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International Journal of Gynaecology...This paper reports an analysis of the measures taken at Preterm, Inc, of Washington, DC, to reduce the incidence of complications of first trimester outpatient...
This paper reports an analysis of the measures taken at Preterm, Inc, of Washington, DC, to reduce the incidence of complications of first trimester outpatient abortions. Data are presented on the 291 complications (40.0/1000) resulting from 7272 procedures performed during 1976. Forty-one women were hospitalized (5.6/1000). It has been our experience that routine use of ultrasonography when gestational age is unclear, careful examination of tissue especially when a small quantity is present and early use of reevacuation to diagnose and treat postabortal complications are essential in reducing the incidence and severity of abortion complications.
Topics: Abortion, Legal; Dilatation and Curettage; Female; Humans; Pregnancy; Pregnancy Tests; Pregnancy Trimester, First; Ultrasonography; Uterine Perforation; Vacuum Curettage
PubMed: 33080
DOI: 10.1002/j.1879-3479.1978.tb00429.x -
BMC Health Services Research Mar 2022Despite the increasing trend of Postabortion Care (PAC) needs and provision, the evidence related to its cost is lacking. This study aims to review the costs of...
BACKGROUND
Despite the increasing trend of Postabortion Care (PAC) needs and provision, the evidence related to its cost is lacking. This study aims to review the costs of Postabortion Care (PAC) per patient at a national level.
METHODS
A systematic review of literature related to PAC cost published in 1994 - October 2020 was performed. Electronic databases such as PubMed, Medline, The Cochrane Library, CINAHL, and PsycINFO were used to search the literature. Following the title and abstract screening, reporting quality was appraised using the Consolidates Health Economic Evaluation (CHEERS) checklist. PAC costs were extrapolated into US dollars ($US) and international dollars ($I), both in 2019.
RESULTS
Twelve studies met the inclusion criteria. All studies reported direct medical cost per patient in accessing PAC, but only three of them included indirect medical cost. All studies reported either average or range of cost. In terms of range, the highest direct cost of PAC with MVA (Medical Vacuum Aspiration) services can be found in Colombia, between $US50.58-212.47, while the lowest is in Malawi ($US15.2-139.19). The highest direct cost of PAC with D&C (Dilatation and Curettage), services is in El Salvador ($US65.22-240.75), while the lowest is in Bangladesh ($US15.71-103.85). Among two studies providing average indirect cost data, Uganda with $US105.04 has the highest average indirect medical cost, while Rwanda with $US51.44 has the lowest.
CONCLUSIONS
Our review shows variability in the cost of PAC across countries. This study depicts a clearer picture of how costly it is for women to access PAC services, although it is still seemingly underestimated. When a study compared the use of UE (Uterine Evacuation) method between MVA and D&C, it is confirmed that MVA treatments tend to have lower costs and potentially reduce a significant cost. Therefore, by looking at both clinical and economic perspectives, improving and strengthening the quality and accessibility of PAC with MVA is a priority.
Topics: Abortion, Induced; Aftercare; Cost-Benefit Analysis; Female; Humans; Malawi; Pregnancy; Vacuum Curettage
PubMed: 35337323
DOI: 10.1186/s12913-022-07765-1 -
African Health Sciences Sep 2023To compare the effectiveness of paracervical block with intramuscular Diclofenac for pain relief during manual vacuum aspiration (MVA) for early pregnancy losses. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To compare the effectiveness of paracervical block with intramuscular Diclofenac for pain relief during manual vacuum aspiration (MVA) for early pregnancy losses.
METHODOLOGY
This was an open label randomized controlled trial. Participants were randomized into two therapeutic groups (A and B) using computer generated numbers. Group A received intramuscular Diclofenac 75 mg. Group B received paracervical block using 1% Lidocaine. Participants were asked to rate their pain level on a continuous 10 cm visual analogue scale (VAS) from 0 (no pain) to 10 (the worst pain ever) within 5 minutes of completing the procedure. Participants' level of satisfaction was assessed within 30 minutes of completing the MVA using Likert scale. Data was analysed using the Statistical Package for Social Sciences (SPSS), Version 20. Test of statistical significance was set at 95% confidence level (P < 0.05). The primary outcome was the level of pain felt by the patient during the procedure (10 cm VAS). Secondary outcomes included patient's satisfaction and adverse events.
RESULTS
There was significant difference in the mean pain level between the intramuscular diclofenac group; 6.5±1.5 (moderate) and those that received paracervical block; 2.3±1.5 (mild), (p-value=0.005). Patients' satisfaction was also better in paracervical block group compared to intramuscular diclofenac group, (p-value=0.005). Both groups were comparable in terms of complications and drug side effects.
CONCLUSION
Findings from the study suggest that the use of paracervical block compared to intramuscular Diclofenac for pain relief during MVA for incomplete miscarriage significantly reduced pain, improved patients' satisfaction and was comparably safe.
Topics: Pregnancy; Female; Humans; Diclofenac; Vacuum Curettage; Anesthesia, Obstetrical; Pain; Lidocaine; Anesthetics, Local
PubMed: 38357159
DOI: 10.4314/ahs.v23i3.4 -
Contraception Jan 1983The IPAS Modified Gynecologic Syringe was compared with the electric pump and standard hand pump in a clinical trial of 1227 women undergoing vacuum aspiration. This... (Comparative Study)
Comparative Study
The IPAS Modified Gynecologic Syringe was compared with the electric pump and standard hand pump in a clinical trial of 1227 women undergoing vacuum aspiration. This modified double-valve syringe was designed to fit larger 8 mm, 10 mm and 12 mm cannulae, which are more suitable for late first trimester procedures. The study was conducted at four centers in which the double-valve syringe was used alternately with the vacuum source normally used at each clinic. Although there were notable inter-center differences with respect to certain outcome variables, results were similar for procedures performed at the same center. The only significant finding was the lower proportion of women requiring D & C to complete uterine evacuation among double-valve syringe patients than among hand pump cases at one center. The data indicate that the double-valve syringe is safe and effective for uterine aspiration in women up to 14 weeks' gestation and may be preferable for use in clinics with limited facilities.
Topics: Abortion, Induced; Adult; Dilatation and Curettage; Female; Humans; Methods; Pregnancy; Pregnancy Trimester, First; Vacuum Curettage
PubMed: 6839759
DOI: 10.1016/0010-7824(83)90056-2 -
Clinical Obstetrics and Gynecology Sep 2021Access to first trimester abortions has increased significantly in the past few decades in low and middle-income countries. Manual vacuum aspiration is now standard of...
Access to first trimester abortions has increased significantly in the past few decades in low and middle-income countries. Manual vacuum aspiration is now standard of care for procedural abortion and postabortion care. Medication abortion has shifted abortions to being performed earlier in pregnancy and is becoming more widely available with new service delivery strategies to broaden access. Widespread availability of misoprostol has made abortions induced outside of the formal medical sector overall safer. In both legally restrictive and supportive environments, there is increased interested in self-managed abortions as part of a shift towards demedicalizing abortion through task-sharing.
Topics: Abortion, Induced; Developing Countries; Female; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, First; Vacuum Curettage
PubMed: 34323227
DOI: 10.1097/GRF.0000000000000626 -
Perfusion Nov 2006The diffusion of minimally invasive cardiac surgery (MICS) during open-heart surgery has increased the use of assisted venous drainage support for cardiopulmonary bypass... (Clinical Trial)
Clinical Trial
The diffusion of minimally invasive cardiac surgery (MICS) during open-heart surgery has increased the use of assisted venous drainage support for cardiopulmonary bypass (CPB). Peripheral cannulation with small cannulae and vacuum-assisted venous drainage (VAVD) during MICS has been adopted in our institution since 1998. After the Heartport technique (HP) experience, the trans-thoracic clamp technique is now currently used. The aim of this study is to report our experience with extrathoracic CPB with VAVD application (on CPB) during open-heart MICS. From October 1999 to June 2006, 193 patients underwent MICS. Thirty-seven (19.2%) patients were treated with the HP--13 (35%) with robotic technology and 156 (80.8%) with trans-thoracic aortic clamping (TTAC). Mean age was 39 years (range: 12-77), and 114 patients (59.1%) were female. A total of 128 patients (66.3%) underwent mitral valve surgery, 57 (29.6%) atrial septal defect closure, five (2.6%) cardiac mass removal, and three (1.5%) tricuspid valve repair. Four patients (2.0%) had a previous cardiac procedure. Peripheral CPB was established with a standard coated circuit. A 14 Fr arterial cannula was inserted into the right jugular vein and positioned at the atrial/superior vena cava junction. A 21 or 28 percutaneous femoral cannula, depending on body surface area, was inserted in the femoral vein and an arterial cannula in the right femoral artery. Gravitational drainage was combined with VAVD. To improve the safety and effectiveness of this technique, we monitored the pressure on each venous cannula and in the reservoir. The mean CPB time was 74.8 +/- 30 min (TTAC) and 119 +/- 48 min (HP); mean aortic clamping time was 51 +/- 19 min (TTAC) and 73 +/- 29 min (HP). We did not record any neurological complication. Two patients (1.0%), one from each group, were converted to sternotomy. Three patients (1.5%) underwent re-exploration for bleeding. In-hospital mortality was 0.5% (N = 1) (HP). Mechanical ventilation time and intensive care unit stay were comparable to those recorded with conventional sternotomy. In conclusion, we found that extrathoracic CPB and VAVD during trans-thoracic clamping is a safe, simple, and effective technique for MICS. However, there is a potential risk of haemolysis and air embolism, which can be prevented with vacuum monitoring, and with the addition of gravitational drainage to reduce vacuum pressure.
Topics: Adolescent; Adult; Aged; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Catheterization; Child; Endoscopy; Female; Femoral Vein; Gravitation; Humans; Jugular Veins; Male; Middle Aged; Minimally Invasive Surgical Procedures; Robotics; Suction; Surgical Instruments; Vacuum Curettage; Vena Cava, Superior
PubMed: 17312860
DOI: 10.1177/0267659106071324 -
European Journal of Obstetrics,... Sep 2017
Topics: Adult; Fallopian Tube Diseases; Female; Humans; Ultrasonography; Uterine Diseases; Vacuum Curettage
PubMed: 28693844
DOI: 10.1016/j.ejogrb.2017.06.039 -
Ultrasound in Obstetrics & Gynecology :... Apr 2016To assess the efficacy of ultrasound-guided suction curettage for management of pregnancies implanted into the lower uterine segment Cesarean section scar.
OBJECTIVES
To assess the efficacy of ultrasound-guided suction curettage for management of pregnancies implanted into the lower uterine segment Cesarean section scar.
METHODS
This was a retrospective study including women diagnosed with Cesarean section scar pregnancy at two large tertiary referral early pregnancy units between 1997 and 2014. Surgical evacuation was offered to selected women presenting in the first trimester ≤ 14 weeks' gestation. All procedures were performed transcervically under ultrasound guidance using suction curettage. A modified Shirodkar cervical suture was used in women who required additional measures to secure hemostasis.
RESULTS
A total of 232 women with Cesarean section scar pregnancy were seen at the referral units; 191/232 (82.3%) women were treated surgically. The median intraoperative blood loss was 100 mL (range, 10-3000 mL); 9/191 (4.7% (95% CI, 1.7-7.7%)) women required blood transfusion and, in one (0.5% (95% CI, 0-1.5%)), life-saving hysterectomy had to be performed because of uncontrollable intraoperative bleeding. Of the women who attended for follow-up, 7/116 (6.0% (95% CI, 1.7-10.3%)) required a repeat surgical procedure because of retained products of conception. Multivariable analysis showed that the gestational sac diameter (odds ratio (OR), 1.10 (95% CI, 1.03-1.17)) and pregnancy vascularity on Doppler examination (OR, 3.41 (95% CI, 1.39-8.33)) were significant predictors of heavy intraoperative blood loss (> 1000 mL).
CONCLUSIONS
Ultrasound-guided suction curettage is an effective method for the treatment of pregnancies implanted into a lower uterine segment Cesarean section scar and is associated with a low risk of blood transfusion and hysterectomy. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Adult; Cesarean Section; Cicatrix; Female; Gestational Age; Humans; Postoperative Complications; Pregnancy; Pregnancy Trimester, First; Pregnancy, Ectopic; Retrospective Studies; Ultrasonography, Interventional; Ultrasonography, Prenatal; Vacuum Curettage
PubMed: 26764166
DOI: 10.1002/uog.15857 -
BMC Pregnancy and Childbirth Jul 2018To evaluate the effects of systemic methotrexate in cesarean scar pregnancy (CSP) patients treated with ultrasound-guided suction curettage.
BACKGROUND
To evaluate the effects of systemic methotrexate in cesarean scar pregnancy (CSP) patients treated with ultrasound-guided suction curettage.
METHODS
A retrospective review of all women presenting with CSP treated with ultrasound-guided suction curettage at Tongji Hospital, Wuhan, China, between January 1, 2013 and December 31, 2015, was conducted. Patients were grouped into those not treated with methotrexate before curettage (group 1), treated with methotrexate by intramuscular injection (group 2) and treated with methotrexate by intravenous injection (group 3). The clinical characteristics and outcomes were analyzed.
RESULTS
Among 107 patients, 47 patients were not treated with methotrexate before curettage, 46 patients had methotrexate administered by intramuscular injection and 14 patients had methotrexate injected intravenously. There were no significant differences among the groups in basic and clinical characteristics, such as age, gravity, parity, positive fetal heart beat and gestational age at diagnosis. Patients presented similar initial human chorionic gonadotropin (hCG) levels in all groups. After treatment with methotrexate or curettage, the percentage changes and varied ranges of the hCG levels were also similar in all groups. There were no significant differences in intraoperative blood loss and retained products of conception among the three groups. However group 1 had significantly shorter hospital stays than the two groups that were treated with methotrexate (p<0.001).
CONCLUSION
By grouping CSP patients who shared similar age, gravity, parity, fetal heart beat positive and gestational age at diagnosis, we found that the presence or absence of methotrexate treatment before curettage resulted in comparable outcomes and hCG levels, although patients who were not treated with methotrexate had significantly shorter stays in the hospital.
Topics: Abortifacient Agents, Nonsteroidal; Adult; Cesarean Section; China; Cicatrix; Female; Humans; Injections, Intramuscular; Length of Stay; Methotrexate; Postoperative Complications; Pregnancy; Retrospective Studies; Surgery, Computer-Assisted; Ultrasonography; Vacuum Curettage
PubMed: 29973177
DOI: 10.1186/s12884-018-1923-x -
The New Zealand Nursing Journal. Kai... Dec 1979
Topics: Abortion, Induced; Female; Humans; Pregnancy; Vacuum Curettage
PubMed: 295095
DOI: No ID Found