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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 -
PloS One 2023Management of uterine evacuation is essential for increasing safe abortion care. Monitoring through surveillance systems tracks changes in clinical practice and provides...
BACKGROUND
Management of uterine evacuation is essential for increasing safe abortion care. Monitoring through surveillance systems tracks changes in clinical practice and provides information to improve equity in abortion care quality.
OBJECTIVE
This study aimed to evaluate the frequency of manual vacuum aspiration (MVA) and medical abortion (MA), and identify the factors associated with each uterine evacuation method after surveillance network installation at a Brazilian hospital.
METHODS
This cross-sectional study included women admitted for abortion or miscarriage to the University of Campinas Women's Hospital, Brazil, between July 2017 and November 2020. The dependent variables were the use of MVA and MA with misoprostol. The independent variables were the patients' clinical and sociodemographic data. The Cochran-Armitage, chi-square, and Mann-Whitney U tests, as well as multiple logistic regression analysis, were used to compare uterine evacuation methods.
RESULTS
We enrolled 474 women in the study, 91.35% of whom underwent uterine evacuation via uterine curettage (78.75%), MVA (9.46%), or MA (11.54%). MVA use increased during the study period (Z = 9.85, p < 0.001). Admission in 2020 (odds ratio [OR] 64.22; 95% confidence interval [CI] 3.79-1086.69) and lower gestational age (OR 0.837; 95% CI 0.724-0.967) were independently associated with MVA, whereas the only factor independently associated with MA was a higher education level (OR 2.66; 95% CI 1.30-5.46).
CONCLUSION
MVA use increased following the installation of a surveillance network for good clinical practice. Being part of a network that encourages the use of evidence-based methods provides an opportunity for healthcare facilities to increase access to safe abortions.
Topics: Pregnancy; Humans; Female; Musa; Aftercare; Cross-Sectional Studies; Abortion, Induced; Vacuum Curettage; Hospitals, University; Abortion, Spontaneous
PubMed: 38100497
DOI: 10.1371/journal.pone.0296009 -
BMJ Case Reports Apr 2021Caesarean scar ectopic pregnancies are the rarest type of ectopic pregnancy. The optimum management regime is not yet established. We report the case of a 39-year-old...
Caesarean scar ectopic pregnancies are the rarest type of ectopic pregnancy. The optimum management regime is not yet established. We report the case of a 39-year-old woman who presented at 11 weeks gestation with painless vaginal bleeding, having had 2 previous caesarean sections. Ultrasound revealed a gestational sac within the caesarean scar niche. On follow-up, her serial ß human chorionic gonadotropin (ßHCG) measurements fell significantly. The woman initially opted for conservative management but subsequently required surgical management. Hysteroscopy demonstrated a sac within the caesarean scar which was successfully evacuated by ultrasound-guided suction curettage, with no complications. Caesarean scar ectopic pregnancies are becoming increasingly common. Diagnosis is primarily through ultrasound using specified criteria. Management may be conservative, medical or surgical excision depending on the clinical circumstances. Hysteroscopy and suction curettage is an effective therapeutic option for caesarean scar ectopic management.
Topics: Adult; Cesarean Section; Cicatrix; Female; Humans; Hysteroscopy; Pregnancy; Pregnancy, Ectopic; Vacuum Curettage
PubMed: 33858897
DOI: 10.1136/bcr-2020-241183 -
BMC Women's Health Dec 2017Every year around 50 million unintended pregnancies worldwide are terminated by induced abortion. Even in countries, where it is legalized and performed in a safe...
BACKGROUND
Every year around 50 million unintended pregnancies worldwide are terminated by induced abortion. Even in countries, where it is legalized and performed in a safe environment, abortion carries some risk of complications for women. Findings of researchers on the factors that influence the sequelae of abortion are controversial and inconsistent. This study evaluates the effects of gestational age and the method of surgical abortion (i.e., dilatation and curettage and vacuum aspiration) on the most common abortion complications: postabortion hemorrhage and fever.
METHODS
We performed a secondary analysis of the data from the population-based Georgian Reproductive Health Survey 2010. Information on 1974 surgical abortions performed >30 days prior to the survey interview were analyzed during the study. Logistic regression statistical analysis was applied to compare the abortion sequelae that followed vacuum aspiration and dilatation and curettage at different gestational ages (<10 weeks and ≥10 weeks). We examined two major early abortion-related complications: postabortion hemorrhage and febrile morbidity (fever ≥38 °C).
RESULTS
Postabortion hemorrhage was reported in 43 cases (1.9%), and febrile morbidity occurred in 44 cases (2%) among all of the surgical abortions. The abortions performed by dilatation and curettage were associated with an estimated fourfold increased risk of developing hemorrhage (OR 4.4, 95% CI 2.2-8.6) and a twofold increased risk of developing fever (OR 2.37, 95% CI 1.17-4.79) compared with the abortions that were performed via vacuum aspiration. The risk of postabortion hemorrhage (OR 1.9, 95% CI 0.8-4.4) or fever (OR 0.9, 95% CI 0.4-2.1) did not significantly differ at gestational age < 10 weeks and ≥10 weeks.
CONCLUSION
Vacuum aspiration was associated with reduced risks of postabortion hemorrhage and fever compared to dilatation and curettage. Gestational age ≥ 10 weeks was not found to be a predictive factor of immediate postabortion complications: hemorrhage and fever.
Topics: Abortion, Legal; Adolescent; Adult; Aftercare; Female; Fever; Georgia; Gestational Age; Health Surveys; Hemorrhage; Humans; Pregnancy; Reproductive Health; Risk Assessment; Risk Factors; Vacuum Curettage
PubMed: 29282060
DOI: 10.1186/s12905-017-0495-7 -
BMC Women's Health Oct 2023Placental polyps are rare complications of delivery or abortion. They are thought to complicate less than 0.25% of all pregnancies, although the actual incidence is...
BACKGROUND
Placental polyps are rare complications of delivery or abortion. They are thought to complicate less than 0.25% of all pregnancies, although the actual incidence is unknown. While they typically occur within four weeks of delivery or abortion, they can have a variable presentation, which can lead to a delay in care.
CASE PRESENTATION
A 35-year-old G4P2012 patient presented at 9 weeks gestation for a medication abortion. Post-abortion ultrasound after one week confirmed the abortion was complete and her bleeding ceased. The patient then presented two months later with the new onset of worrisome bleeding. She was found on ultrasound to have a new hypervascular polypoidal mass in the endometrial cavity. She then underwent an in-office dilation and curettage with an electric vacuum aspirator, which was curative. A follow up ultrasound three months later demonstrated no recurrence.
CONCLUSIONS
Placental polyps are a rare complication following pregnancy and should be included in the differential when a patient presents with bleeding and a new mass in the endometrial cavity on ultrasound following a delivery or abortion, even when frankly retained products of conception had been ruled out at time of abortion.
Topics: Pregnancy; Female; Humans; Adult; Placenta; Abortion, Spontaneous; Uterus; Abortion, Induced; Polyps; Puerperal Disorders
PubMed: 37817177
DOI: 10.1186/s12905-023-02672-x -
Contraception Mar 2017Using the social determinants framework as a guide, this study sought to understand correlates of postabortion contraceptive use at the individual, family and abortion...
OBJECTIVES
Using the social determinants framework as a guide, this study sought to understand correlates of postabortion contraceptive use at the individual, family and abortion service delivery levels.
STUDY DESIGN
This prospective study assessed correlates of contraceptive use 4 months postabortion and timing of initiation using a facility-based sample of 398 abortion clients who selected pills, condoms, injectables or no method immediately following the procedure. We measured potential correlates immediately following abortion, inclusive of spontaneous or induced abortion, and assessed contraceptive use outcomes 4 months postabortion. Multivariable logistic regression models identified correlates at each level. Potential individual level correlates included contraceptive and abortion history and fertility intentions; family correlates included intimate partner violence (IPV), discordance in fertility intentions and household decision-making; and service delivery correlates included procedure type and postabortion contraceptive counseling.
RESULTS
Reported contraceptive use 4 months postabortion was high (85.4%). Contraceptive use at the index pregnancy (resulting in abortion) was the primary correlate of contraceptive use 4 months postabortion (adjusted odds ratio=2.9; 95% confidence interval: 1.5-5.9). Delayed contraceptive initiation was more common among women who reported past year IPV (36.8% vs. 19.5%; p=.03) particularly with spousal accompaniment for abortion, those in relationships with discordant fertility intentions (44.4% vs. 21.9%; p=.04) and those receiving medication abortion (56.7%) or dilation and curettage (57.1%), compared to manual vacuum aspiration (12.6%; p<.01).
CONCLUSIONS
Contraceptive use at the index pregnancy was the primary correlate of contraceptive use 4 months postabortion. Abortion procedure type and relationship dynamics were correlated with delayed postabortion contraceptive initiation. Women who reported IPV delayed initiation when accompanied by their spouse for abortion.
IMPLICATIONS
Postabortion contraceptive counseling should assess previous use patterns and provide information on using contraception effectively. Delayed initiation among women reporting IPV could be addressed through comprehensive, confidential counseling that includes violence screening, support for contraceptive initiation and offer of woman-controlled methods.
Topics: Abortion, Induced; Adult; Aftercare; Bangladesh; Contraception; Contraception Behavior; Counseling; Decision Making; Family Planning Services; Female; Humans; Intimate Partner Violence; Logistic Models; Multivariate Analysis; Pregnancy; Prospective Studies; Time Factors; Vacuum Curettage
PubMed: 27743769
DOI: 10.1016/j.contraception.2016.10.002 -
Anesthesiology Jan 1983
Topics: Abortion, Therapeutic; Adolescent; Adult; Anesthesia, General; Disseminated Intravascular Coagulation; Female; Gestational Age; Hemorrhage; Humans; Placenta; Pregnancy; Pregnancy Trimester, Second; Vacuum Extraction, Obstetrical
PubMed: 6848023
DOI: 10.1097/00000542-198301000-00015 -
Fertility and Sterility May 1978We evaluated the adequacy of a new large-bore vacuum cannula system for midtrimester abortion by randomly allocating patients to be treated with a standard 12-mm vacuum... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
We evaluated the adequacy of a new large-bore vacuum cannula system for midtrimester abortion by randomly allocating patients to be treated with a standard 12-mm vacuum system or the new 15.9-mm system. Cervical dilataion was accomplished by overnight placement of laminaria tents. Blood loss was similar for the two treatment groups and was significantly greater at gestational ages 17 to 18 weeks than for abortions at 16 weeks or less. Operating time was slightly less in the large-cannula group. When the 12-mm cannula was used beyond 13 weeks' gestation, forceps were usually needed to empty the uterus completely. The large-cannula system was able to empty the uterus through 16 weeks, but at 17 and 18 weeks it offered no advantage over the smaller system and forceps were always needed. Complications were minimal. We caution against forcible cervical dilatation to 16 mm and urge the use of laminaria instead. Our findings, together with published reports of the safety of late dilatations and evacuation, would appear to justify wider clinical trials by experienced investigators.
Topics: Abortion, Induced; Adolescent; Adult; Catheterization; Curettage; Female; Humans; Postoperative Complications; Pregnancy; Pregnancy Trimester, Second; Time Factors; Uterine Hemorrhage
PubMed: 668932
DOI: 10.1016/s0015-0282(16)43275-9 -
Annals of Medicine and Surgery (2012) May 2022The management of a large uterine fibroid concurrent with gestational trophoblastic disease (GTD) in a nullipara is complicated, challenging yet should focus on...
INTRODUCTION
The management of a large uterine fibroid concurrent with gestational trophoblastic disease (GTD) in a nullipara is complicated, challenging yet should focus on conserving fertility. We would like to share our experience.
CASE DESCRIPTION
A 28-year-old G1P0A0 of 10-11 weeks' gestation presented with a profuse vaginal bleeding with a history of passing swollen, grape-like tissues from the vagina. Since 7 months prior, a large uterine fibroid >10 cm had been diagnosed on ultrasound. Patient was diagnosed with GTD with β-human chorionic gonadotropin (hCG) levels exceeding 1,000,000 mIU/mL. No pulmonary metastases were detected. She underwent a vacuum curettage for her complete hydatidiform mole.Six days later, she underwent an elective myomectomy. Her nulliparity precluded hysterectomy. Post-discharge, her β-hCG levels plateaued and were consistently high over 3 consecutive measurements. A diagnosis of gestational trophoblastic neoplasia (GTN) was established. Patient is currently undergoing a methotrexate-folinic acid rescue chemotherapy regimen due to her having a low risk, stage 1 GTN.
DISCUSSION
Uterine fibroid may reach exceptional sizes. There is so far no link between GTD and uterine fibroids but their concurrent presence is extremely rare. The definitive management for a large fibroid is hysterectomy but considering the patient's nulliparity, a myomectomy was appropriate. GTD's definitive management is vacuum curettage.Periodical β-hCG measurement should follow discharge. Plateauing β-hCG levels indicated GTN and due to her low-risk GTN, she required a single-agent methotrexate chemotherapy. Most patients with low-risk GTN make a complete recovery.
CONCLUSION
Fertility after myomectomy and GTN generally has an excellent prognosis.
PubMed: 35638016
DOI: 10.1016/j.amsu.2022.103659 -
How risky are second trimester clandestine abortions in Cameroon: a retrospective descriptive study.BMC Women's Health Sep 2014Complications of clandestine abortions increase with gestational age. The aim of this study was to identify complications of second trimester clandestine abortions (STA)... (Observational Study)
Observational Study
BACKGROUND
Complications of clandestine abortions increase with gestational age. The aim of this study was to identify complications of second trimester clandestine abortions (STA) and those of first trimester clandestine abortions (FTA).
METHODS
This retrospective descriptive study was conducted between March 1st and August 31st, 2012 in the University Teaching Hospital and the Central Hospital, Yaoundé (Cameroon). The files of women with clandestine abortions carried out outside our units, but received in our settings for some complications were reviewed. Variables studied were maternal age, parity, marital status, gestational age at the time of abortion, the abortion provider and the method used, the duration of antibiotic coverage, the time interval between abortion and consultation, the complications presented and the duration of hospital stay. Data of 20 women with STA (≥13 weeks 1 day) and those of 74 women with FTA (≤13 complete weeks) were analyzed and compared. The t-test was used to compare continuous variables. P value <0.05 was considered statistically significant.
RESULTS
Women with STA had high parities (P = 0.0011). STAs were mostly performed by nurses and were usually done by dilatation and curettage or dilatation and evacuation, manual vacuum aspiration, intramuscular injection of an unspecified medication, transcervical foreign body insertion, amniotomy and misoprostol. STA complications were severe anemia, hypovolemic shock, uterine perforation and maternal death.
CONCLUSIONS
Clandestine abortions, especially second trimester abortions, are associated with risks of maternal morbidity and mortality especially when done by nurses. Therefore, women should seek for help directly from trained health personnel (Gynecologists & Obstetricians). Moreover, nurses should be trained in uterine evacuation procedures. They should also refer women who want to carry out STA to Gynecologists and Obstetricians. Finally, to reduce the prevalence of abortion in general, the government should make contraception available to all women, as well as use public media to sensitize women on the dangers of abortion and on the need to use family planning services.
Topics: Abortion, Criminal; Abortion, Induced; Adolescent; Adult; Antibiotic Prophylaxis; Cameroon; Female; Gynecology; Humans; Nurses; Obstetrics; Postoperative Complications; Pregnancy; Pregnancy Trimester, Second; Retrospective Studies; Young Adult
PubMed: 25199407
DOI: 10.1186/1472-6874-14-108