-
Fertility and Sterility Oct 2014To demonstrate a technique for separation of miscarriage tissue from maternal decidua to reduce maternal cell contamination for chromosome analysis.
OBJECTIVE
To demonstrate a technique for separation of miscarriage tissue from maternal decidua to reduce maternal cell contamination for chromosome analysis.
DESIGN
Retrospective.
SETTING
University-based infertility center.
PATIENT(S)
Not applicable.
INTERVENTION(S)
Retrospective collection of de-identified images and video from manual vacuum aspiration (MVA) performed after first-trimester pregnancy losses. This project was exempt from institutional review board approval as no patient-identifying data were used.
MAIN OUTCOME MEASURE(S)
Reduction of maternal cell contamination and improvement of the accuracy of chromosome analysis.
RESULT(S)
Video demonstration of separation of miscarriage tissue from maternal decidua after MVA.
CONCLUSION(S)
Chromosome analysis of a miscarriage is performed to assess the etiology of miscarriage and recurrent pregnancy loss. However, maternal cell contamination can limit the accuracy. This video demonstrates a technique for separating miscarriage tissue from maternal decidua after MVA to reduce maternal cell contamination prior to sending tissue for analysis. The same technique has been used in our clinic with first-trimester dilation and curettage using mechanical suction.
Topics: Abortion, Spontaneous; Chromosomes, Human; Decidua; Female; Genetic Predisposition to Disease; Humans; Karyotyping; Pregnancy; Pregnancy Trimester, First; Retrospective Studies; Risk Factors; Specimen Handling; Vacuum Curettage
PubMed: 25150388
DOI: 10.1016/j.fertnstert.2014.07.006 -
The Journal of Family Planning and... Jan 2005Surgical abortion using vacuum aspiration or dilatation and curettage has been the method of choice for termination of pregnancy up to 63 days' gestation since the... (Review)
Review
Surgical abortion using vacuum aspiration or dilatation and curettage has been the method of choice for termination of pregnancy up to 63 days' gestation since the 1960s. Over the last three decades many studies have explored the use of medical methods for inducing abortion at these gestations. Earlier regimens assessed the systemic and intrauterine injection of prostaglandins. This was followed in the 1980s by the introduction of the antiprogesterone, mifepristone. Since its introduction, the uptake of medical abortion has been steadily increasing in countries where it has been available for routine use. Most current clinical protocols require the use of prostaglandins in combination with anti-progesterones or antimetabolites. The safety, efficacy and acceptability of the medical regimen are now well established at all gestations of pregnancy. Provision of medical abortion increases the choice available to women, in particular those wishing to avoid surgery.
Topics: Abortifacient Agents; Abortion, Induced; Antimetabolites; Dilatation and Curettage; Female; Humans; Methotrexate; Mifepristone; Misoprostol; Pregnancy; Pregnancy Trimester, First; Prostaglandins
PubMed: 15720840
DOI: 10.1783/0000000052972906 -
Health Services Insights 2022Data on abortion procedures costs are scarce in low- and middle-income countries. In Mexico, the only known study was conducted more than a decade ago, with data from...
BACKGROUND
Data on abortion procedures costs are scarce in low- and middle-income countries. In Mexico, the only known study was conducted more than a decade ago, with data from years before the abortion legislation. This study estimated the costs, from the health system's perspective, of surgical and medical abortion methods commonly used by women who undergo first-trimester abortion in Mexico.
METHODS
Data were collected on staff time, salaries, medications, consumables, equipment, imaging, and lab studies, at 5 public general hospitals. A bottom-up micro-costing approach was used.
RESULTS
Surgical abortion costs were US$201 for manual vacuum aspiration and US$298 for sharp curettage. The cost of medical abortion with misoprostol was US$85. The use of cervical ripening increases the costs by up to 18%. Staff comprised up to 72% of total costs in surgical abortions. Hospitalization was the area where most of the spending occurred, due to the staff and post-surgical surveillance required.
CONCLUSIONS
Our estimates reflect the costs of "real-life" implementation and highlight the impact on costs of the overuse of resources not routinely recommended by clinical guidelines, such as cervical ripening for surgical abortion. This information will help decision-makers to generate policies that contribute to more efficient use of resources.
PubMed: 36171763
DOI: 10.1177/11786329221126347 -
Obstetrics and Gynecology Mar 1996To describe the use of methotrexate and misoprostol to induce abortion in pregnancies up to 8 weeks when uterine or cervical anomalies make suction curettage difficult...
OBJECTIVE
To describe the use of methotrexate and misoprostol to induce abortion in pregnancies up to 8 weeks when uterine or cervical anomalies make suction curettage difficult or impossible.
METHODS
Four consecutive women, 8 weeks pregnant or less and with failed suction curettage, were given methotrexate 50 mg per square meter intramuscularly followed by a misoprostol 800-microgram suppository 72 hours later. A repeat dose of a misoprostol 800-microgram vaginal suppository was administered on day 4 if there was no bleeding, and an additional dose was given if the repeat beta-hCG titer had not decreased by at least 50%. Subjects were followed-up with serum or urine hCG assays. Complete abortion was defined by vaginal bleeding and a negative urine pregnancy test. Subjects completed a daily symptom log and a satisfaction questionnaire when the abortion was complete.
RESULTS
The four women referred after failed suction curettage had the following anatomic problems: a uterus bicornis bicollis, a bicornuate uterus, uterine leiomyomas, and cervical stenosis resulting from previous laser surgery. All subjects had a complete abortion from methotrexate and misoprostol. Mild gastrointestinal side effects were reported by all four subjects: nausea (two subjects), vomiting (two), and diarrhea (two). The satisfaction questionnaire revealed that all subjects agreed with the statements that "Overall, the procedure went well" and "I would recommend this procedure over a surgical abortion."
CONCLUSION
Methotrexate and misoprostol can induce an abortion when uterine or cervical anomalies make suction curettage difficult or impossible.
Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adult; Drug Therapy, Combination; Female; Folic Acid Antagonists; Humans; Methotrexate; Middle Aged; Misoprostol; Pregnancy; Treatment Failure; Vacuum Curettage
PubMed: 8598972
DOI: 10.1016/0029-7844(95)00406-8 -
Cureus Jun 2022Uterine rupture is an obstetric emergency that traditionally occurs during delivery in a mother with previously known risk factors, especially a uterine scar. However, a...
Uterine rupture is an obstetric emergency that traditionally occurs during delivery in a mother with previously known risk factors, especially a uterine scar. However, a rupture that occurs in an unscarred uterus is uncommon. We report a case of a low-risk mother who presented for induction of labor for late-term pregnancy, without a history of uterine surgery, required vacuum-assisted vaginal delivery for maternal exhaustion, and one hour later was noted to have postpartum hemorrhage. The postpartum hemorrhage was managed medically but was taken for curettage due to continued hemorrhage and hemodynamic instability, followed by laparotomy which identified an 11 cm vertical uterine rupture parallel to the ascending uterine artery concealed in the broad ligament and extending inferiorly to the lateral cervix, necessitating a total abdominal hysterectomy. The patient tolerated the procedures well and was discharged home on postoperative day 2. Highlighting the importance of a high index of suspicion for uterine rupture, even without risk factors, this report describes an atypical presentation and describes an effective stepwise approach to management.
PubMed: 35865436
DOI: 10.7759/cureus.26041 -
BMC Health Services Research Dec 2020Despite a recognized need for midwives to provide post abortion care, there exist barriers preventing them from integrating lifesaving skills such as manual vacuum...
BACKGROUND
Despite a recognized need for midwives to provide post abortion care, there exist barriers preventing them from integrating lifesaving skills such as manual vacuum aspiration (MVA) into practice. This collaborative research with the Professional Association of Congolese Midwives (SCOSAF), sought to understand how certain midwives in the Democratic Republic of Congo (DRC) have overcome barriers to successfully integrate MVA for post abortion care. Specifically, in order to provide locally-driven solutions to the problem of inadequate post abortion care in the DRC, this study aimed to identify examples of positive deviance, or midwives who had successfully integrated MVA in complex working environments following an in-service training facilitated by their midwifery association, SCOSAF.
METHODS
Creswell's mixed method comparative case study design was used to identify positive deviant midwives who had practiced MVA one or more times post training and to explore their strategies and enabling factors. Other midwives who had not practiced MVA post training permitted for a comparison gro cup and further interpretations. Sources of data included a sequential survey and semi-structured interviews.
RESULTS
All 102 midwives invited to be surveyed were recruited and 34% reported practicing MVA post training (positive deviant midwives). No statistical significance was found between the two groups' demographics and practice facility type. Overall, both groups had positive attitudes regarding midwifery-led MVA and legalization of abortion. Positive deviant midwives demonstrated and described more confidence and competence to practice and teach MVA. They were more likely to identify as teachers and overcome interprofessional barriers by teaching MVA to physicians, medical students and other midwives and position themselves as experts during post abortion emergencies.
CONCLUSION
Results provided important insight to midwives' integration of post abortion care in Kinshasa. Strategies used by positive deviant midwives in emergencies allowed them to navigate challenging contexts in order to practice MVA, while simultaneously increasing the credibility of their profession and the dissemination of evidenced-based MVA practice. Programs designed to work with and promote positive deviant midwives as knowledge brokers could be tested for their overall impact on the diffusion of midwifery-led MVA to improve access to safe, respectful reproductive care.
Topics: Abortion, Induced; Democratic Republic of the Congo; Female; Humans; Midwifery; Pregnancy; Qualitative Research; Vacuum Curettage
PubMed: 33302962
DOI: 10.1186/s12913-020-05997-7 -
American Journal of Public Health Jul 1975Menstrual regulation is a safe, effective, and economical method of fertility control. Its increased safety compared to first trimester abortion establishes menstrual...
Menstrual regulation is a safe, effective, and economical method of fertility control. Its increased safety compared to first trimester abortion establishes menstrual regulation by vacuum aspiration for treatment of up to 14 days missed menstrual period as probably better medical practice than waiting to confirm the presence of a pregnancy. Because it is a postcontraceptive method, menstrual regulation has potential in family planning services both as a recruitment service and for the treatment of contraceptive failures. Its use as an only method of fertility control is being studied. The acceptance of this new family planning service will primarily depend on its availability, dissemination of information about the service, and the ability of women freely to avail themselves of the service without delay. Although long term effects of single and repeated use of menstrual regulation are not known, its immediate complications are few and it can be recommended as a useful addition to present fertility control methods in family planning programs.
Topics: Abortion, Induced; Adolescent; Adult; Age Factors; Consumer Behavior; Contraception; Costs and Cost Analysis; Family Planning Services; Female; Humans; Middle Aged; Pregnancy; Time Factors; Vacuum Curettage
PubMed: 1147115
DOI: 10.2105/ajph.65.7.731 -
PloS One 2018Abortion-related mortality accounts for 8% of all global maternal deaths and 97% of the estimated 25 million unsafe abortions performed each year occur in low- and...
BACKGROUND
Abortion-related mortality accounts for 8% of all global maternal deaths and 97% of the estimated 25 million unsafe abortions performed each year occur in low- and middle-income countries. Haiti has the highest rate of maternal mortality in the western hemisphere and to further understand the circumstances of induced abortion in Haiti, the current work uses data from the 2012 Demographic and Health Survey (DHS) to describe the methods of induced abortion in Haiti between 2007-2012 and to identify potential factors associated with use of different abortion methods.
METHODS
This is a secondary analysis of nationally representative cross-sectional data from the 2012 Haitian DHS, a two-stage cluster randomized household survey. Analysis included descriptive statistics on participant demographics, methods of abortion, and location of / assistant for the abortion. Multivariate regression was conducted to determine if demographic characteristics were associated with: 1) increased or decreased odds of having an abortion; or 2) increased or decreased odds of reporting an evidence based or non-evidence based method of abortion.
RESULTS
Among the 14,287 women of childbearing age who completed the 2012 Haiti DHS survey, 289 women reported having an induced abortion in the previous five years. Recommended methods, manual vacuum aspiration (MVA) or misoprostol alone, were used in 26.6% of the abortions (n = 77). Additionally, 13.8% (n = 40) of abortions used these recommended methods in combination with a non-evidenced based method such as injections, plants or tablets. A total of 92 women had a dilation and curettage (D&C) abortion, either alone (n = 77) or in combination with another method (n = 15) and over a quarter (n = 80) of reported abortions were conducted by non-evidence based methods (n = 80). A majority of abortions using a recommended method were assisted by a relative/friend (n = 28) or were unassisted (n = 34). Most abortions occurred in private homes (n = 174) with hospitals/clinics being the second most common location (n = 84). Women in the middle (OR = 3.3, 95% CI = 2.0-5.6) and highest (OR = 7.4, 95% CI = 4.4-12.3) wealth brackets were more likely to have had an abortion in comparison to women in the lowest wealth bracket. Women who had ever been in a marital union were more likely to have had an abortion than those who had not. The only demographic factor predictive of aborting using a recommended method was living in an urban area, with urban-dwelling women being less likely to use a recommended abortion method (OR = 0.4, 95% CI = 0.2-0.9) in comparison with women living in rural settings.
CONCLUSION
In a nationally representative survey in Haiti, 2% of women of childbearing age reported having an abortion in the five years prior to the survey. A large proportion of these abortions were carried out using non-evidence based methods and over half occurred outside of the formal health care system. Understanding women's attitudes, knowledge and barriers around abortion is paramount to improving knowledge and access to evidence-based abortion care in an effort to decrease maternal morbidity and mortality in Haiti.
Topics: Abortion, Induced; Adolescent; Adult; Attitude; Cross-Sectional Studies; Female; Haiti; Humans; Income; Knowledge; Middle Aged; Multivariate Analysis; Pregnancy; Surveys and Questionnaires; Urban Population; Young Adult
PubMed: 30408133
DOI: 10.1371/journal.pone.0206967 -
International Journal of Gynaecology... Jul 2014The Obstetrical and Gynaecological Society of Bangladesh was an important advocate in mobilizing government authorities to adopt new techniques for postabortion care and...
The Obstetrical and Gynaecological Society of Bangladesh was an important advocate in mobilizing government authorities to adopt new techniques for postabortion care and provide long-acting contraceptives post abortion. With the support of the International Federation of Gynecology and Obstetrics (FIGO), the Society provided commodities and training to increase the use of these techniques in 7 private and public hospitals and clinics. Data from two of these institutes for the January 2012 to June 2013 period showed a rapid decrease in the use of dilation and curettage, an increase in the use of manual vacuum aspiration (MVA) and misoprostol, and the progressive adoption of long-acting reversible contraceptives, permanent contraception, and injectable contraceptives in one of these two hospitals. The Directorates General of Health and Family Planning incorporated training in the use of MVA and misoprostol in their national operation plans. The success in these hospitals shows that the proposed changes have been well accepted by providers and clients.
Topics: Abortifacient Agents, Nonsteroidal; Abortion, Incomplete; Aftercare; Bangladesh; Contraception; Contraceptive Agents; Dilatation and Curettage; Female; Humans; International Agencies; Misoprostol; Pregnancy; Societies, Medical; Vacuum Curettage
PubMed: 24792403
DOI: 10.1016/j.ijgo.2014.03.004 -
Cureus Jul 2020Introduction Worldwide numbers of patients suffering from complex wounds appear to increase annually. These patients present with acute, sub-acute and chronic wounds...
Introduction Worldwide numbers of patients suffering from complex wounds appear to increase annually. These patients present with acute, sub-acute and chronic wounds which can be difficult to manage. Management of these patients typically requires a multi-disciplinary approach by a plastic surgeon, orthopaedic surgeon and infectious disease control team. Despite the advent of numerous new techniques and technologies, negative pressure wound therapy (NPWT) remains a cornerstone to the management of complex wounds. We present our experience with NPWT in this study. Methods This is a retrospective study of 380 patients who were treated with NPWT in the last 10 years at a single center. We receive hundreds of infected wounds of limbs each year which are either post-traumatic or post-debridement. Frequency of dressing change, C-reactive protein levels, bacterial cultures, complication rate and cost of apparatus in each case were noted. All patients received systemic antibiotics during the treatment. Results We reviewed hospital data of 520 patients in which debridement was performed. Of the 520 patients derided, 380 patients were treated with NPWT, and included in study. Number of NPWT sessions was decided on the basis of wound status (adequate healthy granulation tissue, clinically improved circulation). A single session of NPWT dressing was applied in 84% (n = 320) patients, 8% (n = 31) patients needed two sessions of NPWT dressing, 6% (n = 24) patients had three sessions of NPWT dressing and only 1% (n = 5) patients did not respond to NPWT dressing. 78% (n = 297) patients had reduced levels of C-reactive protein levels and wound cultures were negative in 54% (n = 208) patients after application of NPWT dressing. Minor complications occurred in 0.7% (n = 3) patients due to occult osteomyelitis. In 0.5% (n = 2) patients, NPWT dressing was discontinued due to persistent leakage near a natural orifice. Sinus formation was seen in 6% (n = 23) patients who were treated with curettage and conventional dressings. The mean pain score on the verbal analogue scale was 3 out of 10. The mean cost of an NPWT dressing apparatus was 90 dollars. Conclusion We conclude from this study that NPWT dressing can be easily applied to any region of the body and it can be customized to the needs of patients from different socio-economic status.
PubMed: 32879811
DOI: 10.7759/cureus.9464