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Ochsner Journal 2018Cesarean scar pregnancy is an ectopic pregnancy embedded in the myometrium of a cesarean scar. Several types of conservative treatment have been used to treat cesarean...
BACKGROUND
Cesarean scar pregnancy is an ectopic pregnancy embedded in the myometrium of a cesarean scar. Several types of conservative treatment have been used to treat cesarean scar pregnancy, but no management protocol has been established for this rare, life-threatening condition. The purpose of this study was to evaluate the feasibility of suction curettage as a first-line treatment in early cesarean scar pregnancy.
METHODS
During a 4-year period, 19 cases of cesarean scar pregnancy were diagnosed at Süleymaniye Maternity Hospital in Istanbul, Turkey. Suction curettage and Foley balloon tamponade were performed as a first-line treatment in 13 patients. Medical records and treatment results of the patients were evaluated.
RESULTS
The mean maternal age was 32.5 years (range, 24-39 years). The mean gestational sac diameter was 13.65 mm (range, 7.6-27 mm), and mean endometrial thickness was 10.7 mm (range, 6.7-14.6 mm). A measurable fetal pole for crown-rump length was available for 6 (46.1%) patients. None of the fetuses had cardiac activity. Suction curettage under ultrasound guidance and Foley balloon tamponade were successful as the primary treatment in 13 of 13 patients. No major complications occurred during or after the procedure.
CONCLUSION
Our data suggest that surgical evacuation under ultrasound guidance with Foley balloon tamponade is a safe and successful treatment modality in carefully selected patients with early cesarean scar pregnancy.
PubMed: 30275785
DOI: 10.31486/toj.17.0118 -
BMJ Global Health 2018The maternal mortality ratio is decreasing globally, although it remains high in Malawi. Unsafe abortion is a major cause and treatment of complications after abortion...
INTRODUCTION
The maternal mortality ratio is decreasing globally, although it remains high in Malawi. Unsafe abortion is a major cause and treatment of complications after abortion is a big burden on the health system. Even though manual vacuum aspiration (MVA) is the recommended surgical treatment of incomplete abortions in the first trimester, many hospitals in Malawi continue to use sharp curettage. It is known to have more complications and is more expensive in the long run. The purpose of this study was to determine the effectiveness of a structured MVA training programme in the treatment of incomplete abortions in Malawi.
METHODS
A quasi-experimental before-and-after study design was employed in an MVA training programme for health personnel at three hospitals in Southern Malawi. A total of 53 health personnel at the Queen Elizabeth Central Hospital and the district hospitals of Chikwawa and Chiradzulu (intervention hospitals) were trained in the use of MVA. Kamuzu Central Hospital in Lilongwe and the Thyolo District Hospital served as control institutions. Medical files for all women treated for an incomplete abortion at the study hospitals were reviewed before and after the intervention. Information on demographic and obstetric data and the type of treatment was collected.
RESULTS
There was a significant increase in the use of MVA from 7.8% (95% CI 5.8 to 10.3) to 29.1% (95% CI 25.9 to 32.5) 1 year after the intervention. In comparison, we found a mere 3% increase in the control hospitals.
CONCLUSIONS
By providing a refresher training programme to health personnel who treat women with incomplete abortions, it was possible to increase the use of MVA as recommended in the Malawi national guidelines.
PubMed: 30271625
DOI: 10.1136/bmjgh-2018-000823 -
BMC Women's Health Sep 2018Induced abortion is one of the most common gynecological procedures in Sweden, but there is still little knowledge about the adverse effects. The aims of this study are...
BACKGROUND
Induced abortion is one of the most common gynecological procedures in Sweden, but there is still little knowledge about the adverse effects. The aims of this study are to provide an overview of complications of medical and surgical abortions and to evaluate the impact of bacterial screening to prevent postabortal infections.
METHODS
All women who underwent induced abortion at Skaraborg Hospital between 2008 and 2015 are included in the study. Bacterial screening for chlamydia, gonorrhea, mycoplasma, and bacterial vaginosis was performed prior to the abortions. Abortion complications, categorized as bleeding, infection, or incomplete abortion were assessed in women who came in contact with the gynecological clinic within 30 days after the procedure.
RESULTS
A total of 4945 induced abortions were performed during the study period. Nearly all, 4945 (99.7%) were eligible for inclusion in the study. Medical abortions < 12 weeks were the most common procedure (74.7%), followed by surgical abortions (17.5%), and medical abortion > 12 weeks (7.8%). Complications were registered in 333 (6.7%) of all abortions. Among medical abortions < 12 weeks, the complication frequency increased significantly, from 4.2% in 2008 to 8.2% in 2015 (RR 1.49, 95% 1.04-2.15). An incomplete abortion was the most common complication related to medical abortions < 12 weeks. Of all women who tested positive for one or several bacteria at the screening and therefore received antibiotics, 1.4% developed a postabortal infection. Among those who tested negative at the screening, 1.7% developed infectious complications.
CONCLUSIONS
The share of complications related to medical abortions < 12 weeks increased significantly during 2008-2015 without any evident cause. Women who tested positive for one or several bacteria upon screening and received antibiotics experienced almost an equal proportion of postabortal infections compared to women who tested negative upon screening. The screening process seems to fulfill its purpose of reducing the risk of infectious complications.
Topics: Abortifacient Agents; Abortion, Incomplete; Abortion, Induced; Adult; Bacterial Infections; Chlamydia Infections; Female; Follow-Up Studies; Gonorrhea; Humans; Incidence; Longitudinal Studies; Mass Screening; Mycoplasma Infections; Postoperative Complications; Pregnancy; Preoperative Period; Prevalence; Prospective Studies; Retrospective Studies; Sweden; Vaginosis, Bacterial
PubMed: 30253769
DOI: 10.1186/s12905-018-0645-6 -
International Journal of Hyperthermia :... 2018To evaluate the correlation between the gestational sac size and the effect and safety of high intensity focused ultrasound (HIFU) combined with ultrasound-guided...
The impact of gestational sac size on the effectiveness and safety of high intensity focused ultrasound combined with ultrasound-guided suction curettage treatment for caesarean scar pregnancy.
OBJECTIVE
To evaluate the correlation between the gestational sac size and the effect and safety of high intensity focused ultrasound (HIFU) combined with ultrasound-guided suction curettage for caesarean scar pregnancy (CSP).
METHODS
Seventy-six patients with CSP were enrolled. Based on their gestational sac size, patients were divided into three groups: Group 1 (n = 16, 10-20 mm), Group 2 (n = 28, 21-30 mm) and Group 3 (n = 32, >30 mm). All of them were treated by HIFU combined with ultrasound-guided suction curettage. Baseline characteristics, parameters and adverse events of HIFU, and intraoperative hemorrhage during ultrasound-guided suction curettage were recorded.
RESULTS
The median treatment time and average treatment intensity of HIFU in Group 3 were significantly higher than Group 1 (p < .05); the median HIFU treatment power in Group 2 and Group 3 were both significantly higher than that of Group 1 (p < .05). The median sonication time of HIFU in Group 3 was significantly longer than patients in the other two groups (p < .05). The size of the gestational sac had a positive correlation with all the above-mentioned parameters of HIFU and blood loss during ultrasound-guided suction curettage (p < .05). No statistically significant differences were observed among the three groups in the duration of vaginal bleeding post-curettage and the time necessary for serum β-hCG to return to normal levels (p > .05).
CONCLUSIONS
HIFU combined with ultrasound-guided suction curettage is a safe and effective clinical approach for CSP. Gestational sac size is a meaningful factor for predicting the efficacy and safety of HIFU treatment and hemorrhage during ultrasound-guided suction curettage.
Topics: Adult; Cesarean Section; Female; Gestational Sac; Humans; Pregnancy; Ultrasonography; Vacuum Curettage
PubMed: 30200790
DOI: 10.1080/02656736.2018.1496485 -
Acta Obstetricia Et Gynecologica... Dec 2018Women with miscarriage experience several negative emotional feelings such as grief, isolation, coping, and despair. However, less is known about how the type of... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Women with miscarriage experience several negative emotional feelings such as grief, isolation, coping, and despair. However, less is known about how the type of treatment and diagnosis of miscarriage influence the emotional experience.
MATERIAL AND METHODS
The present study was a randomized prospective longitudinal cohort study, in which women with spontaneous miscarriage (n = 35), and women with missed miscarriage (n = 67), were included to answer three validated questionnaires: Revised Impact of Miscarriage Scale, Perinatal Grief Scale, and Montgomery and Åsberg Depression Rating Scale, concerning experience of miscarriage, psychological well-being, and mental health 1 week and 4 months after finalized treatment.
RESULTS
There was no difference between the 2 diagnosis groups in feelings as measured by Revised Impact of Miscarriage Scale, Montgomery and Åsberg Depression Rating Scale, and Perinatal Grief Scale 1 week after the miscarriage. However, the psychological well-being improved significantly 4 months after the miscarriage. Separated by treatment, women treated with misoprostol alone had more depressive symptoms than women treated with misoprostol and subsequent vacuum aspiration.
CONCLUSIONS
It can be concluded that diagnosis of miscarriage had limited influence on the experiences of miscarriage, but shorter duration of treatment with misoprostol and subsequent vacuum aspiration resulted in fewer depressive symptoms.
Topics: Abortifacient Agents, Nonsteroidal; Abortion, Spontaneous; Adult; Combined Modality Therapy; Depression; Female; Grief; Humans; Longitudinal Studies; Misoprostol; Pregnancy; Prospective Studies; Psychiatric Status Rating Scales; Risk Factors; Time Factors; Treatment Outcome; Vacuum Curettage
PubMed: 30063247
DOI: 10.1111/aogs.13432 -
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 -
International Journal of Environmental... Feb 2018Malawi has a high maternal mortality rate, of which unsafe abortion is a major cause. About 140,000 induced abortions are estimated every year, despite there being a...
Malawi has a high maternal mortality rate, of which unsafe abortion is a major cause. About 140,000 induced abortions are estimated every year, despite there being a restrictive abortion law in place. This leads to complications, such as incomplete abortions, which need to be treated to avoid further harm. Although manual vacuum aspiration (MVA) is a safe and cheap method of evacuating the uterus, the most commonly used method in Malawi is curettage. Medical treatment is used sparingly in the country, and the Ministry of Health has been trying to increase the use of MVA. The aim of this study was to investigate the treatment of incomplete abortions in three public hospitals in Southern Malawi during a three-year period. All medical files from the female/gynecological wards from 2013 to 2015 were reviewed. In total, information on obstetric history, demographics, and treatment were collected from 7270 women who had been treated for incomplete abortions. The overall use of MVA at the three hospitals during the study period was 11.4% (95% CI, 10.7-12.1). However, there was a major increase in MVA application at one District Hospital. Why there was only one successful hospital in this study is unclear, but may be due to more training and dedicated leadership at this particular hospital. Either way, the use of MVA in the treatment of incomplete abortions continues to be low in Malawi, despite recommendations from the World Health Organization (WHO) and the Malawi Ministry of Health.
Topics: Abortion, Incomplete; Abortion, Induced; Adult; Female; Hospitals, Public; Humans; Malawi; Pregnancy; Uterus; Vacuum Curettage; Young Adult
PubMed: 29466308
DOI: 10.3390/ijerph15020370 -
PloS One 2018Post abortion complications are the third leading cause of maternal death after hemorrhage and hypertension in Botswana where abortion is not legalized. This study aimed...
BACKGROUND
Post abortion complications are the third leading cause of maternal death after hemorrhage and hypertension in Botswana where abortion is not legalized. This study aimed at assessing the management of post abortion complications in Botswana.
METHODS
A retrospective study was conducted at four hospitals in Botswana in 2014. Socio-demographic, patient management and outcomes data were extracted from patients' medical records. Descriptive statistics and chi-square test were used to analyze and present the data.
RESULT
A total of 619 patients' medical records were reviewed. The duration of hospital stay prior to uterine evacuation ranged from less than an hour to 480 hours. All the patients received either prophylactic or therapeutic antibiotics. Use of parenteral antibiotics was significantly associated with severity of abortion, second trimester abortion, use of blood products and the interval between management's decision and uterine evacuation. Uterine evacuation for retained products of conception was achieved by metallic curettage among 516 (83.4%) patients and by vacuum aspiration in 18 (2.9%). At all the study sites, Misoprostol or Oxytocin were used concurrently with surgical evacuation of the uterus. None use of analgesics or anesthetics in the four hospitals ranged between 12.4% to 28.8%.
CONCLUSION
There is evidence of delayed patient care and prolonged hospital stay. Metallic curette was the primary method used for uterine evacuation across all the facilities. Pain management and antibiotics use was not standardized. A protocol has to be developed with the aim of standardizing post abortion care.
Topics: Abortion, Criminal; Abortion, Induced; Adolescent; Adult; Botswana; Cross-Sectional Studies; Female; Humans; Length of Stay; Middle Aged; Misoprostol; Pregnancy; Retrospective Studies; Vacuum Curettage; Young Adult
PubMed: 29451883
DOI: 10.1371/journal.pone.0192438 -
BMJ Open Feb 2018Abortion complications cause significant morbidity and mortality. We aimed to assess the severity and factors associated with abortion complications (induced or...
OBJECTIVES
Abortion complications cause significant morbidity and mortality. We aimed to assess the severity and factors associated with abortion complications (induced or spontaneous), and the management of postabortion care (PAC) in Zimbabwe.
DESIGN
Prospective, facility-based 28 day survey among women seeking PAC and their providers.
SETTING
127 facilities in Zimbabwe with the capacity to provide PAC, including all central and provincial hospitals, and a sample of primary health centres (30%), district/general/mission hospitals (52%), private (77%) and non-governmental organisation (NGO) (68%) facilities.
PARTICIPANTS
1002 women presenting with abortion complications during the study period.
MAIN OUTCOME MEASURES
Severity of abortion complications and associated factors, delays in care seeking, and clinical management of complications.
RESULTS
Overall, 59% of women had complications classified as mild, 19% as moderate, 19% as severe, 3% as near miss and 0.2% died. A median of 47 hours elapsed between experiencing complication and receiving treatment; many delays were due to a lack of finances. Women who were rural, younger, not in union, less educated, at later gestational ages or who had more children were significantly more likely to have higher severity complications. Most women were treated by doctors (91%). The main management procedure used was dilatation and curettage/dilatation and evacuation (75%), while 12% had manual vacuum aspiration (MVA) or electrical vacuum aspiration and 11% were managed with misoprostol. At discharge, providers reported that 43% of women received modern contraception.
CONCLUSION
Zimbabwean women experience considerable abortion-related morbidity, particularly young, rural or less educated women. Abortion-related morbidity and concomitant mortality could be reduced in Zimbabwe by liberalising the abortion law, providing PAC in primary health centres, and training nurses to use medical evacuation with misoprostol and MVA. Regular in-service training on PAC guidelines with follow-up audits are needed to ensure compliance and availability of equipment, supplies and trained staff.
Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Abortion, Spontaneous; Adolescent; Adult; Aftercare; Contraception; Cross-Sectional Studies; Female; Humans; Middle Aged; Misoprostol; Multivariate Analysis; Postoperative Complications; Pregnancy; Prospective Studies; Regression Analysis; Severity of Illness Index; Vacuum Curettage; Young Adult; Zimbabwe
PubMed: 29440163
DOI: 10.1136/bmjopen-2017-019658 -
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