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International Journal of Gynaecology... Jul 2014Manual vacuum aspiration (MVA) and medical abortion were introduced to replace dilation and curettage/evacuation for incomplete abortions, and postabortion contraception...
Manual vacuum aspiration (MVA) and medical abortion were introduced to replace dilation and curettage/evacuation for incomplete abortions, and postabortion contraception was provided in 5 selected public hospitals in Pakistan. In the largest hospital, an Ipas MVA training center since 2007, MVA use reached 21% in 2008. After the International Federation of Gynecology and Obstetrics (FIGO) and UNFPA provided MVA kits, MVA use increased dramatically to 70%-90% in 2010-2013. In 2 of the remaining 4 hospitals in which the Society of Obstetricians and Gynecologists of Pakistan trained doctors in May 2012 and January 2013, the target of having 50% of women managed by MVA and medical abortion (MA) was met; however, in the third hospital only 43% were treated with MVA and MA. In the fourth hospital, where misoprostol and electric vacuum aspiration use was 64% and 9%, respectively, before training, an MVA workshop introduced the technique. Postabortion contraception was provided to 9%-29% of women, far below the target of 60%.
Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Aftercare; Contraception; Dilatation and Curettage; Female; Gynecology; Hospitals, Public; Humans; Misoprostol; Obstetrics; Pakistan; Pregnancy; Societies, Medical; Vacuum Curettage
PubMed: 24743026
DOI: 10.1016/j.ijgo.2014.03.016 -
BMJ Case Reports Jul 2021A 49-year-old woman, G8P7, presented with 1 week of worsening vaginal bleeding and abdominal cramps in the setting of a recently discovered unplanned pregnancy....
A 49-year-old woman, G8P7, presented with 1 week of worsening vaginal bleeding and abdominal cramps in the setting of a recently discovered unplanned pregnancy. Vaginal ultrasound findings and a significantly elevated human chorionic gonadotropin (hCG) level were concerning for molar pregnancy. She developed signs of hyperthyroidism on the night of admission, for which the endocrinology team was consulted. Laboratory data were consistent with hyperthyroidism. The patient was believed to have thyrotoxicosis secondary to molar pregnancy with concern for impending thyroid storm. Her mental health disorder and bacteraemia made taking care of her further challenging. She was started on a beta-blocker, antithyroid agent and intravenous corticosteroids. She underwent an uncomplicated suction dilation and curettage (D&C), with resolution of her symptoms a few days after. At a follow-up appointment, the patient continued to be asymptomatic and was feeling well.
Topics: Antithyroid Agents; Female; Humans; Hydatidiform Mole; Middle Aged; Pregnancy; Thyroid Crisis; Thyrotoxicosis; Vacuum Curettage
PubMed: 34226253
DOI: 10.1136/bcr-2021-242131 -
International Journal of Gynaecology... Apr 2023Globally, 25% of pregnancies end up in induced abortion, the majority of which are unsafe. Abortion is safe when conducted according to WHO recommendations. The... (Review)
Review
Globally, 25% of pregnancies end up in induced abortion, the majority of which are unsafe. Abortion is safe when conducted according to WHO recommendations. The objective of the present study was to identify gaps in the data published on abortion and make recommendations to the Ministry of Health, Uganda. The search strategy included PubMed, Google Scholar articles (from October 2020 to May 2021) on unsafe abortion in Uganda, reviewed data from the Association of Obstetricians and Gynecologists of Uganda (AOGU) members' baseline survey (2019), Health Management Information System (HMIS) summary data (2015-2016 to 2019-2020), and the Uganda Demographic and Heath Survey (DHS) report (2011, 2016). From the 200 articles and national health surveys identified, 37 articles and two national representative surveys met our criteria: prevalence, factors, estimating cost of induced abortion, and complications associated with safe and unsafe abortion in both low- and high-income countries. There are many unsafe abortions in restrictive environments. Abortion is one of the leading causes of maternal and morbidity. Physicians favor dilatation and curettage over manual vacuum aspiration and medical methods for the evacuation of retained products. Several gaps still exist in the published articles, HMIS data, and DHS data, leading to missed opportunities for data to inform policy and practice.
Topics: Pregnancy; Female; Humans; Uganda; Abortion, Induced; Surveys and Questionnaires; Health Surveys; Policy
PubMed: 36436881
DOI: 10.1002/ijgo.14588 -
The International Journal of... Jun 2022The culture failure rate of conventional karyotyping in products of conception evacuated from early pregnancy loss by traditional electrical vacuum aspiration and/or...
OBJECTIVE
The culture failure rate of conventional karyotyping in products of conception evacuated from early pregnancy loss by traditional electrical vacuum aspiration and/or dilation & curettage remains high. We aim to determine whether obtaining products of conception from early pregnancy loss via another evacuation approach, ultrasound-guided manual vacuum aspiration, could decrease the culture failure rate of karyotyping.
METHODS
For patients with early pregnancy loss, ultrasound-guided manual vacuum aspiration (Case group) and traditional electrical vacuum aspiration and/or dilation & curettage (Control group) were applied as surgical methods for pregnancy loss management respectively. The evacuated products of conception were subjected to cytogenetic karyotyping analysis. The primary outcome was the culture failure rate of karyotyping. Secondary outcomes included the chromosomal abnormality spectrum, maternal cell contamination, and complications from the manual vacuum aspiration procedure.
RESULTS
For the case group, 132 products of conception were genetically analyzed by conventional karyotyping. The culture failure rate was significantly lower than that of the control cohort (2.3% vs 7.4%, p = 0.027). 65.2% of cases were abnormal within the detection scope of karyotyping. The euploid female to male ratio was 0.82 (18:22), suggesting a lower likelihood of maternal cell contamination. The efficacy in achieving complete evacuation was 99.6%. There were no significant complications from the procedure.
CONCLUSION
Ultrasound-guided manual vacuum aspiration approach significantly decreased the culture failure rate of karyotyping and decreased maternal cell contamination tendency, enabling a high and accurate cytogenetic diagnosis. It is especially crucial when the cytogenetic analysis is required in the early pregnancy loss clinics.
Topics: Abortion, Spontaneous; Cohort Studies; Cytogenetic Analysis; Female; Humans; Male; Pregnancy; Ultrasonography, Interventional; Vacuum Curettage
PubMed: 35580747
DOI: 10.1016/j.biocel.2022.106226 -
The Journal of Obstetrics and... Apr 2021To evaluate the risk factors and incidence of Asherman Syndrome in women with post-abortion uterine evacuation and curettage.
AIM
To evaluate the risk factors and incidence of Asherman Syndrome in women with post-abortion uterine evacuation and curettage.
METHODS
A total of 2546 patients who had surgical abortion (uterine evacuation and curettage) before the 20th gestational week with indications of missed abortion, anembryonic pregnancy, incomplete abortion, and elective curettage in a tertiary antenatal care center were recruited. The patients were called and surveyed for their symptoms; including infertility, oligo-amenorrhea and recurrent pregnancy loss, preterm birth and intrauterine growth retardation and abnormal placentation as criteria of Asherman Syndrome. Diagnostic (office) hysteroscopy was performed for 177 who had one of those complaints.
RESULTS
The incidence of Asherman Syndrome was 1.6% (n = 43/2546). History of ≥3 abortions was the main factor that increased the risk of Asherman Syndrome for by 4.6 times. Use of vacuum aspiration or sharp curettage, premedication for cervical priming, and having a pregnancy >10th gestational weeks were not risk factors for Asherman Syndrome.
CONCLUSION
When the diagnosis was based on presence of symptoms who underwent uterine instrumentation, the incidence of Asherman Syndrome was found to be 1.6%. Repeated abortions were the main risk factor for Asherman Syndrome and avoiding from repeated uterine instrumentations may have a role in prevention.
Topics: Curettage; Dilatation and Curettage; Female; Gynatresia; Humans; Incidence; Infant, Newborn; Pregnancy; Premature Birth; Risk Factors; Vacuum Curettage
PubMed: 33462894
DOI: 10.1111/jog.14667 -
Journal of Nepal Health Research Council Apr 2020Nepal government has legalized abortion and approved both medical abortion and manual vacuum aspiration for first trimester pregnancy. However, there is inadequate... (Comparative Study)
Comparative Study
BACKGROUND
Nepal government has legalized abortion and approved both medical abortion and manual vacuum aspiration for first trimester pregnancy. However, there is inadequate evidence in our setup to comment on the acceptability and complications of medical abortion and manual vacuum aspiration for termination of pregnancy up to nine weeks of gestation. The objective of this study is to compare the reasons for termination of pregnancy, effectiveness and complications between medical abortion and manual vacuum aspiration in termination of pregnancy up to nine weeks.
METHODS
A comparative study was conducted among women requesting termination of pregnancy up to nine weeks of gestation in Comprehensive Abortion Care unit of Paropakar Maternity and Women's Hospital. Women were kept in medical abortion and manual vacuum aspiration groups after they chose the method. They were advised for follow up in two weeks. Reasons for termination, effectiveness and complications of medical abortion and manual vacuum aspiration were compared using Chi square test.
RESULTS
In a total of 160 women, the most common reason for termination of pregnancy was completion of the family. In manual vacuum aspiration group 43 (58.9%) women had minimal per vaginal bleeding while 30 (40.54%) women in medical abortion group had per vaginal bleeding for 6-10 days(p less than 0.001). Rate of complete abortion in medical abortion group was 85.14% (n=63) and in manual vacuum aspiration group was 93.15% (n=68).
CONCLUSIONS
The complications following medical abortion were higher than manual vacuum aspiration in termination of pregnancy up to nine weeks. Rate of completeness of abortion following manual vacuum aspiration is superior over medical abortion.
Topics: Abortion, Legal; Female; Humans; Nepal; Pregnancy; Pregnancy Trimester, First; Vacuum Curettage
PubMed: 32335605
DOI: 10.33314/jnhrc.v18i1.1710 -
Cardiovascular Revascularization... Dec 2023Transcatheter aspiration is utilized for removal of thrombi and vegetations in inoperable patients and high-risk surgical candidates where medical therapy alone is...
BACKGROUND
Transcatheter aspiration is utilized for removal of thrombi and vegetations in inoperable patients and high-risk surgical candidates where medical therapy alone is unlikely to achieve desired outcome. A number of case reports and series have been published since the introduction of AngioVac system (AngioDynamics Inc., Latham, NY) in 2012 where this technology was used in the treatment of endocarditis. However, there is a lack of consolidated data reporting on patient selection, safety and outcomes.
METHODS
PubMed and Google Scholar databases were queried for publications reporting cases where transcatheter aspiration was used for endocarditis vegetation debulking or removal. Data on patient characteristics, outcomes and complications from select reports were extracted and systematically reviewed.
RESULTS
Data from 11 publications with 232 patients were included in the final analyses. Of these, 124 had lead vegetation aspiration, 105 had valvular vegetation aspiration, and 3 had both lead as well as valvular vegetation aspiration. Among the 105 valvular endocarditis cases, 102 (97 %) patients had right sided vegetation removal. Patients with valvular endocarditis were younger (mean age 35 years) vs. patients with lead vegetations (mean age 66 years). Among the valvular endocarditis cases, there was a 50-85 % reduction in vegetation size, 14 % had worsening valvular regurgitation, 8 % had persistent bacteremia and 37 % required blood transfusion. Surgical valve repair or replacement was subsequently performed in 3 % and in-hospital mortality was 11 %. Among patients with lead infection, procedural success rate was reported at 86 %, 2 % had vascular complications and in-hospital mortality was 6 %. Persistent bacteremia, renal failure requiring hemodialysis, and clinically significant pulmonary embolism occurred in about 1 % each.
CONCLUSIONS
Transcatheter aspiration of vegetations in infective endocarditis has acceptable success rates in vegetation debulking as well as rates of morbidity or mortality. Large prospective multi-center studies are warranted to determine predictors of complications, thus helping identify suitable patients.
Topics: Female; Humans; Adult; Aged; Prospective Studies; Vacuum Curettage; Endocarditis, Bacterial; Endocarditis; Bacteremia
PubMed: 37331887
DOI: 10.1016/j.carrev.2023.06.006 -
Contraception Sep 2022To evaluate whether administration of intranasal fentanyl reduces reported pain during first-trimester uterine aspiration. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate whether administration of intranasal fentanyl reduces reported pain during first-trimester uterine aspiration.
STUDY DESIGN
We conducted a multicenter, randomized, double-blind, placebo-controlled trial of patients with pregnancies less than or equal to 14 weeks gestation seeking uterine aspiration for induced abortion, early pregnancy loss, or failed medication abortion. We randomized participants 1:1 to either intranasal fentanyl 100 mcg or intranasal placebo. All participants received ibuprofen and a standardized paracervical block. The primary outcome was pain indicated at the time of uterine aspiration on a 100 mm visual analog scale (VAS). We designed the study to detect a 15 mm difference in mean pain scores, which required 53 people in each arm for a total of 106 participants. Secondary outcomes included postprocedure pain and patient satisfaction with pain control.
RESULTS
From March 2017 through June 2018, we screened 355 people for eligibility and enrolled 107 participants. Those who received intranasal fentanyl reported similar uterine aspiration pain to participants who received placebo (58.4 ± 28.0 fentanyl vs 58.6 ± 24.5 placebo, p = 0.97). Participants who received intranasal fentanyl also reported similar postprocedure pain scores compared to participants who received placebo (19.1 ± 19.4 fentanyl vs 17.2 ± 19 placebo, p = 0.63), and were equally satisfied with procedure pain control (66.8 ± 31.2 fentanyl vs 63.3 ± 29.2 placebo, p = 0.57).
CONCLUSION
Intranasal fentanyl did not decrease reported pain with first-trimester uterine aspiration, nor did it decrease postprocedure pain compared to placebo. As an adjunct to ibuprofen and paracervical block, intranasal fentanyl did not improve patient satisfaction with pain control.
IMPLICATIONS
Intranasal fentanyl does not reduce reported pain with first-trimester uterine aspiration, however abortion-seeking patients are amenable to receiving intranasal medications for pain management.
Topics: Abortion, Induced; Double-Blind Method; Female; Fentanyl; Humans; Ibuprofen; Pelvic Pain; Pregnancy; Pregnancy Trimester, First
PubMed: 35472333
DOI: 10.1016/j.contraception.2022.04.008 -
Obstetrics and Gynecology Apr 2018To evaluate uterine evacuation of patients with molar pregnancy, comparing manual with electric vacuum aspiration. (Comparative Study)
Comparative Study
OBJECTIVE
To evaluate uterine evacuation of patients with molar pregnancy, comparing manual with electric vacuum aspiration.
METHODS
This is a retrospective cohort study of patients with molar pregnancy followed at the Rio de Janeiro Trophoblastic Disease Center from January 2007 to December 2016. The individual primary study outcomes were incomplete uterine evacuation, uterine perforation, development of uterine synechia, and development of postmolar gestational trophoblastic neoplasia. Secondary endpoints were other features of the perioperative outcomes (operative time, rate of transfusion, hemoglobin change, length of stay) and the clinical course of neoplasia (Prognostic Risk Score, presence of metastases, time to remission, and need for multiagent chemotherapy).
RESULTS
Among 1,727 patients with molar pregnancy, 1,206 underwent electric vacuum aspiration and 521 underwent manual vacuum aspiration. After human chorionic gonadotropin normalization, patients with benign molar pregnancy were followed for 6 months and patients treated for gestational trophoblastic neoplasia were followed for 12 months. Baseline risk factors for gestational trophoblastic neoplasia and demographic features were similar between the treatment groups. Uterine synechia developed less frequently after manual vacuum aspiration than after electric vacuum aspiration, 6 of 521 vs 63 of 1,206 (adjusted odds ratio [OR] 0.21, 95% CI 0.09-0.49), despite no differences in the occurrence of incomplete uterine evacuation, 65 of 521 vs 161 of 1,206 (adjusted OR 0.93, 95% CI 0.69-1.27), development of postmolar gestational trophoblastic neoplasia, 90 of 521 vs 171 of 1,206 (adjusted OR 1.26, 95% CI 0.96-1.67), or the need for multiagent chemotherapy, 22 of 521 vs 41 of 1,206 (adjusted OR 0.81, 95% CI 0.73-1.28).
CONCLUSION
Manual vacuum aspiration appears to be similar to electric vacuum aspiration for treatment of molar pregnancy and may be associated with less development of uterine synechia.
Topics: Adolescent; Adult; Brazil; Child; Chorionic Gonadotropin; Female; Humans; Hydatidiform Mole; Logistic Models; Middle Aged; Multivariate Analysis; Neoplasm Staging; Pregnancy; Retrospective Studies; Risk Factors; Vacuum Curettage; Young Adult
PubMed: 29528932
DOI: 10.1097/AOG.0000000000002522 -
Best Practice & Research. Clinical... Jan 2020Latin America hosts the most restrictive abortion legislation globally. In 2007, Mexico, the second largest Catholic country in the world, decriminalized elective... (Review)
Review
Latin America hosts the most restrictive abortion legislation globally. In 2007, Mexico, the second largest Catholic country in the world, decriminalized elective abortion within the first twelve weeks of pregnancy in the capital: Mexico City (also known as Federal District of Mexico). Following the reform, the Mexico City Ministry of Health (MX-MOH) implemented safe and legal services. Free services are provided to Mexico City residents and a sliding fee of up to $100 is applied to women from other Mexican states. Conscientious objection (CO) was addressed and included in service provision guidelines. Since 2007, 18 of 32 states amended their penal codes to restrict abortion. The road toward increasing access to abortion services at the MX-MOH included a shift from dilation and curettage (D&C) to medical abortion (MA), first with the misoprostol-alone regimen, followed by the combined mifepristone-misoprostol regimen. Manual vacuum aspiration is offered to out-of-state-women or to those beyond the gestational age where MA is less effective. Contraceptive uptake among abortion seekers is high (up to 95% of them prefer a free method of their choice). The Legal Interruption of Pregnancy program at the MX-MOH continues to provide effective, safe, reliable, and free services. However, women from indigenous groups residing in rural areas, those with low schooling, and adolescents with an unintended pregnancy who live in rural, urban, peri-urban districts, and at the state level are underserved despite being legally eligible to receive abortion services. Therefore, information and services for the disadvantaged groups need to be strengthened.
Topics: Abortion, Induced; Abortion, Legal; Adolescent; Contraception, Postcoital; Female; Health Policy; Health Services Accessibility; Humans; Mexico; Mifepristone; Misoprostol; Pregnancy; Reproductive Rights; Vacuum Curettage; Women's Rights
PubMed: 31501010
DOI: 10.1016/j.bpobgyn.2019.07.009