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The Cochrane Database of Systematic... Sep 2010Incomplete miscarriage is a major problem that should be effectively managed with safe and appropriate procedures. Surgical evacuation of the uterus for management of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Incomplete miscarriage is a major problem that should be effectively managed with safe and appropriate procedures. Surgical evacuation of the uterus for management of incomplete miscarriage usually involves vacuum aspiration or sharp curettage.
OBJECTIVES
To compare the safety and effectiveness of surgical uterine evacuation methods for management of incomplete miscarriage.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2010).
SELECTION CRITERIA
Randomized trials where different surgical methods were used to manage incomplete miscarriage were eligible for inclusion.
DATA COLLECTION AND ANALYSIS
We extracted population characteristics, settings, and exclusion criteria, in addition to outcomes such as complications of the procedure, duration, need for re-evacuation, blood transfusion, and analgesia/anesthesia.
MAIN RESULTS
Two trials (involving 550 women) were included. Vacuum aspiration was associated with statistically significantly decreased blood loss (mean difference (MD) -17.10 ml, 95% confidence interval (CI) -24.05 to -10.15 ml), less pain during the procedure (risk ratio (RR) 0.74, 95% CI 0.61 to 0.90), and shorter duration of the procedure (MD -1.20 minutes, 95% CI -1.53 to -0.87 minutes), than sharp metal curettage, in the single study that evaluated these outcomes in 357 women. Serious complications such as uterine perforation and other morbidity were rare and the sample sizes of the trials were not large enough to evaluate small or moderate differences.
AUTHORS' CONCLUSIONS
Although the review indicates that vacuum aspiration is safe, quick to perform, and less painful than sharp curettage, and should be recommended for use in the management of incomplete miscarriage, the results are based on data from only one study. Analgesia and sedation should be provided as necessary for the procedure.
Topics: Abortion, Incomplete; Dilatation and Curettage; Female; Humans; Pregnancy; Treatment Outcome; Vacuum Curettage
PubMed: 20824830
DOI: 10.1002/14651858.CD001993.pub2 -
Best Practice & Research. Clinical... Aug 2014Induced abortion is one of the most commonly performed gynaecological procedures in the world. Medical and surgical methods are available for both first- and... (Review)
Review
Induced abortion is one of the most commonly performed gynaecological procedures in the world. Medical and surgical methods are available for both first- and second-trimester abortions. Generally, for women presenting between 7 and 14 weeks gestation, vacuum aspiration is an appropriate method. Medical method of abortion is otherwise recommended for women who present before or after that time frame. Clinical guidelines should be available in all healthcare sectors providing abortion services to ensure a uniformly high standard of care for all women requesting abortions. Services should ensure that written, objective, evidence-guided information is available for women considering abortion to take away before the procedure, including complications and sequelae of abortion. Nearly one-half of abortions occurring worldwide are considered unsafe abortions, and these can result in maternal morbidity and mortality. Prevention of unsafe abortion is key, and requires a multi-pronged approach, including provision of contraception and expanded access to safe termination of pregnancy.
Topics: Abortion, Induced; Female; Global Health; Guidelines as Topic; Humans; Maternal Mortality; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Vacuum Curettage
PubMed: 24962349
DOI: 10.1016/j.bpobgyn.2014.05.005 -
The Journal of Obstetrics and... Apr 2012The aim of this study was to compare the efficacy of modified electric vacuum aspiration (mEVA) and sharp curettage (SC) for treatment of incomplete abortion. (Comparative Study)
Comparative Study Randomized Controlled Trial
AIM
The aim of this study was to compare the efficacy of modified electric vacuum aspiration (mEVA) and sharp curettage (SC) for treatment of incomplete abortion.
MATERIAL AND METHODS
A randomized controlled trial was conducted between 1 March 2005 and 15 December 2009. Ninety-four women with incomplete abortion were randomly allocated into two groups, group A (n = 47) underwent mEVA and group B (n=47) underwent SC. The procedures were performed using the paracervical block with 20 mL of lidocaine. Successful management and complication were assessed. Successful management was defined as complete uterine evacuation with no need for the second surgical procedure.
RESULTS
There were differences in women characteristics between groups. The successful rate of management was 100% for both groups. However, the operative time and estimated blood loss were less in the mEVA group than in the SC group. Severe pain was significantly less prevalent in group A than group B. Suspected endometritis was found in two (4.3%) patients in each group.
CONCLUSIONS
The efficacy of mEVA was the same as that of SC in successful management of incomplete abortion, but pain was experienced more often in the SC group.
Topics: Abortion, Incomplete; Adult; Female; Humans; Pregnancy; Vacuum Curettage
PubMed: 22380491
DOI: 10.1111/j.1447-0756.2011.01762.x -
Archives of Gynecology and Obstetrics Nov 2012This study compared the hospital charges, duration of in-hospital procedures, clinical course and complications between manual vacuum aspiration (MVA) and sharp... (Comparative Study)
Comparative Study
OBJECTIVE
This study compared the hospital charges, duration of in-hospital procedures, clinical course and complications between manual vacuum aspiration (MVA) and sharp curettage.
MATERIALS AND METHODS
A prospective observational study was conducted during the May 2007-April 2008 period in Songklanagarind Hospital, Thailand. Forty cases of pregnancy ≤9 weeks of gestation, with conditions of an incomplete abortion, a blighted ovum or missed abortion were treated with either MVA or sharp curettage. Both groups were compared in terms of demographic and obstetric data, hospitalization cost, clinical course and complications.
RESULTS
The obstetric data of both groups showed that the median parity was two, with a median gestation age of 8 weeks. The median total hospital expenditure was 54.67 USD for patients using the MVA technique and 153.97 USD for the sharp curettage group (p < 0.01). The median duration of in-hospital care in the MVA group was significantly less than that of the sharp curettage group, 4 versus 20 h, respectively (p < 0.01). 90 % of patients in the MVA group had only one visit compared with 72.5 % in the sharp curettage group (p = 0.04). No complications needing further curettage or treatment in either group were noted.
CONCLUSION
The use of MVA in the management of a first-trimester abortion is practical, safe, cheap and time-saving.
Topics: Abortion, Incomplete; Abortion, Missed; Adult; Dilatation and Curettage; Female; Hospital Costs; Humans; Length of Stay; Operative Time; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Thailand; Vacuum Curettage
PubMed: 22684851
DOI: 10.1007/s00404-012-2405-4 -
The Journal of Family Practice Dec 1983In the decade after the legalization of elective abortion by a Supreme Court decision in January 1973, suction curettage has been widely used and accepted as a safe...
In the decade after the legalization of elective abortion by a Supreme Court decision in January 1973, suction curettage has been widely used and accepted as a safe outpatient procedure for first-trimester abortion. Evaluation of the patient for feasibility of the procedure requires careful assessment of gestational age and the determination of the absence of an ectopic pregnancy and conditions that might contraindicate local anesthesia. Counseling clarifies the patient's options and ensures her understanding of the implications of abortion so that she can give an informed consent. Suction curettage is performed under local anesthesia using a sterile plastic cannula or curette inserted through a progressively dilated cervix with aspiration of the uterine contents by an electric pump. The procedure is completed by the physician's examination of the aspirate for the presence of placental villi. Postoperative instructions include contraception and monitoring for hemorrhage and infection prior to a return visit in 10 to 14 days. Complications can be reduced by careful selection of patients with appropriate duration of pregnancy, the use of gentle operative technique, antibiotics for prophylaxis of infection, and a continued maintenance of experience and procedural skill by the physician.
Topics: Abortion, Induced; Dilatation and Curettage; Female; Humans; Postoperative Complications; Pregnancy; Pregnancy Trimester, First; Vacuum Curettage
PubMed: 6644256
DOI: No ID Found -
Journal of Ayub Medical College,... 2011To compare the efficacy, safety and cost effectiveness of Manual Vacuum Aspiration (MVA) with dilatation and curettage (DNC) in the management of early pregnancy failure. (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVES
To compare the efficacy, safety and cost effectiveness of Manual Vacuum Aspiration (MVA) with dilatation and curettage (DNC) in the management of early pregnancy failure.
METHODS
One hundred patients of spontaneous abortion, incomplete or missed, with gestational age <12 weeks were included in the study. Using a Random Number Table, these patients were assigned to undergo either DNC or MVA.
RESULTS
The distribution of age, parity and gestational age was similar in both groups. The mean duration of procedure was significantly higher (p<0.0001) in DNC (8.98 +/- 2.64 minutes) as compared to 5.88 +/- 2.43 minutes in MVA. The duration of hospital stay was significantly lower (p<0.0001) in MVA group (3.48 +/- 1.2 hours) as compared to 7.42 +/- 1.93 minutes in DNC group. Similarly the cost of procedure was also significantly lower (p=0.0001) in MVA group (PKR 1410 +/- 243.4) compared to PKR 3460 +/- 908.24 in DNC group.
CONCLUSION
MVA is as effective as conventional dilatation and curettage for treatment of early pregnancy failure while it causes less blood loss, is less time consuming, requires a shorter hospital stay and thus costs less. It does not require general anaesthesia and complication rate is less than dilatation and curettage.
Topics: Abortion, Spontaneous; Adolescent; Adult; Dilatation and Curettage; Female; Humans; Middle Aged; Vacuum Curettage; Young Adult
PubMed: 23272429
DOI: No ID Found -
Journal of Minimally Invasive Gynecology Apr 2022
Topics: Curettage; Dilatation and Curettage; Fallopian Tubes; Female; Humans; Hysteroscopy; Pregnancy; Uterine Perforation; Vacuum Curettage
PubMed: 34902595
DOI: 10.1016/j.jmig.2021.12.006 -
The Cochrane Database of Systematic... 2001Incomplete abortion is a major problem that should be effectively managed with safe and appropriate procedures. Surgical evacuation of the uterus for management of... (Review)
Review
BACKGROUND
Incomplete abortion is a major problem that should be effectively managed with safe and appropriate procedures. Surgical evacuation of the uterus for management of incomplete abortion usually involves vacuum aspiration or sharp curettage.
OBJECTIVES
To compare the safety and effectiveness of surgical uterine evacuation methods for management of incomplete abortion.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group trials register, Medline from 1966, Popline from 1970, and the Cochrane Controlled Trials Register. Trials were also identified from reference lists of reviews. Date of last search: October 2000.
SELECTION CRITERIA
Randomized trials where different surgical methods were used to manage incomplete abortion were eligible for inclusion.
DATA COLLECTION AND ANALYSIS
We extracted population characteristics, settings, and exclusion criteria, in addition to outcomes such as complications of the procedure, duration, need for re-evacuation, blood transfusion, and analgesia/anesthesia.
MAIN RESULTS
Two trials were included. Vacuum aspiration was associated with statistically significantly decreased blood loss (-17 mls weighted mean difference, 95% confidence interval (CI) -24 to -10 mls), less pain (relative risk (RR): 0.74, 95% CI 0.61, 0.90), and shorter duration of procedure (-1.2 minutes weighted mean difference, 95% CI -1.5 to -0.87 minutes), than sharp curettage, in the single study that evaluated these outcomes. Serious complications such as uterine perforation and other morbidity were rare and the sample sizes of the trials were not large enough to evaluate small or moderate differences.
REVIEWER'S CONCLUSIONS
Vacuum aspiration is safe, quick to perform, and less painful than sharp curettage, and should be recommended for use in the management of incomplete abortion. Analgesia and sedation should be provided as necessary for the procedure.
Topics: Abortion, Incomplete; Dilatation and Curettage; Female; Humans; Pregnancy; Treatment Outcome; Vacuum Curettage
PubMed: 11279744
DOI: 10.1002/14651858.CD001993 -
Lakartidningen Oct 1980
Topics: Adult; Dilatation and Curettage; Female; Humans; Middle Aged; Pain; Uterus; Vacuum Curettage
PubMed: 7453380
DOI: No ID Found -
Nursing Times
Topics: Cost-Benefit Analysis; Equipment Design; Humans; Patient Selection; Pressure Ulcer; Vacuum Curettage; Wound Healing; Wound Infection
PubMed: 11957602
DOI: No ID Found