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Taiwanese Journal of Obstetrics &... Sep 2019Suction curettage is recommended for molar evacuation rather than sharp curettage because of its safety. However, the superiority of suction curettage with respect to... (Observational Study)
Observational Study
OBJECTIVE
Suction curettage is recommended for molar evacuation rather than sharp curettage because of its safety. However, the superiority of suction curettage with respect to the incidence of gestational trophoblastic neoplasia (GTN) has not been reported. This study aimed to compare the efficacy and safety of two evacuation procedures, vacuum aspiration and forceps/blunt curettage, for complete hydatidiform moles (CHMs) to determine the differences between them.
MATERIALS AND METHODS
Patients with androgenetic CHM determined by multiplex short tandem repeat polymorphism analysis were included in this observational cohort study. Patients underwent evacuation with forceps and blunt curettage (forceps group) before March 2013 and with vacuum aspiration (vacuum group) thereafter. GTN was diagnosed based on the International Federation of Gynecology and Obstetrics 2000 criteria. The incidence of GTN and other clinical parameters were compared.
RESULTS
Ninety-two patients were diagnosed with androgenetic CHM. The number of patients in the forceps and vacuum groups was 41 and 51, respectively. The incidence of GTN was 12.2% (5/41) and 13.7% (7/51) in the forceps and vacuum groups, respectively, which was not significantly different (P = 1, Fisher's exact test). No major adverse events, such as uterine perforation and blood transfusion, were noted in either group. The median surgery time was shorter in the vacuum group (16 min) than in the forceps group (25 min) (P = 0.05, Mann-Whitney U test).
CONCLUSION
There were no differences in the incidence of GTN between the forceps and vacuum groups for androgenetic CHM. However, vacuum aspiration could have the advantage of a shorter surgery period. The use of vacuum aspiration for molar pregnancy seems to be safer. Therefore, we recommend suction curettage for the first evacuation of hydatidiform moles.
Topics: Adult; Cohort Studies; Curettage; Female; Gestational Trophoblastic Disease; Humans; Hydatidiform Mole; Incidence; Postoperative Complications; Pregnancy; Surgical Instruments; Treatment Outcome; Uterine Neoplasms; Vacuum Curettage
PubMed: 31542087
DOI: 10.1016/j.tjog.2019.07.012 -
Acta Obstetricia Et Gynecologica... 1982Out of 332 patients in whom endometrial biopsy was considered to be indicated, vacuum curettage by th VabraR method could be performed on 296 (89%)-age range 23 to 71...
Out of 332 patients in whom endometrial biopsy was considered to be indicated, vacuum curettage by th VabraR method could be performed on 296 (89%)-age range 23 to 71 years, mean 45.7-in all cases as an outpatient procedure without anesthesia. Material sufficient for histological diagnosis was obtained in 276 (93.3%), 7 (2.4%) of whom had endometrial cancer, 14 (4.7%) adenomatous hyperplasia, and 29 (9.8%) cystic hyperplasia. Of the 20 patients in which the curettings could not be assessed, subsequent conventional curettage showed postmenopausal mucosa in 12 cases, endometrial polyps in 4 and atrophic mucosa due to contraceptive pill in 4. Moderate and severe pain was experienced by 47 (15.8%) and 7 (2.3%) patients respectively, and 2 (0.6%) had a vasovagal reaction. There was one case (0.3%) of endometritis and 6 (2%) of postoperative bleeding. During a follow-up period of 1-5.5 (mean 2.4) years, 16 patients have developed bleeding again, but repeated vacuum curettage disclosed benign conditions in all, with no endometrial cancer apart from the cases diagnosed primarily. Vacuum curettage is a quick, simple, and cheap method for histological diagnosis of endometrial tissue. It does not require anesthesia, patient acceptability is high, and reliability satisfactory.
Topics: Adult; Aged; Biopsy; Dilatation and Curettage; Endometrial Hyperplasia; Endometrium; Female; Follow-Up Studies; Humans; Middle Aged; Uterine Hemorrhage; Uterine Neoplasms; Vacuum Curettage
PubMed: 7148413
DOI: No ID Found -
Lancet (London, England) Jun 1979
Comparative Study
Topics: Ambulatory Care; Cost-Benefit Analysis; Dilatation and Curettage; Evaluation Studies as Topic; Female; Humans; Vacuum Curettage
PubMed: 86890
DOI: No ID Found -
BMC Pregnancy and Childbirth Nov 2020The World Health Organization does not recommend dilatation and sharp curettage (D&C) for the surgical treatment of miscarriage during the first trimester because this... (Comparative Study)
Comparative Study Randomized Controlled Trial
Safety and efficacy of manual vacuum suction compared with conventional dilatation and sharp curettage and electric vacuum aspiration in surgical treatment of miscarriage: a randomized controlled trial.
BACKGROUND
The World Health Organization does not recommend dilatation and sharp curettage (D&C) for the surgical treatment of miscarriage during the first trimester because this may cause Asherman's syndrome due to endometrial damage; therefore, suction remains the primary treatment option. While manual vacuum aspiration (MVA) has been widely used since the 1990s outside Japan, the use of an MVA device (Women's MVA system) was approved in Japan in October 2015. Here, we examined the efficacy of the MVA kit in women surgically treated for miscarriage.
METHODS
This retrospective cohort study was conducted between 2014 and 2018 at the International University of Health and Welfare Hospital in Japan. Women who underwent surgical treatment for miscarriage within 12 weeks of pregnancy were identified and enrolled in the study. A total of 404 women were included who underwent the following procedures: 121 D&C, 123 electric vacuum aspiration (EVA), and 160 MVA. For each participant, the duration of surgery, amount of bleeding, amount of anesthetic used, incomplete abortion requiring repeat procedures, and intraoperative/postoperative complications were evaluated.
RESULTS
The duration of surgery was 13.7 ± 7.2, 11.2 ± 4.2, and 6.9 ± 4.3 min in the D&C, EVA, and MVA groups, respectively (p = 1.00). The amount of anesthetic used was not significantly different among all groups. Bleeding of ≥ 100 mL was confirmed in three (2.4%), one (0.8%), and one (0.6%) patient(s) in the D&C, EVA, and MVA groups, respectively (p = 0.50). Incomplete abortion was identified in three (2.4%), two (1.6%), and one (0.6%) patient(s) in the D&C, EVA, and MVA groups, respectively (p = 0.61). However, severe intraoperative/postoperative complications were not observed in any group.
CONCLUSIONS
Surgical treatment for miscarriage performed using the MVA kit has safety and efficacy similar to those of conventional methods, such as D&C and EVA.
Topics: Abortion, Spontaneous; Adult; Female; Hospitals, Teaching; Humans; Japan; Length of Stay; Patient Satisfaction; Pregnancy; Pregnancy Trimester, First; Retrospective Studies; Safety; Vacuum Curettage; Vacuum Extraction, Obstetrical
PubMed: 33198679
DOI: 10.1186/s12884-020-03362-4 -
Clinical Obstetrics and Gynecology Dec 2023First-trimester abortion is a common and safe procedure. A focused history and physical examination are essential for providing this care. Laboratory assessment can...
First-trimester abortion is a common and safe procedure. A focused history and physical examination are essential for providing this care. Laboratory assessment can include Rh typing, hemoglobin, and cervicitis testing as indicated by a patient's risk factors. Procedural abortion in the first trimester includes cervical dilation with or without cervical preparation, and uterine evacuation utilizing a manual vacuum aspirator or electric vacuum aspirator. Complications occur rarely and are often easily managed at the time of diagnosis.
Topics: Pregnancy; Female; Humans; Pregnancy Trimester, First; Vacuum Curettage; Abortion, Induced; Abortion, Spontaneous; Cervix Uteri; Pregnancy Trimester, Second
PubMed: 37750678
DOI: 10.1097/GRF.0000000000000808 -
Fertility and Sterility Dec 2023To study the comparison between hysteroscopic morcellation (HM) of retained products of conception (RPOC) with ultrasound (US)-guided electric vacuum aspiration in terms... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To study the comparison between hysteroscopic morcellation (HM) of retained products of conception (RPOC) with ultrasound (US)-guided electric vacuum aspiration in terms of intrauterine adhesion (IUA) formation, efficacy, and complications.
DESIGN
A randomized controlled, nonblinded trial.
SETTING
Three teaching hospitals and one university hospital from April 2015 to June 2022.
PATIENTS
A total of 133 women with RPOC on US, ranging from 1-4 cm, were randomized to receive either HM or electric vacuum aspiration.
INTERVENTION
Hysteroscopic morcellation was performed with the TruClear System (Medtronic, Minneapolis, MN, USA). Electric vacuum aspiration was performed using an 8- or 10-mm flexible plastic Karman cannula under US guidance. Women allocated to vacuum aspiration underwent the procedure as soon as possible.
MAIN OUTCOME MEASURES
In the HM group, an office diagnostic hysteroscopy was planned a minimum of 6 weeks after the end of pregnancy, followed by retained product of conception removal at least 8 weeks after the end of the pregnancy. Postoperatively, an office second-look hysteroscopy was scheduled to assess the primary outcome of IUAs.
RESULTS
Postoperative IUAs were seen in 14.3% (9/63) of patients in the HM group and 20.6% (13/64) of patients in the vacuum aspiration group (-6% [-19.1% to 7.1%]). Significantly more RPOC were removed completely by HM compared with vacuum aspiration (95.2% vs. 82.5% (-14% [-24.9% to -3.1%]), and additional operative hysteroscopy was less frequently necessary in the HM group (12.5%) compared with the vacuum aspiration group (31.3%) (-20.1% [-34.3% to -6%]). The median operating time was shorter for vacuum aspiration compared with HM (5.80 minutes vs. 7.15 minutes). No differences were observed between HM and vacuum aspiration for the occurrence of intraoperative or postoperative complications (5.5% vs. 5.0% and 2.7% vs. 1.3%, respectively).
CONCLUSION
In our randomized controlled trial, no significant differences were found in the occurrence of IUAs and complications. However, the RPOC were more often completely removed by HM than vacuum aspiration, and the HM group required fewer additional hysteroscopic treatments.
CLINICAL TRIAL REGISTRATION NUMBER
NTR4923 (https://trialsearch.who.int/Trial2.aspx?TrialID=NTR4923). Date of registration: November 23, 2014, date of initial participant enrollment: January 1, 2015.
Topics: Pregnancy; Humans; Female; Morcellation; Uterine Diseases; Hysteroscopy; Pregnancy Complications; Vacuum Curettage
PubMed: 37657600
DOI: 10.1016/j.fertnstert.2023.08.956 -
Journal of Minimally Invasive Gynecology Dec 2023Suction curettage is preferred over sharp curettage in obstetric settings. We compare the quality of operative tissue sampling between sharp curettage and suction...
STUDY OBJECTIVE
Suction curettage is preferred over sharp curettage in obstetric settings. We compare the quality of operative tissue sampling between sharp curettage and suction curettage using electric vacuum aspiration for nonobstetric abnormal uterine bleeding in reproductive-aged women.
DESIGN
A retrospective cohort study.
SETTING
Community hospital in Long Island, New York.
PATIENTS
Women ages 21 to 45 years (n = 257) who underwent operative curettage procedure for nonobstetric abnormal uterine bleeding.
INTERVENTIONS
Independent ratings of specimens from suction curettage using electric vacuum aspiration and sharp curettage by 2 pathologists blinded to method of tissue collection.
MEASUREMENTS AND MAIN RESULTS
The primary outcome was percentage of organized tissue, indicative of a higher-quality pathology specimen. Specimens obtained by electric suction curettage (p <.001) had a significantly higher percentage of organized tissue (M = 66.28, SD = 20.33) than sharp curettage (M = 55.51, SD = 24.17). There were no differences between the curettage groups for operative time, blood loss, intraoperative complications, or pathology diagnosis.
CONCLUSION
Specimens obtained with suction curettage contained more organized tissue with similar pathologist satisfaction and confidence scores than sharp curettage. We suggest clinicians consider electric suction curettage in the diagnostic workup of abnormal uterine bleeding in reproductive-aged women. In addition, patient-centered benefits include no increase in operative time, blood loss, or complication rate compared with sharp curettage.
Topics: Pregnancy; Humans; Female; Adult; Vacuum Curettage; Retrospective Studies; Uterine Diseases; Curettage; Uterine Hemorrhage
PubMed: 37661082
DOI: 10.1016/j.jmig.2023.08.428 -
Obstetrics and Gynecology Jul 2018
Topics: Female; Humans; Hydatidiform Mole; Pregnancy; Vacuum Curettage
PubMed: 29939922
DOI: 10.1097/AOG.0000000000002720 -
Fortschritte Der Medizin Jun 1980In a material of 665 aspiration curettages of the uterus we investigated the advantages and problems as well as the clinical reliability of this method. In 15% of all...
In a material of 665 aspiration curettages of the uterus we investigated the advantages and problems as well as the clinical reliability of this method. In 15% of all cases the procedure could not be proceeded by technical reason or by insufficient material for histological diagnosis. On the other hand diagnostic accuracy in endometrial cancer is as reliable as in conventional curettage in general anaesthesia. The curettage can easily be performed with minimal costs as an out-patient procedure. This is the main advantage of aspiration curettage.
Topics: Adult; Aged; Diagnostic Errors; Dilatation and Curettage; Endometrium; Female; Humans; Middle Aged; Polyps; Uterine Neoplasms; Vacuum Curettage
PubMed: 7409709
DOI: No ID Found -
The Journal of Obstetrics and... Nov 2022Endometrial biopsy is generally performed with a metal uterine curette sonde; however, recently, many types of vacuum aspirators are available, including the manual...
AIM
Endometrial biopsy is generally performed with a metal uterine curette sonde; however, recently, many types of vacuum aspirators are available, including the manual vacuum aspiration (MVA) system. We used the women's MVA system for endometrial sampling and evaluated its effectiveness in determining the presence of endometrial malignancy.
METHODS
Forty-seven samples were examined using the following procedures after measuring endometrial thickness by transvaginal ultrasonography: fractional curettage biopsy (Bx; 20 samples), total curettage under general anesthesia (T/C; 13 samples), and MVA (14 samples). The quality of the endometrial samples was classified into four types: 1-4, where 1 denoted poor and 4, good quality.
RESULTS
The mean score of the MVA group was significantly higher than that of the partial curettage biopsy group (p = 0.0065). No differences were observed between the MVA and total curettage groups (p = 1.00). When patients were divided into two groups according to endometrial thickness (<10 mm or ≥10 mm) and analyzed, both the MVA and T/C groups did not show a significant difference in their scores compared to the Bx group when the endometrial thickness was <10 mm. However, when the endometrial thickness was ≥10 mm, the MVA and T/C groups had significantly better scores than the Bx group (p = 0.0225 and p = 0.0244, respectively). Vagal reflex, as an adverse event, was observed only in two patients in the Bx group (2/20, 10%).
CONCLUSION
Considering its quality and safety, Karman-type MVA for endometrial sampling could be an alternative to fractional curettage using a metallic uterine curette sonde.
Topics: Humans; Female; Vacuum Curettage; Endometrium; Endometrial Neoplasms; Uterine Neoplasms; Biopsy
PubMed: 36054542
DOI: 10.1111/jog.15403