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Morbidity and Mortality Weekly Report.... Nov 2009Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States.
PROBLEM/CONDITION
Since 1969, CDC has conducted abortion surveillance to document the number and characteristics of women obtaining legal induced abortions in the United States.
REPORTING PERIOD COVERED
2006.
DESCRIPTION OF SYSTEM
Each year, CDC requests abortion data from the central health agencies of 52 reporting areas (the 50 states, New York City, and the District of Columbia); these data are provided to CDC voluntarily. In 2006, data were received from 49 reporting areas. For the purpose of trend analysis, data were evaluated from the 46 areas that reported data every year during 1996-2006.
RESULTS
For 2006, a total of 846,181 abortions were reported to CDC. Among the 46 areas that provided data consistently during 1996-2006, a total of 835,134 abortions (98.7% of the total) were reported; the abortion rate was 16.1 abortions per 1,000 women aged 15-44 years, and the abortion ratio was 236 abortions per 1,000 live births. During the previous decade (1997-2006), reported abortion numbers, rates, and ratios decreased 5.7%, 8.8%, and 14.8%, respectively; most of these declines occurred before 2001. During the previous year (2005-2006), the total number of abortions increased 3.1%, and the abortion rate increased 3.2%; the abortion ratio was stable. In 2006, as during the previous decade (1997-2006), women aged 20-29 years accounted for the majority (56.8%) of abortions and had the highest abortion rates (29.9 abortions per 1,000 women aged 20-24 years and 22.2 abortions per 1,000 women aged 25-29 years); by contrast, abortion ratios were highest at the extremes of reproductive age. Adolescents aged 15-19 years accounted for 16.5% of all abortions in 2006 and had an abortion rate of 14.8 abortions per 1,000 adolescents aged 15-19 years; women aged >or=35 years accounted for a smaller percentage (12.1%) of abortions and had lower abortion rates (7.8 abortions per 1,000 women aged 35-39 years and 2.6 abortions per 1,000 women aged >or=40 years). During 1997-2006, the percentage of abortions and the abortion rate increased among women aged >or=35 years but declined among adolescents aged
or=21 weeks' gestation (1.3%). During 1997-2006, the percentage of abortions performed at curettage (including vacuum aspiration, sharp curettage, and dilation and evacuation procedures), followed by medical (nonsurgical) abortion (10.6%). Deaths of women associated with complications from abortions for 2006 are being investigated under CDC's Pregnancy Mortality Surveillance System. In 2005, the most recent year for which data were available, seven women were reported to have died as a result of complications from known legal induced abortions. No reported deaths were associated with known illegal induced abortions. INTERPRETATION
Among the 46 areas that reported data consistently during 1996-2006, decreases in the total reported number, rate, and ratio of abortions were attributable primarily to reductions before 2001. During 2005-2006, the total number and rate of abortions increased. In 2005, as in the previous years, reported deaths related to abortions occurred only rarely.
PUBLIC HEALTH ACTION
Abortion surveillance in the United States continues to provide the data needed to examine trends in the number and characteristics of women obtaining abortions. Policymakers and program planners can use these data to guide and evaluate efforts to prevent unintended pregnancies.
Topics: Abortion, Legal; Adolescent; Adult; Age Factors; Female; Gestational Age; Humans; Population Surveillance; Pregnancy; Pregnancy Trimesters; Pregnancy in Adolescence; United States; Young Adult
PubMed: 19940837
DOI: No ID Found -
Journal of Zhejiang University.... Apr 2005Sir Run Run Shaw Hospital (SRRSH) has developed a form of laparoscopic hepatectomy, resecting by curettage and suction. Such resection has been carried out successfully...
Sir Run Run Shaw Hospital (SRRSH) has developed a form of laparoscopic hepatectomy, resecting by curettage and suction. Such resection has been carried out successfully in 6 patients who had liver tumors. The results are satisfactory. And after the operation, there is a very effective perioperative nursing ensuring the patient's recovery.
Topics: Adult; Aged; Female; Health Education; Humans; Laparoscopy; Liver; Male; Middle Aged; Perioperative Nursing; Retrospective Studies; Treatment Outcome; Vacuum Curettage
PubMed: 15754429
DOI: 10.1631/jzus.2005.B0301 -
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 -
Frontiers in Endocrinology 2021Cesarean scar pregnancy affects 6% of all ectopic pregnancies in women with prior cesarean section, and there is currently no consensus on the optimal treatment. Options... (Comparative Study)
Comparative Study Randomized Controlled Trial
A Comparison of Ultrasound Guided Curettage With and Without Uterine Artery Embolization on Controlling Intraoperative Blood Loss for a Cesarean Scar Pregnancy Treatment: Study Protocol for a Randomized Clinical Trial.
INTRODUCTION
Cesarean scar pregnancy affects 6% of all ectopic pregnancies in women with prior cesarean section, and there is currently no consensus on the optimal treatment. Options of surgical treatment have a risk of intraoperative blood loss; therefore, uterine artery embolization (UAE) has been considered as an option of reducing intraoperative blood loss. However, UAE may be overused in clinical practice, especially in China. We present this protocol for a randomized clinical trial investigating the necessity of performing UAE for cesarean scar pregnancy, in combination with surgical suction curettage, taking into account the different subtypes of cesarean scar pregnancy. We recently developed a risk-scoring system (QRS) to estimate intraoperative blood loss, with 93.8% sensitivity and 6.3% false negative. Through this randomized clinical trial, we will retrospectively validate the QRS score on predicting intraoperative blood loss.
METHODS AND ANALYSIS
We propose undertaking a randomized clinical trial sequentially recruiting 200 patients. All the patients will randomly receive ultrasound guided curettage with or without UAE. Data on the subtypes of cesarean scar pregnancy (Types 1 and II and III) detected by ultrasound will be collected before operation. The score on estimating intraoperative blood loss assessed by our recently developed quantitative risk-scoring system (QRS) will be collected before the operation. We will primarily compare the duration of the operation, intraoperative blood loss, and complications between the two groups. We will also retrospectively analyze the association of subtypes of cesarean scar pregnancy and the options of treatment and validate the QRS score. Outcomes of subsequent pregnancy within the 2-year follow-up will be secondary outcomes.
TRIAL REGISTRATION NUMBER
[website], identifier ChiCTR2100041654.
Topics: Blood Loss, Surgical; Cesarean Section; China; Cicatrix; Curettage; False Negative Reactions; Female; Humans; Pregnancy; Pregnancy Outcome; Pregnancy, Ectopic; Randomized Controlled Trials as Topic; Retrospective Studies; Risk; Risk Assessment; Sensitivity and Specificity; Ultrasonography; Ultrasonography, Interventional; Uterine Artery Embolization; Vacuum Curettage
PubMed: 34194390
DOI: 10.3389/fendo.2021.651273 -
Case Reports in Women's Health Dec 2023Gestational trophoblastic disease (GTD) is an abnormal pregnancy caused by the placenta, which can potentially metastasise. Suction evacuation is recommended for...
Gestational trophoblastic disease (GTD) is an abnormal pregnancy caused by the placenta, which can potentially metastasise. Suction evacuation is recommended for diagnosis and treatment, and dilatation and evacuation (D&E) is usually performed under intravenous anaesthesia due to the short operation time and minimal blood loss. We refer to the guidelines produced by the Japan Society of Obstetrics and Gynaecology (JSOG), and acknowledge that practices vary globally. However, to the best of our knowledge, there is no evidence on perioperative management and arrangements in D&E required for managing giant hydatidiform moles, such as preventing massive haemorrhage, respiratory dysfunction with a pathogenesis like ovarian hyperstimulation syndrome (OHSS), or intensive care needs. This case report describes perioperative considerations for managing a giant hydatidiform mole using D&E in a uterus enlarged to the third-trimester pregnancy size. A 28-year-old multiparous woman was clinically diagnosed with a hydatidiform mole after a spontaneous miscarriage due to abnormal genital bleeding, systemic oedema, and abdominal distention. Ultrasound and computed tomography showed a ballooning uterus with a third-trimester pregnancy size, a robust intrauterine mass, and ascites. Serum hCG levels were extremely high (>3,000,000 mIU/mL), confirming the clinical diagnosis of a hydatidiform mole. Emergency D&E was safely performed under multidisciplinary perioperative management, with careful preparation and support. This is a rare experience-based case report and valuable documentation detailing multidisciplinary perioperative management under general anaesthesia. To the best of our knowledge, this is the first report describing the considerations, details, and innovations required in the perioperative management of giant hydatidiform moles using D&E.
PubMed: 37954516
DOI: 10.1016/j.crwh.2023.e00556 -
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 -
Medical Archives (Sarajevo, Bosnia and... Apr 2020The association of acute intermitetn porphyria (AIP) with pregnancy and as a cause of spontaneous abortion is rare.
INTRODUCTION
The association of acute intermitetn porphyria (AIP) with pregnancy and as a cause of spontaneous abortion is rare.
AIM
To show a case of AIP known before pregnancy in a patient who had a spontaneous abortion.
CASE REPORT
A gynecologist examined 26-year-old patient in the 8th week of gestation, due to initial spontaneous abortion, abdominal pain, constipation, muscle weakness, vomiting and dark colour of urine. Her therapy was dydrogesterone. In consultation with an anesthesiologist, a short intravenous anesthesia, vacuum aspiration, and curettage were performed.During hospitalization, the patient ceased to take harmful drugs and she was given haemarginate, glucose and symptomatic drugs, and she recovered completely.
CONCLUSION
Treatment of threatened spontaneous abortion in AIP remains the subject of dilemma and controversy, and future research is needed.
Topics: Abortion, Spontaneous; Adult; Aminolevulinic Acid; Contraceptives, Oral, Hormonal; Disease Progression; Dydrogesterone; Female; Humans; Porphobilinogen; Porphyria, Acute Intermittent; Pregnancy; Progestins; Vacuum Curettage
PubMed: 32577061
DOI: 10.5455/medarh.2020.74.153-155 -
Revista Colombiana de Obstetricia Y... Sep 2019To describe the safety of medical and surgical treatments used in women seeking voluntary pregnancy termination.
OBJECTIVE
To describe the safety of medical and surgical treatments used in women seeking voluntary pregnancy termination.
METHODS
Historical cohort of all pregnant women with up to 26 weeks of gestation who received treatment for voluntary pregnancy termination in a referral institution in Medellín, Colombia, between January 2013 and December 2014.Sampling was consecutive. Measured variables included sociodemographic and obstetric variables, undesired effects, and complications of the voluntary pregnancy termination treatment. A descriptive analysis was carried out.
RESULTS
Overall, 87 women were included. The mean age at the time of termination was 24 years (inter-quartile range [IQR] = 12), 69.0% were single, and 73,4% were unemployed. The main reason for termination was the risk to the mother's health in 61,0% of cases, followed by a history of sexual violence in 26.4% and fetal malformations in 12.6%; a total of 70 women (80,4%) had less than 18 weeks of gestation and were treated with misoprostol plus manual vacuum aspiration; 17 (19,6%) had between 18 and 26 weeks of gestation and were treated with misoprostol followed by dilation and curettage. The first group (gestational age <18 weeks) experienced undesired effects such as pain and vomiting; in the second group (> or equal to 18 weeks), 41.0% of the women experienced hemorrhage.
CONCLUSIONS
The risk to the mother's health was the main reason for the termination of pregnancy. Termination before 18 weeks was found to be safe, while termination between 18 and 26 weeks using misoprostol and curettage was associated with a high frequency of hemorrhage.
Topics: Abortifacient Agents, Nonsteroidal; Abortion, Induced; Adolescent; Adult; Cohort Studies; Colombia; Dilatation and Curettage; Female; Gestational Age; Humans; Misoprostol; Pregnancy; Pregnancy Trimester, Second; Vacuum Curettage; Young Adult
PubMed: 31738487
DOI: 10.18597/rcog.3267 -
BMC Women's Health Oct 2021Retained products of conception (POC) following uterine evacuation can lead to adverse sequelae, including hemorrhage, endometritis, intrauterine adhesions, and...
BACKGROUND
Retained products of conception (POC) following uterine evacuation can lead to adverse sequelae, including hemorrhage, endometritis, intrauterine adhesions, and reoperation. Use of procedural transvaginal sonography (TVUS) in the operating room has been proposed to help decrease retained POC.
METHODS
A retrospective review of all first trimester uterine evacuation procedures from 1/2015 to 2/2017 was performed, noting use of transabdominal ultrasonography, retained products of conception, and complications. A practice change was implemented in May 2018, in which routine intra-procedural TVUS use was initiated. A second retrospective chart review was conducted to assess for post-implementation incidence of retained POC, re-operation, and associated complications.
RESULTS
Prior to intra-procedural TVUS implementation, 130 eligible procedures were performed during the specified timeframe, with 9/130 (6.9%) incidence of retained products of conception. TAUS was performed in 59/130 (45.4%) of procedures, and 4/9 (44.4%) of those with retained products. There were eight re-operative procedures in seven patients, and two patients were treated with misoprostol. Complications included hemorrhage, Asherman's syndrome and endometritis. Following implementation, 95 first trimester procedures were performed with transvaginal sonography, with 0 (0%) cases of retained POC (p = 0.01), no incidences of re-operation (p = 0.02), and one case of Asherman's syndrome. TVUS findings led to additional focused suction curettage in 20/95 (21.0%) of procedures. The endometrium was measured on procedure completion in 64 procedures, with a mean thickness of 5.5 mm (1-12 mm).
CONCLUSION
Implementation of routine TVUS during uterine evacuation may reduce the incidence of retained POC and associated reoperation rates. Further multi-center trials are needed to confirm this finding.
Topics: Female; Humans; Pregnancy; Pregnancy Trimester, First; Quality Improvement; Retrospective Studies; Ultrasonography; Vacuum Curettage
PubMed: 34602062
DOI: 10.1186/s12905-021-01488-x -
International Journal of Hyperthermia :... 2022To evaluate the effectiveness of high-intensity focused ultrasound (HIFU) combined with hysteroscopy-guided suction curettage (HGSC) in treating cervical pregnancy.
OBJECTIVE
To evaluate the effectiveness of high-intensity focused ultrasound (HIFU) combined with hysteroscopy-guided suction curettage (HGSC) in treating cervical pregnancy.
MATERIALS AND METHODS
This is a retrospective study. Seven patients with cervical pregnancy who visited the Third Xiangya Hospital of Central South University from January 2015 to December 2020 were enrolled in the current study. All seven patients were treated with HIFU under conscious sedation. All of them underwent HGSC at an average of 2 ± 1 days (range: 1-3 days) after HIFU. Before the therapy, the patient's clinical characteristics were collected, including duration of amenorrhea, gravidity and parity, the patient history of cesarean section and miscarriage, and the size of the gestational sac. The levels of β-hCG and hemoglobin in serum were also reviewed. To assess the clinical outcomes of this combined treatment, the suction time of HGSC, bleeding volume, the clearance time of β-hCG, and the time with returning of menstruation were evaluated.
RESULTS
All seven patients (average age: 31 ± 6 years) have experienced amenorrhea (duration range, 48 ± 8 days) before the treatment of HIFU. The average number of pregnancies was four, and the number of deliveries was one. Previous medical history showed six patients had cesarean sections, and five patients have been miscarriages. After HIFU treatment, the fetal heartbeats were stopped in all seven patients based on the diagnosis by doppler ultrasound. The bleeding of gestational tissue decreased significantly. All patients had only mild lower abdominal pain, no fever, intestinal damage, or other complications were reported. The average operation time of operative suction curettage was 21 ± 9 min (range: 9-32 min), and the median bleeding volume was 10 ± 8 mL (range: 2-20 mL). Follow-up observations showed that the menstruations were returned in patients at an average of 38 ± 9 days (range: 30-50 days) after the treatment. The β-hCG decreased from 41773 ± 32242 mIU/mL to 13101 ± 8454 mIU/mL in 29 ± 10 days after surgery.
CONCLUSION
Based on these results with small subjects, we concluded that HIFU combined with HGSC might be an effective and safe treatment for patients with cervical pregnancy.
Topics: Adult; Amenorrhea; Cesarean Section; Female; Humans; Hysteroscopy; Pregnancy; Pregnancy, Ectopic; Retrospective Studies; Vacuum Curettage
PubMed: 36120736
DOI: 10.1080/02656736.2022.2123565