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Zhonghua Fu Chan Ke Za Zhi Nov 2019To evaluate the clinical characteristics and diagnostic strategies of early hydatidiform mole. A retrospective cohort study was conducted of 526 women with...
To evaluate the clinical characteristics and diagnostic strategies of early hydatidiform mole. A retrospective cohort study was conducted of 526 women with hydatidiform mole who underwent suction curettage and were confirmed by histopathology in Dalian Maternal and ChildHealth Care Hospital from Feb. 2013 to Feb. 2018, including 484 women with gestational age less than or equal to 12 weeks (the early group) and 42 women with gestational age greater than 12 weeks (the late group). The clinical characteristics between the two groups were compared, and the pathological diagnosis and pre-evacuation ultrasound examination of the early group were further discussed. Compared with the late group, the clinical characteristics of the early group tended to be atypical, and the incidence of vaginal bleeding, excessive uterine size, theca lutein cysts (>6 cm) and pregnancy complications decreased significantly (all 0.05). The serum level of β-hCG in the early group was significantly lower than that in the late group (2.382, 0.017). While there was no significant difference in the pre-evacuation ultrasound detection rate between the two groups (53.5% vs 66.7%; χ(2)=2.697, 0.101). Five hundred and fifteen patients completed the follow-up, and 38 patients with post-mole neoplasia were all cured. There was no significant difference in the malignant transformation rate of hydatidiform mole between the two groups (7.0% vs 11.9%; χ(2)=0.745, 0.388). In the early group, 302 cases of complete hydatidiform mole (CHM), 179 cases of partial hydatidiform mole (PHM) and 3 cases of unclassified hydatidiform mole (UHM) were histologically diagnosed, according to pathological morphology combined with p57(KIP2) immunohistochemical staining. Compared with pathological diagnosis, the overall pre-evacuation ultrasound detection rate in the early hydatidiform mole was 53.5% (259/484), which was significantly better for complete (78.1%, 236/302) versus partial (11.7%, 21/179) hydatidiform moles (χ(2)=199.224, 0.01). There was significantly weak negative correlation between the overall ultrasound detection rate and gestational age of hydatidiform mole (=-0.211, 0.01). The gestational age of early PHM was significantly longer than that of CHM (68.0 vs 58.5 days; -8.048, 0.01). The clinical presentations of early hydatidiform mole are not typical. Although ultrasound examination identifies only about half of hydatidiform moles, ultrasonography is still an important auxiliary examination method. Morphological examination combined with p57(K)IP2 immunohistochemical staining could effectively diagnose early hydatidiform mole, so as to reduce the missed diagnosis of hydatidiform mole.
Topics: China; Chorionic Gonadotropin, beta Subunit, Human; Female; Gestational Age; Humans; Hydatidiform Mole; Incidence; Pregnancy; Retrospective Studies; Time Factors; Treatment Outcome; Ultrasonography; Uterine Hemorrhage; Uterine Neoplasms; Vacuum Curettage
PubMed: 31752459
DOI: 10.3760/cma.j.issn.0529-567x.2019.11.008 -
Journal of Health Monitoring Jun 2022Unwanted pregnancies and abortions are experiences shared by many women. In light of the fact that some general framework conditions are currently changing in Germany,...
Unwanted pregnancies and abortions are experiences shared by many women. In light of the fact that some general framework conditions are currently changing in Germany, and that the Corona pandemic represents a particular challenge for the care of women with unwanted pregnancies, current data from the statistics on terminations of pregnancy of the Federal Statistical Office are outlined. Compared to Europe, Germany has a low proportion of induced abortions. In 2021, 94,596 abortions were reported. The number of abortions as well as the abortion rate and the abortion ratio have decreased since 2001. 95.8% of abortions took place according to the so-called counselling provision. In more than half of the abortions (52.1%) vacuum aspiration was used, in 11.4% curettage, 32.3% were medical abortions using mifepristone. There are large regional differences in the method used.
PubMed: 35891938
DOI: 10.25646/9956 -
Medicine Jul 2022Interstitial pregnancy (IP) is a rare but extremely life-threatening form of ectopic pregnancy. The traditional surgical treatment for this anomaly is the resection of...
RATIONALE
Interstitial pregnancy (IP) is a rare but extremely life-threatening form of ectopic pregnancy. The traditional surgical treatment for this anomaly is the resection of uterine cornua or fallopian tubes, which often damages their structural integrity, thereby compromising the reproductive potential for women who wish to preserve fertility.
PATIENT CONCERNS
A 33-year-old female was admitted to our hospital with suspected ectopic pregnancy, following a 4-weeks history of positive pregnancy tests after uterine evacuation. The patient was hemodynamically stable on arrival. Ultrasound revealed an empty uterus with an eccentric gestational sac located at the fundus and surrounded by a thin myometrium, indicative of a suspected interstitial pregnancy.
DIAGNOSIS AND INTERVENTION
After failed attempt at medical management with a single dose of intramuscular methotrexate, the patient was arranged for hysteroscopy-assisted laparoscopy. In surgery, the uterine cavity appeared empty, and a 2 × 2 cm bulge with increased vascularity at the right uterine courna was identified upon examination. The gestational sac was aspirated through the vagina from the right ostium of the uterine tube using a suction curette pointing at the right ostium. Sutures were not needed afterward, and the myometrial anatomy was left undisrupted. The diagnosis of IP was confirmed by the postoperative histological report.
OUTCOMES
Perioperative blood loss was approximately 10 ml and the operative time was 40 minutes. The patient had an uneventful postoperative recovery and was discharged after 3 days. Subsequent follow-ups showed a significant reduction in the patient serum beta hCG to 48IU/L within 5 days postoperation, and a negative result after 7 days.
LESSONS
This novel surgical technique is an alternative minimally-invasive approach for selected early diagnosed and hemodynamically stable IP patients. The technique represents a safe, quick, and simple approach combining the benefits of laparoscopy, such as allowing for immediate conversion of cornuectomy when uterus ruptures, and the benefits of suction curettage, such as shorter operative time and minimal blood loss. We believe patients with interstitial pregnancy who still have fertility wishes would benefit from this surgical technique to a larger extent in the future.
Topics: Adult; Female; Humans; Hysteroscopy; Laparoscopy; Pregnancy; Pregnancy, Interstitial; Uterus; Vacuum Curettage
PubMed: 35777020
DOI: 10.1097/MD.0000000000029730 -
Cureus May 2021Background Nitazoxanide shows adequate activity against coronavirus. The aim of this study was to describe the behavior of coronavirus disease 2019 (COVID-19) in...
Background Nitazoxanide shows adequate activity against coronavirus. The aim of this study was to describe the behavior of coronavirus disease 2019 (COVID-19) in pregnant women treated with nitazoxanide. Methodology This cross-sectional study included the files of COVID-19 positive pregnant women treated with nitazoxanide 500 mg every 6 hours, levofloxacin every 12 hours, and clarithromycin 500 mg every 12 hours. Results The data of 51 women (mean age: 27.4 ± 7.2 years) were analyzed. Eleven (21.56%) patients had to receive medical attention in the intensive care unit. There were 22 (43.13%) preterm deliveries, 21 by cesarean and one by vaginal delivery. The medical attention of this population was as follows: 31 cesareans, five vaginal deliveries, nine still pregnant, two requiring manual vacuum aspiration, two ectopic pregnancies, one requiring curettage, and one requiring hysterotomy. There were seven (13.72%) cases of preeclampsia, and there were two (3.92%) deaths. Conclusion Nitazoxanide prescription could be an option against COVID-19 in pregnancy due to its safety profile.
PubMed: 34131543
DOI: 10.7759/cureus.15002 -
BMC Women's Health Oct 2021Retained products of conception (POC) following uterine evacuation can lead to adverse sequelae, including hemorrhage, endometritis, intrauterine adhesions, and...
BACKGROUND
Retained products of conception (POC) following uterine evacuation can lead to adverse sequelae, including hemorrhage, endometritis, intrauterine adhesions, and reoperation. Use of procedural transvaginal sonography (TVUS) in the operating room has been proposed to help decrease retained POC.
METHODS
A retrospective review of all first trimester uterine evacuation procedures from 1/2015 to 2/2017 was performed, noting use of transabdominal ultrasonography, retained products of conception, and complications. A practice change was implemented in May 2018, in which routine intra-procedural TVUS use was initiated. A second retrospective chart review was conducted to assess for post-implementation incidence of retained POC, re-operation, and associated complications.
RESULTS
Prior to intra-procedural TVUS implementation, 130 eligible procedures were performed during the specified timeframe, with 9/130 (6.9%) incidence of retained products of conception. TAUS was performed in 59/130 (45.4%) of procedures, and 4/9 (44.4%) of those with retained products. There were eight re-operative procedures in seven patients, and two patients were treated with misoprostol. Complications included hemorrhage, Asherman's syndrome and endometritis. Following implementation, 95 first trimester procedures were performed with transvaginal sonography, with 0 (0%) cases of retained POC (p = 0.01), no incidences of re-operation (p = 0.02), and one case of Asherman's syndrome. TVUS findings led to additional focused suction curettage in 20/95 (21.0%) of procedures. The endometrium was measured on procedure completion in 64 procedures, with a mean thickness of 5.5 mm (1-12 mm).
CONCLUSION
Implementation of routine TVUS during uterine evacuation may reduce the incidence of retained POC and associated reoperation rates. Further multi-center trials are needed to confirm this finding.
Topics: Female; Humans; Pregnancy; Pregnancy Trimester, First; Quality Improvement; Retrospective Studies; Ultrasonography; Vacuum Curettage
PubMed: 34602062
DOI: 10.1186/s12905-021-01488-x -
European Journal of Obstetrics,... Nov 2021Manual Vacuum Aspiration (MVA) is a well-established management option for early pregnancy loss or early termination of pregnancy. MVA is performed as out-patient...
OBJECTIVE
Manual Vacuum Aspiration (MVA) is a well-established management option for early pregnancy loss or early termination of pregnancy. MVA is performed as out-patient surgical procedure using local anaesthetic whereby aspiration of uterine contents is achieved through use of a hand-held negative pressure syringe. Ireland's first MVA service was established at the Rotunda Hospital Dublin in April 2020,. The purpose of this study was to gather feedback from women who had undergone MVA in the unit.
STUDY DESIGN
Prospective mixed methods study of women attending for uterine aspiration under local anaesthetic from July to October 2020 in the unit. Consenting women were contacted one week following MVA via telephone. The survey conducted consisted of structured closed questions along with open-ended questions, to assess womens satisfaction in relation to all aspects of the MVA service.
RESULTS
Nineteen women took part in the study, a response rate of 86.4%. Participants reported feeling well informed prior to attending for MVA. Prior to the procedure, pain expectation scores were high but actual reported pain scores were much lower. Although some participants did find MVA uncomfortable, the fact the procedure was very quick and the side effects so minimal generally negated this. The location and set up of the clinic scored highly among participants as did the staff of the clinic. Overall satisfaction with the MVA service was high with 84.2% of participants reporting they would opt again for MVA in the future.
CONCLUSIONS
Women living in Ireland are interested and agreeable with having Manual Vacuum Aspiration as an available option for management of early pregnancy complications. Consideration should be given to expansion of MVA services nationally.
Topics: Abortion, Induced; Abortion, Spontaneous; Anesthesia, Local; Female; Humans; Patient Satisfaction; Pregnancy; Prospective Studies; Vacuum Curettage
PubMed: 34624739
DOI: 10.1016/j.ejogrb.2021.09.008 -
International Journal of Gynaecology... Jul 2020To explore the strategies undertaken to decentralize menstrual regulation services and implement task-sharing, including barriers and facilitators, with nonphysician...
OBJECTIVE
To explore the strategies undertaken to decentralize menstrual regulation services and implement task-sharing, including barriers and facilitators, with nonphysician providers in Bangladesh.
METHODS
We conducted a desk review of relevant policies and health service information from grey and published literature on task-sharing in menstrual regulation services, plus stakeholder interviews with 19 representatives of relevant health organizations to investigate facilitators for and barriers to the implementation of task-sharing of these services.
RESULTS
Task-sharing in menstrual regulation began in 1979 as part of the national family planning program. The Ministry of Health and Family Welfare has guidelines for menstrual regulation services provided by a wide range of healthcare workers using manual vacuum aspiration and the medications misoprostol and mifepristone. Despite government approval, implementation of task-sharing is challenging owing to lack of skilled providers, lack of facility readiness, and unmet need for family planning.
CONCLUSION
The government needs to implement effective planning for skills building of nonphysician providers and ensuring facility readiness for provision of menstrual regulation services to reduce unsafe abortion in Bangladesh.
Topics: Abortion, Induced; Bangladesh; Family Planning Services; Female; Humans; Menstrual Cycle; Mifepristone; Misoprostol; Pregnancy; Vacuum Curettage
PubMed: 33219997
DOI: 10.1002/ijgo.13009 -
Obstetrics and Gynecology Oct 2020To assess whether mifepristone pretreatment adversely affects the cost of medical management of miscarriage.
OBJECTIVE
To assess whether mifepristone pretreatment adversely affects the cost of medical management of miscarriage.
METHODS
Decision tree analyses were constructed, and Monte Carlo simulations were run comparing costs of combination therapy (mifepristone and misoprostol) with monotherapy (misoprostol alone) for medical management of miscarriage in multiple scenarios weighing clinical practice, patient income, and surgical evacuation modalities for failed medical management. Rates of completed medical evacuation for each were obtained from a recent randomized controlled trial.
RESULTS
In every scenario, combination therapy offered a significant cost advantage over monotherapy. Using a Monte Carlo analysis, cost differences favoring combination therapy ranged from 6.3% to 19.5% in patients making federal minimum wage. The cost savings associated with combination therapy were greatest in scenarios using a staged approach to misoprostol administration and in scenarios using in-operating room dilation and curettage as the only modality for uterine evacuation, a savings of $190.20 (99% CI 189.35-191.07) and $217.85 (99% CI 217.19-218.50) per patient in a low-income wage group, respectively. A smaller difference was seen in scenarios using in-office manual vacuum aspiration to complete medical management failures. As patients' wages increased, the difference in cost between combination therapy and monotherapy increased.
CONCLUSION
Mifepristone combined with misoprostol is, overall, more cost effective than monotherapy, and therefore cost should not be a deterrent to its adoption in the management of miscarriage.
Topics: Abortifacient Agents; Abortion, Incomplete; Abortion, Induced; Cost-Benefit Analysis; Dilatation and Curettage; Drug Therapy, Combination; Female; Humans; Mifepristone; Misoprostol; Monte Carlo Method; Practice Patterns, Physicians'; Pregnancy
PubMed: 32925621
DOI: 10.1097/AOG.0000000000004063 -
Fertility and Sterility Jan 2022To report a peculiar case of ultrasound diagnosis of spontaneous angular twin pregnancy. In literature, the terms "angular," "interstitial," and "cornual" pregnancies...
OBJECTIVE
To report a peculiar case of ultrasound diagnosis of spontaneous angular twin pregnancy. In literature, the terms "angular," "interstitial," and "cornual" pregnancies are often used inappropriately. Confusion in terminology may have contributed to difficulties in developing diagnostic ultrasound criteria to differentiate these ectopic pregnancies.
DESIGN
Case report.
SETTING
Obstetrics and Gynecology, Community Hospital "S. Maria delle Croci."
PATIENT
A 28-year-old patient with a previous cesarean delivery was admitted to our hospital for management of a presumed angular ectopic pregnancy. Transvaginal ultrasound confirmed an ectopic dichorionic diamniotic twin pregnancy eccentrically located in the right superior angle of the uterine cavity: the first gestational sac appeared to have right angular implantation, whereas the second gestational sac seemed to deepen inside the myometrium, with a thin myometrial margin of only 3 mm.
INTERVENTIONS
After discussing the risks, the patient requested to proceed with termination. A single intramuscular injection of 75 mg of methotrexate was administered, followed by ultrasound-guided hysterosuction after 19 days due to severe vaginal bleeding.
MAIN OUTCOME MEASURES
An early and accurate ultrasound diagnosis of a high-risk condition allowed for conservative medical treatment.
RESULTS
The serum beta-human chorionic gonadotropin levels progressively decreased. After 1 month, a clinical and ultrasound examination showed a regular endometrial line with a regular reappearance of menstrual bleeding.
CONCLUSIONS
Although there are remarkable advances in ultrasound techniques, angular pregnancy remains a condition of difficult diagnosis and management; it is potentially dangerous and may lead to severe complications. An early and accurate diagnosis of this condition is necessary to avoid complications and individualize the subsequent management.
Topics: Adult; Conservative Treatment; Female; Humans; Italy; Laparoscopy; Methotrexate; Pregnancy; Pregnancy, Angular; Pregnancy, Twin; Twins, Dizygotic; Ultrasonography; Vacuum Curettage
PubMed: 34961613
DOI: 10.1016/j.fertnstert.2021.09.003 -
Sexual and Reproductive Health Matters Dec 2023Although Pakistan's Essential Package of Health Services was recently updated to include therapeutic and post-abortion care, little is known about current health...
Although Pakistan's Essential Package of Health Services was recently updated to include therapeutic and post-abortion care, little is known about current health facility readiness for these services. This study assessed the availability of comprehensive abortion care, and readiness of health facilities to deliver these services, within the public sector in 12 districts of Pakistan. A facility inventory was completed in 2020-2021 using the WHO Service Availability and Readiness Assessment, with a newly developed abortion module. A composite readiness indicator was developed based on national clinical guidelines and previous studies. Just 8.4% of facilities reported offering therapeutic abortion, while 14.3% offered post-abortion care. Misoprostol (75.2%) was the most common method provided by facilities that offer therapeutic abortion, followed by vacuum aspiration (60.7%) and dilatation and curettage (D&C) (59%). Few facilities had all the readiness components required to deliver pharmacological or surgical therapeutic abortion, or post-abortion care (<1%), but readiness was higher in tertiary (22.2%) facilities. Readiness scores were lowest for "guidelines and personnel" (4.1%), and slightly higher for medicines and products (14.3-17.1%), equipment (16.3%) and laboratory services (7.4%). This assessment highlights the potential to increase the availability of comprehensive abortion care in Pakistan, particularly in primary care and in rural areas, to improve the readiness of health facilities to deliver these services, and to phase out non-recommended methods of abortion (D&C). The study also demonstrates the feasibility and utility of adding an abortion module to routine health facility assessments, which can inform efforts to strengthen sexual and reproductive health and rights.
Topics: Pregnancy; Female; Humans; Health Services Accessibility; Pakistan; Abortion, Induced; Health Facilities; World Health Organization
PubMed: 36897212
DOI: 10.1080/26410397.2023.2178265