical, invasive and surgical interventions.

2 Introduction – Procedure – Surgery Information

2a- Precautions to be Taken Before Entrepreneurship – Operation-Surgery:

You will be informed about the procedure – operation – surgery to be performed, and you will be asked to sign this informed consent form. This practice is necessary to ensure that you understand the entire procedure. If you have any questions or concerns, please feel free to ask. Information about anesthesia and potential risks will be explained in detail by the relevant specialist since the procedure – operation – surgery will be performed under local or sedative drugs. There are tests that need to be done before the procedure – operation – surgery, which vary depending on your age, medical condition, and the procedure to be applied to you. Your doctor will generally refer you to hospitals if these tests are necessary for you to undergo. You can also choose the institution that suits your budget.

2b- Important Aspects Regarding the Entrepreneurship – Transaction – Surgery Process:

The procedure will be performed vaginally. The cervix will be dilated sufficiently to allow passage of the surgical instruments to be used in the procedure, and then the pregnancy material inside the uterus will be aspirated using a vacuum syringe (Karman aspirator) or vacuum. If necessary, sharp curettes may need to be used to ensure minimal remaining material inside. It is impossible to remove the pregnancy material 100% from the uterus. Your body will gradually eliminate the rest. A urinary catheter may be inserted at the end of the procedure if necessary. This catheter will be removed by your doctor when deemed appropriate after the surgery. In some cases, the material inside may not be completely removed due to its location or characteristics. In such cases, the procedure may be partially completed, and multiple sessions may be required to complete the treatment, or it may not be possible to perform it at all if difficulties arise. Partially completed cases can manifest as “incomplete procedures” with findings such as a control ultrasound showing an EL line, the absence of uterine cry sounds, or no additional material being aspirated with the Karman aspirator. Therefore, in the following days, if abnormalities, problems, or suspicions arise regarding the removal of pregnancy material, a new procedure may be planned or medication may be given to aid in the expulsion of remaining material. If other pathologies are detected during the procedure (polyps, molar pregnancy, etc.), interventions required for these conditions may be performed for your faster recovery and for the procedure to be fully successful, as long as it is in your best interest. In such cases, additional interventions may be performed for your health if deemed necessary.

During the planned procedure, unexpected and unwanted situations may occur.

● Cervical spasm
● Cervical anomaly
● Uterine anomaly
● Previous partial adhesions or constrictions within the uterus or cervix
● Retroverted uterus
● Adenomyotic uterus
● Uterus with chronic infection
● Uterus with altered parenchymal structure
● Uterine dissection during dilation with Hegar dilators
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These conditions may lead to the failure or impossibility of the procedure. After the doctor determines a suitable timeframe for your condition, they may recommend another surgical intervention. If that also fails, hospitalization may be suggested with medication support, promoting adequate cervical dilation and mobilization of pregnancy material towards uterine expulsion under hospital conditions. In such a case, failure to perform the abortion may occur. Your doctor will discuss a new plan with you for the way forward.”

According to various mathematical models, fertilization (conception) can occur up to 6 days before ovulation. The estimated lifespans of sperm and the egg are 1.4 days and 0.7 days, respectively.
● The probability of sperm surviving for more than 5 days is 5%,
● The probability of sperm surviving for ~7 days or longer is 1%.
● Sperm that has reached the Tuba uterina may have a longer lifespan.

Vacuum-assisted abortion procedures cause minimal damage to the uterine tissue; therefore, the uterus can heal itself quickly, so please refrain from sexual intercourse for at least 15 days after the procedure. You can become pregnant again after an abortion. This does not indicate that your pregnancy was terminated. In a uterus with increased blood flow and improved pregnancy performance, the gestational sac grows rapidly.

Please do not engage in sexual intercourse before the abortion procedure. Do not think, “I’m already going to have an abortion, so there won’t be any pregnancy, and if there is, it can be terminated.” Although it is rare, a new pregnancy can occur due to sexual intercourse before abortion and the rapid healing of the uterus with vacuum aspiration. Pregnancy is a complex condition with various abnormalities. Remember that the procedure is completed when the uterine cavity is checked with an ultrasound after each abortion.

Superfetation, superfecundation, and superovulation situations may be rare, but they can find you, might have found you now, remain undetected, and can lead to a situation that will be understood later; in other words, the risk is not zero. We do not have absolute knowledge of your private life and sexual experiences; people can even report such matters to a physician inadequately, covertly, or inaccurately.

In the abortion procedure, pregnancy material has come out with a vacuum aspirator – removed + in the ultrasound control, the uterine interior is clean, in a linear form + a cry sound can be heard + more material may not come out with vacuum abortion.

These are signs that indicate the success of the procedure but are not 100% certain. That’s why, even if the doctor tells you that the abortion procedure was successful, you need to come for a follow-up examination and request an appointment with the doctor after you have finished the prescriptions he has written for you due to the abortion procedure. Five days after the antibiotics prescribed to you by the doctor for the abortion procedure have run out, contact us via WhatsApp at 0546 774 01 59.

Even if you feel well, Even if you think there are no problems, If the doctor has not recommended a follow-up appointment for you on a nearby date, request a “new examination, reevaluation appointment.” This is a mandatory examination that you must undergo, and we emphasize this clearly in this consent form, especially in writing. This is the written version of my invitation to you.

There are no conditions such as superfetation, superfecundation, superovulation, etc., but if continuing pregnancy material is observed (as I explained above), unfortunately, it can be a ‘difficult pregnancy’ situation, and the doctor may recommend another curettage. The ‘difficult pregnancy’ situation can be easily overcome with ‘doctor compliance.’ I have explained how important doctor compliance is in the curettage procedure in the most understandable way. The doctor does not guarantee absolute removal of the material in one session, one time during the curettage procedure.

If you do not accept one or more of these procedures, you must notify us “immediately – right now” of your request. Because failing to meet your demands may put Mesut Bayraktar in an inappropriate position.

2c-Important Considerations for Entrepreneurship-Transaction-Postoperative :

If necessary, various medications can be given to you intravenously, intramuscularly, subcutaneously, orally, or through the respiratory tract. Similarly, detailed information about blood or blood product transfusions will be provided to you if needed. Blood or urine tests may be required while under observation. All of these measures aim to facilitate your recovery as quickly as possible and prevent undesirable conditions from arising. While the average length of your hospital stay may be a few hours, this duration may vary depending on factors such as recovery and the occurrence of undesirable conditions. After discharge, you may be instructed to continue some medications. Your doctor will provide you with detailed information on how long to take the medications, how to use them, and when to return, all in this format. In cases of medical necessity, you may be admitted to an inpatient ward for a period or monitored in the intensive care unit. When an abortion procedure is performed due to pregnancy, antibiotics are prescribed to every patient without exception, even if the procedure is carried out with the utmost sterility and cleanliness, to prevent infection or exacerbation of existing chronic uterine inflammation. You should promptly obtain and start the prescription that your doctor has written for you.

Some people, feeling well after the entrepreneurial-operation-surgery process, may refrain from taking the prescription, attributing it to false well-being and excessively relying on their own resistance. Do not do this. 3-7 days later, inflammation in the uterus, pain and bleeding can occur in women who have had an abortion with blood clots accumulating in the uterus, and they may have to go to the nearest hospital. Another doctor at this hospital may interpret the accumulation of blood clots in the uterus as the continuation of pregnancy due to their similar appearance (which shows that you did not come to me first and went to another physician, indicating non-compliance). Remember, after every abortion procedure, the uterine cavity is checked with ultrasound to ensure that the pregnancy material is completely evacuated. When evacuation occurs, the uterine lining is seen as a straight line, and/or a crying sound is heard, and no more material is coming out with vacuum devices, and it cannot be aspirated. The abortion procedure is an intervention that requires compliance with the physician, carries the risk of repeat procedures, and can create complications. Waiting at home; When fainting develops, which guarantees death or permanent illness, the responsibility of coming to the doctor or going from doctor to doctor, hospital to hospital, is not the physician.

3-) Informing About the Risks of Surgery – Operation:

There is a risk of encountering unwanted conditions related to your surgery. These conditions are not limited to those described below. Writing everything in this document and making it textbook-like means you may not learn anything at all. Problems, albeit rare, may require a re-entry, procedure, or surgery. Necessary precautions will be taken to prevent these from occurring. If they do occur, the treatment period may be extended, or additional treatments may be necessary. In rare cases, these conditions can lead to death. It is very difficult to predict in advance whether all of these unwanted conditions, some of which have been explained below, will occur or not.

3a- Special Risks

Bleeding:

Apart from bleeding considered clinically insignificant up to a certain amount, rare but serious bleeding can also occur, necessitating urgent surgery or transfusion of blood products.

Organ injuries:

Injuries related to perforation and/or burning can occur in large and small blood vessels, the uterus, ovaries, fallopian tubes, intestines, bladder, and urinary tract. Depending on the nature, size, or location of these injuries or the placement of myoma, additional surgical interventions may be necessary in the future, which could make it difficult or prevent one from having children. In cases of urinary tract injuries, long-term catheterization of the bladder or the placement of a stent/tube in the urinary tract may be required.

Failure to perform or complete the process:

It may not be possible to perform or complete it due to technical difficulties or physical barriers. Pregnancy material may not be partially/fully obtainable.

Transition to laparoscopy (closed abdominal surgery) or laparotomy (open abdominal surgery):

Open or closed abdominal surgery may be necessary due to unusual bleeding/injury.

Embolism (blockage of blood vessels with clots, fat, or gas):

There may be a clot formation in the leg veins due to prolonged immobility (deep vein thrombosis). In this condition, which requires preventive treatment to prevent prolonged blood clotting, a clot in the leg veins can break off and travel up to the pulmonary artery (Pulmonary embolism). The risk of clot formation can increase due to certain patient-specific factors (conditions predisposing to coagulation, obesity, vascular diseases, smoking, diabetes, limited mobility, etc.). Very rarely, blood vessels can be blocked by gas or fat instead of deep vein thrombosis.

Adhesions in the uterus:

Adhesions can form within the uterus after the procedure. This can lead to disruptions in the menstrual cycle or difficulty in getting pregnant or maintaining pregnancy. Additional surgeries may be required in this situation. These adhesions can also exist before the procedure, causing the inability to perform or partial completion of the abortion procedure, the need for repeat procedures, and even hospitalization.

Vaginal bleeding:

Depending on the procedure, there may be some bleeding from the cervix or inside the uterus for a few days. This bleeding gradually decreases and subsides. In cases where the bleeding does not stop, the cause is determined through examination, and necessary treatment is administered by the physician. If vaginal bleeding does not stop, you need to come for a doctor’s examination and request an appointment for the examination. Please request a “new examination appointment” if the physician has not recommended a closer date to you, even if you feel well and even if you do not think there is any problem. You are required to undergo this examination, and we emphasize the importance of it to you through this informed consent form.

Pain:

A significant portion of pains decrease or disappear within a few days after surgery. Rarely, this period can be extended. Pain relievers are used in the treatment of pain. When your pain does not go away, the cause is determined through an examination, and the necessary treatment is applied by the physician. If your pain related to the gynecological area does not subside, you should come for a doctor’s examination and request an appointment for the examination. Five days after the antibiotics prescribed by the doctor for the abortion procedure have finished, via WhatsApp at 0546 774 01 59, even if you feel well, even if you think there is no problem, if the doctor has not recommended a “new examination appointment” for you, please request it. This is a mandatory examination that you must have done, and we emphasize this to you, especially with this consent form.

Infection (inflammation):

Various infections – inflammations can be observed after surgery, abortion procedures, or intrauterine interventions, or those that are already chronic can flare up. If a respiratory tract infection, intrauterine infection, or intra-abdominal infection develops, necessary tests are performed, and appropriate antibiotic treatment is initiated based on the results. In case of abscess formation, it is necessary to either drain the abscess or remove it completely through surgery. The risk of infection may increase due to certain factors related to the patient (obesity, vascular diseases, diabetes, smoking, immunodeficiencies, etc.). If the infection does not subside, prolongs, or does not effectively regress with medication, the cause is attempted to be determined through examination, and necessary treatment is applied by the physician. When the infection or inflammation does not resolve, it is necessary to come for a medical examination and request an appointment for an examination. Even if you feel well, even if you think that there is no problem, if the physician has not recommended a “new examination appointment” to you, request it. This is a mandatory examination that you must undergo, and we specifically emphasize this to you with this informed consent form.

3b- General Risks:

Various complications defined in medical literature may arise during and after the procedure, surgery, or operation due to the medication and medical equipment used. Additionally, mild numbness in the incision area or permanent scarring, short or long-term pain and numbness due to positioning during procedures, diarrhea or constipation, insufficient lung aeration (atelectasis), heart rhythm disorders, sudden cardiac arrest, allergies, loss and insufficiency of limb and organ functions, paralysis, brain damage, and epileptic seizures are rare but important conditions that you should be aware of and may encounter. Due to these reasons, antibiotic treatment or additional surgeries may be necessary, and your treatment may need to be continued in intensive care.

3c- Blood, Blood Product Transfusion, and Risks:

Bleeding may occur during a medical procedure or surgery. Following these bleedings or for the correction of anemia, blood and blood products, which we refer to as whole blood, erythrocytes, fresh frozen plasma, and platelet suspension, can be administered. Depending on the administration of these products, minor reactions such as fever, itching, redness, and other allergic reactions can occur at an approximate rate of 1/100,000. More serious reactions such as bleeding, a decrease in blood pressure, kidney failure, or death are less than 1/10,000. The incidence rate of viral hepatitis and HIV is 1/10,000 – 1/500,000.

3d- DEATH RISK:

There is a risk of death in all kinds of simple to advanced treatments, interventions, and surgical procedures. A doctor cannot guarantee the preservation of life in any surgical or medical procedure. The occurrence of death can be sudden or can happen in hospital rooms, at home, on the way, etc., for reasons that cannot be predicted, known, foreseen, or even revealed in examinations. The actual cause of death may not be found in a forensic autopsy, and a different, related or unrelated cause of death may be identified. If there were such an obvious and pronounced risk of death, the doctor would have taken measures to reduce this risk to the lowest possible level. Remember that the risk of death cannot be eliminated. The doctor practices the profession to keep patients alive and improve their quality of life. If you are currently considering making accusing claims (negligent or non-negligent) against the doctor in case of the occurrence of death; if you cannot accept the risk of death; I recommend that you abandon this procedure now and continue your life with your current health condition. In reference to the doctor being an intelligent and conscious individual, I hereby commit that I/we will not interpret the current situation as causing negligent or non-negligent death if the patient’s/my death occurs; I/we will not claim it.

4-) Information About the Benefits and Success Rate of the Procedure:

The purpose of this procedure is to remove the pregnancy material from the uterus. The method we will apply to you is not only a highly successful and rapidly yielding treatment but also allows for a definitive diagnosis by examining the removed tissue pathologically when necessary.

5-) Alternatif Options to Entrepreneurship-Procedure-Surgery:

The options suitable for your condition have been indicated by your doctor: o Periodic follow-up
o Medication therapy
o Placement of a uterine intrauterine device containing hormones o Laparotomy o Laparoscopy o None

6-) Special Additional Risks in Case of Non-Performance of the Entrepreneurship-Operation-Surgery

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7-) Cost:

Cost of the patient’s treatment and/or complications that may develop, additional treatment requirement expenses, all kinds of transportation costs, accommodation expenses, hospital fees, hospital consumables and medicine costs, operating room usage fee, each examination fee after the abortion procedure, repeat abortion procedure. Please sign this consent form on the condition that the fees, accommodation and transportation fees of the Physician due to the patient’s treatment, etc. will be paid to the Physician in cash by themselves or their legal representatives. As the patient and/or their representative, we will make all payments; We will not avoid payment; We will not create financial excuses as excuses for not paying treatment fees; We will not leave the physician in difficulty in the practice of his profession; We will not make the practice of medicine a cruelty to physicians by hiding or diminishing our existing assets or wealth; We declare and accept that we will not cause financial burden to the physician with these or similar actions. By exhibiting humane and conscientious approaches to cultivation; In order to avoid financial payments that may arise in case the procedure turns into a technical difficulty or undesirable complication, and to leave the burden of treatment to the Physician, and even to request a refund of the payments made; I undertake that I will not violate the doctor and his treatment in a threatening – blackmail approach such as “your diagnoses are wrong – your treatments are wrong; I will report you to the prosecutor’s office”. In return, the physician practices his profession according to his strength and means. In cases of dispute, Muğla Courts are authorized.

8-) Informed Consent of the Patient:

I received detailed information from Dr. Mesut Bayraktar about the diagnosis and treatment of my medical condition, medical – surgical treatment or diagnostic interventions. I read every page of this document, which is 5 (five) pages in total, and learned the issues I did not understand by asking Dr. Mesut Bayraktar. The benefits of the treatment, the chance of success and duration, possible negativities that may occur during my treatment, possible risks, complications, and failures were explained in detail. When I refused the diagnosis and treatment methods recommended to me, I was explained what other risks might threaten my health. I was informed about whether there was another treatment method that could be applied instead of this treatment. I was given the necessary information about the possible costs of all diagnostic and treatment methods to be applied in the hospital due to my illness. I was explained that unless my situation was an emergency, I had the opportunity to discuss the details of the anesthesia with an anesthesiologist. Unless my situation was urgent, I was informed about the tests I needed to have before the surgery and I understood the importance of having the tests done. It was explained that any additional intervention other than those described in this form could be implemented to prevent serious harm to my health and save my life. If situations arise during the planned interventions and/or treatments that may require additional interventions and treatments; I authorize my physician and other healthcare personnel to perform interventions, procedures or surgeries. I know that no assurance/guarantee can be given to me regarding the outcome. It was explained that the procedure may involve blood and blood product transfusion and its possible risks. I consent to blood and blood product transfusion if necessary during my treatment. Provided that patient privacy rights are observed, I approve permanent and temporary skin markings necessary for treatment planning and application, taking inside and outside body photographs and other imaging procedures to verify my identity and monitor the developments in the treatment area. All of the examination, treatment and result information regarding my disease can be used and published by Dr. Mesut Bayraktar for retrospective and prospective scientific studies, for the purpose of discussing with colleagues – getting ideas and suggestions, to improve himself and medical science, to develop science for the benefit of humanity, on the condition that all my identity information remains confidential. I allow.

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Intramuscular Injection Procedure:

Intramuscular injection can be applied for a variety of reasons. This procedure involves injecting medication into the muscle (upper outer part of the arm, upper outer part of the hip, or upper front part of the thigh). Intramuscular injection can be performed in a wide variety of diseases (infections, all kinds of pain, chronic diseases, etc.). To give an example of intramuscular administration, some vaccines, painkillers, antipyretic drugs, some antibiotics, vitamins, etc. Some drugs are prepared only for intramuscular administration and cannot be administered to the body by any other way. Many drugs are available in forms designed to be taken intramuscularly, intravenously or orally. Administering the drug intramuscularly allows it to be effective in a shorter time. Intramuscular injection is usually given in the upper outer part of the buttock. However, it can also be applied to one of the other areas listed above when deemed necessary by the physician or upon the request of the patient. In practice, the skin is cleaned with an antiseptic solution and the needle is inserted into the area and the drug is injected into the muscle. After the medication is administered, the needle is withdrawn and the area is rubbed with dry cotton. If you do not strain yourself during the procedure, the possibility of the following side effects is very low. Therefore, take deep breaths during the procedure. Pain may be felt during intramuscular injection and after the needle is withdrawn. Rarely, infection, bleeding, bruising, lump-shaped swelling and permanent or temporary nerve damage (loss of strength, numbness) may occur at the injection site. Very rarely, the needle may break during injection. You must provide sufficient information to the physician about whether this procedure has been done before, the medications the patient uses, any accompanying diseases, whether there is a bleeding disorder or allergy .

Information about you (identity information, your pictures, your ailments, the treatment given) can be never shared in any medium without your written consent or court order; on the internet, social media sharing sites, etc. will not be disclosed – will not be shared. Likewise, the patient and/or parent/guardian cannot share photographs/ information / suggestions / recommendations / complaints / comments etc. regarding Op.Dr.Mesut Bayraktar without obtaining Op.Dr.Mesut Bayraktar’s written permission; undertakes not to share anything in the form of.

I declare that this form has been fully explained to me, that I have read or had it read to me, and that I understand its content.

This section must be written in the patient’s or legal representative’s own handwriting.

The statement “I READ, I UNDERSTAND, I ACCEPT” will be written.

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The statement “I RECEIVED ONE COPY IN PERSON” will be written in the handwriting of the patient or their legal representative.

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