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Ginekologia Polska 2017
Topics: Adult; Amenorrhea; Cesarean Section; Cicatrix; Diagnosis, Differential; Embolization, Therapeutic; Female; Gynatresia; Humans; Hysteroscopy; Pregnancy; Pregnancy Complications; Pregnancy, Ectopic; Vacuum Curettage
PubMed: 29303219
DOI: 10.5603/GP.a2017.0114 -
International Journal of Gynaecology... Jun 1994Traditionally, management of incomplete abortion involves use of D&C or suction curettage in the operating room. Such management is costly and time-consuming. In order...
OBJECTIVES
Traditionally, management of incomplete abortion involves use of D&C or suction curettage in the operating room. Such management is costly and time-consuming. In order to potentially save time and money, we studied the use of manual vacuum aspiration curettage (MVAC) for the management of this problem.
METHODS
Data on hospital charges and times (e.g. waiting time, procedure time) were obtained for all cases of incomplete abortion presenting to hospital between January 1990 and July 1992. Between January 1990 and July 1991, all cases were managed traditionally. After July 1991, all cases were managed using MVAC in either the emergency room or the labor ward.
RESULTS
Compared to the use of electrical suction equipment in the operating theatre, MVAC procedures resulted in significant savings in terms of both waiting times and costs. Waiting time was reduced by 52% and procedure time was reduced from a mean of 33 min to 19 min (P < 0.01). Total hospital costs were reduced by 41% (P < 0.01).
CONCLUSIONS
Use of manual vacuum aspiration curettage in the management of incomplete abortion can reduce hospital costs and save time for both patients and clinicians.
Topics: Abortion, Incomplete; Cost of Illness; Cost-Benefit Analysis; Emergencies; Female; Humans; Operating Rooms; Pregnancy; Vacuum Curettage
PubMed: 7926246
DOI: 10.1016/0020-7292(94)90252-6 -
European Journal of Obstetrics,... Dec 2014To investigate the efficacy and safety of transabdominal ultrasound-guided suction curettage alone in endogenous cesarean scar pregnancy (CSP).
OBJECTIVE
To investigate the efficacy and safety of transabdominal ultrasound-guided suction curettage alone in endogenous cesarean scar pregnancy (CSP).
STUDY DESIGN
From 2009 to 2013, 21 women with endogenous CSP who had no other therapy underwent suction curettage alone guided with transabdominal ultrasound.
RESULTS
All patients were successfully treated with suction curettage alone. No one needed emergency blood transfusion or uterine artery embolization. The average gestational age was 51.1±7.56 days. The mean thickness of the lower anterior uterine wall was 0.5cm, ranging from 0.3cm to 0.9cm. The average blood loss during surgery was 81.3±33.5 (30-150)ml. The mean time for achieving a normal β-HCG level was 26.9 days.
CONCLUSION
Transadominal ultrasound-guided suction curettage was a feasible and effective method for lower risk endogenous CSP patients with the myometrial layer between the gestational sac and the bladder more than 3mm before 10 gestational weeks.
Topics: Adult; Blood Loss, Surgical; Blood Transfusion; Cesarean Section; Cicatrix; Female; Humans; Incidence; Pregnancy; Pregnancy, Ectopic; Retrospective Studies; Treatment Outcome; Ultrasonography; Uterine Artery Embolization; Vacuum Curettage
PubMed: 25461346
DOI: 10.1016/j.ejogrb.2014.10.017 -
Obstetrics and Gynecology May 2005To quantify the relative benefits and harms of different management options for first-trimester miscarriage. (Comparative Study)
Comparative Study Meta-Analysis Review
OBJECTIVE
To quantify the relative benefits and harms of different management options for first-trimester miscarriage.
DATA SOURCES
MEDLINE, EMBASE, and Cochrane Controlled Trials Register searches (1966 to July 2004), including references of retrieved articles.
METHODS OF STUDY SELECTION
Randomized trials assigning women with first-trimester missed or incomplete miscarriage to surgical, medical, or expectant management were included. Primary outcomes were successful treatment and patient satisfaction. Secondary outcomes included moderate or severe bleeding, blood transfusion, emergency curettage, pelvic inflammatory disease, nausea, vomiting, and diarrhea. Comparisons used the risk difference. Between-study heterogeneity and random effects summary estimates were calculated.
TABULATION, INTEGRATION, AND RESULTS
Complete evacuation of the uterus was significantly more common with surgical than medical management (risk difference 32.8%, number needed to treat 3, success rate of medical management 62%) and with medical than expectant management (risk difference 49.7%, number needed to treat 2). Success rate with expectant management was spuriously low (39%) in the latter comparison. Analysis of cases with incomplete miscarriage only showed that medical management still had two thirds the chance to induce complete evacuation compared with surgical management, but it was better than expectant management. Data from studies that evaluated outcome at 48 hours or more after allocation indicated again that medical management had a better success rate than expectant management but a worse success rate than surgical management; expectant management probably had much lower success rates than surgical evacuation, but data were very sparse. Patient satisfaction data were sparse. Moderate or severe bleeding was less common with medical than expectant management (risk difference 3.2%) and possibly surgical management (risk difference 2.1%). There was a considerable amount of missing information, in particular for secondary outcomes.
CONCLUSION
One additional success can be achieved among 3 women treated surgically rather than medically. Expectant management has had remarkably variable success rates across these studies, depending probably on the type of miscarriage. Greater standardization of outcomes should be a goal of future research.
Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Abortion, Missed; Abortion, Spontaneous; Adolescent; Adult; Dilatation and Curettage; Female; Follow-Up Studies; Humans; Methotrexate; Misoprostol; Pregnancy; Pregnancy Trimester, First; Risk Assessment; Treatment Outcome; Vacuum Curettage
PubMed: 15863551
DOI: 10.1097/01.AOG.0000158857.44046.a4 -
Der Unfallchirurg Apr 1997Between 1 January 1992 and 31 July 1995, 313 patients with acute and chronic infections were treated by vacuum sealing (VS). The average duration of VS treatment was...
Between 1 January 1992 and 31 July 1995, 313 patients with acute and chronic infections were treated by vacuum sealing (VS). The average duration of VS treatment was 16.7 days, and there was an average of 3.1 changes in the VS system. In acute infections (n = 203) the wounds were closed by secondary suturing (65.5%), spontaneous epithelialization (17.2%), skin grafting (12.3%) and flap transfer (2%). Six patients died (3%). Infection recurred in 3.9% and was cured by another VS treatment. Unstable scar formations (1%) were treated by free flap transfers. When compared with standard open-wound treatment, the low-cost VS technique offers great advantages with regard to hospital hygiene, patient comfort and therapeutic results.
Topics: Abscess; Drainage; Empyema; Female; Gels; Humans; Occlusive Dressings; Reoperation; Surgical Flaps; Surgical Wound Infection; Treatment Outcome; Vacuum Curettage
PubMed: 9229781
DOI: 10.1007/s001130050123 -
International Journal of Gynaecology... Oct 2003To compare manual and electric vacuum aspiration for surgical abortions between 14 and 18 weeks of pregnancy. (Comparative Study)
Comparative Study
OBJECTIVES
To compare manual and electric vacuum aspiration for surgical abortions between 14 and 18 weeks of pregnancy.
METHODS
A consecutive case series of pregnant women presenting to Johns Hopkins Bayview Medical Center for abortion. There were 73 women in the manual vacuum aspiration group and 37 women in the electric vacuum aspiration group. Dilatation and evacuation was performed using manual or electric vacuum aspiration according to protocol. Procedure time was assessed with the t-test.
RESULTS
In all cases, abortion was performed with initial vacuum. Group sizes were sufficient to detect a 20% difference in mean procedure time with 80% power (calculated with two separate S.D.s for procedure time). There was no significant difference in procedure time between the two groups.
CONCLUSIONS
Manual vacuum aspiration can be safely and effectively used in second-trimester abortion procedures and should be more widely investigated for this purpose.
Topics: Abortion, Induced; Adult; Clinical Competence; Feasibility Studies; Female; Gestational Age; Humans; Pregnancy; Pregnancy Trimester, Second; Retrospective Studies; Time Factors; Vacuum Curettage
PubMed: 14511866
DOI: 10.1016/s0020-7292(03)00304-7 -
Obstetrics and Gynecology Nov 2008
Topics: Abortion, Induced; Anti-Infective Agents, Local; Antibiotic Prophylaxis; Endocarditis, Bacterial; Female; Humans; Practice Guidelines as Topic; Pregnancy; Vacuum Curettage
PubMed: 18978122
DOI: 10.1097/AOG.0b013e31818cb91a -
Acta Obstetricia Et Gynecologica... 1987In the management of patients with molar pregnancy, a repeat uterine curettage is generally advocated after evacuation of the hydatidiform mole. To assess the usefulness...
In the management of patients with molar pregnancy, a repeat uterine curettage is generally advocated after evacuation of the hydatidiform mole. To assess the usefulness of a repeat curettage, we reviewed our experience with this procedure over an 8-year period. We found that it was unnecessary in 90% of the cases and did not predict or influence the outcome in all but one case of invasive mole. We feel that the procedure is not cost-effective and should be reserved for patients with specific indications such as incomplete evacuation and abnormal uterine bleeding.
Topics: Chorionic Gonadotropin; Cost-Benefit Analysis; Dilatation and Curettage; Female; Humans; Hydatidiform Mole; Pregnancy; Uterine Neoplasms; Vacuum Curettage
PubMed: 3122513
DOI: 10.3109/00016348709103641 -
Obstetrical & Gynecological Survey Feb 2001Approximately one in four women will experience a miscarriage during her lifetime. For more than 50 years, the standard management of early pregnancy failure has been a... (Review)
Review
Approximately one in four women will experience a miscarriage during her lifetime. For more than 50 years, the standard management of early pregnancy failure has been a dilatation and curettage (D & C). Typically, the procedure is performed in an operating room, which significantly increases cost. There is little objective information in the modem literature to prove that a D & C for all patients will lower morbidity or improve emotional well being. Treatment options include expectant management, D & C in an outpatient setting, and medical management with misoprostol (not approved by the U.S. Food and Drug Administration for treatment of early pregnancy failure). The medical literature supports that expectant management may result in more complications, including the need for "emergent" curettage, if clinicians do not understand the true normal course of expectant management. In general, women prefer some form of active management. Dilatation and curettage can be performed safely in the office or other outpatient setting using manual vacuum aspiration. Vaginal misoprostol will cause expulsion in 80% to 90% of women up to 13 weeks' uterine size or gestation, including patients who have a gestational sac present. However, these data come from only three trials involving a total of 42 subjects treated with vaginal misoprostol, and another study of 42 women who received vaginal misoprostol for "missed abortion" before a scheduled D & C. There is a significant lack of information from large-scale studies about when treatment is necessary and the relative efficacy, rates of side effects, and acceptability of these various treatment options for early pregnancy failure.
Topics: Abortifacient Agents, Nonsteroidal; Abortion, Missed; Dilatation and Curettage; Female; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, First; Treatment Outcome; Vacuum Curettage
PubMed: 11219590
DOI: 10.1097/00006254-200102000-00024 -
PloS One 2023In Kenya, where abortion is legally restricted, most abortions are induced using unsafe procedures, and lead to complications treated in public health facilities. The...
BACKGROUND AND OBJECTIVES
In Kenya, where abortion is legally restricted, most abortions are induced using unsafe procedures, and lead to complications treated in public health facilities. The introduction of Manual Vacuum Aspiration (MVA) to treat incomplete abortion has improved the management of abortion complications. However, this technology comes with pain whose management has been a challenge. This paper explores the lived experiences of pain (management) during MVA to document the contributing factors.
METHODS
We used an ethnographic approach to explore girls and healthcare providers' experiences in offering and accessing post-abortion care in Kilifi County, Kenya. The data collection approach included participant observation and informal conversations in public health facilities and neighboring communities, as well as in-depth interviews with 21 girls and young women treated for abortion complication and 12 healthcare providers.
RESULTS
Our findings show that almost all patients described the MVA as the most painful procedure they have ever experienced. The unbearable pain was explained by various factors, including the lack of preparedness of health facilities to offer PAC services (i.e. lack of pain medicine, lack of training, inadequate knowledge and grasp of pain medication guidelines, and malfunctioning MVA kits). Moreover, the attitudes of healthcare providers and facilities management toward the MVA device limited the supply and replacement of MVA kits. Moreover, the scarcity of pain medicines also gave some providers the opportunity to abuse patients guided by their values, whereby they would deny patients pain medication as a form of "punishment" if they were suspected of inducing their abortion, especially adolescent girls.
CONCLUSION
The study findings suggest the need for clearer guidelines on pain medication, value clarification and attitude transformation training for providers, systematizing the use of medical uterine evacuation using medical abortion drug and strengthening the supply chain of pain medication and MVA kits to reduce the pain and improve the quality of post-abortion care.
Topics: Pregnancy; Adolescent; Humans; Female; Kenya; Vacuum Curettage; Pain; Abortion, Induced; Abortion, Spontaneous
PubMed: 37619217
DOI: 10.1371/journal.pone.0289689