Abstract
Study Objective The use of intraoperative sonographic guidance for second trimester elective dilation and curettage (D & E) procedure reduces the incidence of uterine perforation. Nevertheless, the role of intraoperative sonographic guidance during curettage procedure following second trimester medical induction has not been evaluated. We aim to evaluate the effect of intraoperative sonographic guidance during curettage procedure following second trimester uterine evacuation. Design A retrospective cohort study. Setting A Gynecology department at a tertiary university‐affiliated medical center. Patients or Participants Patients undergoing second trimester medical induction up to 23 6/7 weeks estimated gestational age who underwent uterine curettage after delivery of the fetus. Interventions Women undergoing curettage procedure under continuous ultrasound guidance were compared with those undergoing curettage without ultrasound guidance. Measurements and Main Results One hundred ninety four patients underwent a curettage without intraoperative sonographic guidance, while 79 underwent the procedure utilizing intraoperative sonographic guidance. The overall rate of composite adverse outcome was higher among those undergoing curettage under intraoperative sonographic guidance as compared with no sonographic guidance (39.2% vs. 20.6%, P=0.002). Placental morbidity (12.6% vs. 5.6%, P=0.04) and infectious complications (7.5% vs. 2.5%. P=0.05) were more frequent among those undergoing curettage using intraoperative sonographic guidance. In a multivariate logistic regression analysis, intraoperative ultrasound guidance was the only independent factor positively associated with an adverse outcome (P=0.001). Procedure time was longer when ultrasound guidance was used; 9:52 min. vs. 6:58 min. (P Conclusion Intraoperative ultrasonography guidance during curettage after second trimester uterine evacuation is associated with a higher complication rate than no guidance.
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