Vacuum Aspiration Research Articles

Manual vacuum aspiration (women's MVA) for endometrial biopsy for patients with suspected endometrial malignancies.

Endometrial biopsy is generally performed with a metal uterine curette sonde; however, recently, many types of vacuum aspirators are available, including the manual vacuum aspiration (MVA) system. We used the women's MVA system for endometrial sampling and evaluated its effectiveness in determining the presence of endometrial malignancy. Forty-seven samples were examined using the following procedures after measuring endometrial thickness by transvaginal ultrasonography: fractional curettage biopsy (Bx; 20 samples), total curettage under general anesthesia (T/C; 13 samples), and MVA (14 samples). The quality of the endometrial samples was classified into four types: 1-4, where 1 denoted poor and 4, good quality. The mean score of the MVA group was significantly higher than that of the partial curettage biopsy group (p=0.0065). No differences were observed between the MVA and total curettage groups (p=1.00). When patients were divided into two groups according to endometrial thickness (<10 mm or ≥10 mm) and analyzed, both the MVA and T/C groups did not show a significant difference in their scores compared to the Bx group when the endometrial thickness was <10 mm. However, when the endometrial thickness was ≥10 mm, the MVA and T/C groups had significantly better scores than the Bx group (p=0.0225 and p=0.0244, respectively). Vagal reflex, as an adverse event, was observed only in two patients in the Bx group (2/20, 10%). Considering its quality and safety, Karman-type MVA for endometrial sampling could be an alternative to fractional curettage using a metallic uterine curette sonde.

Laparoscopic Management of Partial Molar Caesarean Scar Ectopic Pregnancy

To demonstrate laparoscopic management of a molar scar ectopic pregnancy. Stepwise demonstration of the technique with narrated video footage. Cesarean scar ectopic pregnancy and molar pregnancy are 2 separate extremely rare pathologies with an incidence range from 1/1800 to 1/2500 of all pregnancies for the former [1,2]. The concurrence of both cesarean scar ectopic and molar pregnancy is furthermore exceptionally rare, and there are only 8 reported cases of cesarean scar molar pregnancy in literature till date [3]. There is a high risk of uterine rupture, uncontrolled hemorrhage, hysterectomy, and significant maternal morbidity owing to thin myometrium and fibrous scar after cesarean section [4,5]. Knowledge and awareness about this clinical condition aid in early diagnosis and reduced morbidity. Here, we present a rare case of cesarean scar ectopic pregnancy that was operated for failed medical management and diagnosed to be molar scar ectopic pregnancy intraoperatively. Total laparoscopic approach to molar scar ectopic pregnancy excision involved the following steps, strategies to minimize blood loss, and complete enucleation of tissue: (1) Hysteroscopy to localize the scar ectopic and its type and size (2) Bladder dissection to expose scar (3) Intramyometrial injection of vasopressin (4) Use of harmonic scalpel to delineate the gestational sac (5) Complete evacuation of products of conception (6) Excision of scar tissue (7) Uterine repair in 2 layers CONCLUSION: There are only 8 reported cases of cesarean scar molar pregnancy in literature till date, and all patients had at least 2 previous uterine curettages with abnormally increased β-hCG levels. The clinical manifestations were varied, the most common symptom being vaginal bleeding for a period >1 month, including our case [3]. Considering the limitations of ultrasound, magnetic resonance imaging, and serum hCG levels in the differential diagnosis of molar cesarean scar pregnancy from normal cesarean scar pregnancy, postoperative specimen should be sent for histologic examination [6]. As seen in our case, the possibility of molar pregnancy at cesarean scar ectopic site should be kept in mind in cases with rising β-hCG levels despite continuous medical interventions, which was being medically managed for 3 months. Our case is the first to be successfully managed with laparoscopic surgery as the previously reported cases were managed with suction evacuation, chemotherapy, laparotomy, or hysterectomy [3].

A Comparative Study on the Effectiveness of Paracervical Block and Diclofenac Versus Paracervical Block and Pentazocine for Analgesia During Manual Vacuum Aspiration

Management of incomplete abortion with the use of manual vacuum aspiration is associated with pain. A good pain relief option is necessary during the procedure to improve the outcome and increase patients’ satisfaction. The study was aimed atdetermining and comparing the effectiveness of combining paracervical block with pentazocine and paracervical block with diclofenac as pain relief during manual vacuum aspiration for first-trimester incomplete abortion. This study involved 100 eligible women with the diagnosis of first-trimester incomplete abortion. Half of the participants were given paracervical block and intramuscular pentazocine 60 mg stat while the other half were given paracervical block and intramuscular diclofenac 75 mg stat before the manual vacuum aspiration procedure. The intensity of pain during the procedure was assessed using the Visual Analogue Scale (VAS). The level of significance was set at p value&lt;0.05. The mean pain intensity was significantly higher in the diclofenac group than in the pentazocine group. From the study it was concluded that intramuscular pentazocine used as an adjunct to paracervical block during manual vacuum aspiration when compared to intramuscular diclofenac as an adjunct to paracervical block was found to be a more effective method of pain relief. The patient’s level of satisfaction was same in both study arms. However, participants in the pentazocine arm had more side effects.

PROSPECTIVE STUDY ON EFFICACY OF MIFEPRISTONE AND MISOPROSTOL VS MISOPROSTOL ALONE IN 1ST TRIMESTER MTP.

Background: Unsafe abortions are the third leading cause of maternal mortality in India, close to 8 women die from unsafe abortion each day.(1) MMR in India is 103/100,000 live births (2017-2019),unsafe abortion account for 8% of the MMR. Both MTP act of 1971 and MTP amendment act 2021,which expanded the scope of the act and provides impetus for safer abortions, are progressive and encouraging. Each year 4.7-13.2%of maternal death attributed due to unsafe abortions (2). Unsafe abortion accounts for 13% of maternal deaths worldwide of which 19% occurs in South East Asia (3, 4).Medical methods of abortion has become preferable method with availability of prostaglandin analogue misoprostol and antiprogesterone mifepristone. There are many studies for both drugs and each study claims its schedule to be superior and safer than others.(5,6,7) AIM:This study mainly aims to compare efficacy of Mifepristone and Misoprostol combination versus Misoprostol alone in procuring complete abortions in first trimester by comparing their Need for Manual /electric vacuum aspiration. OBJECTIVES: Ÿ To compare efficacy in relation to gestational period. Ÿ To compare the Success rate of combination drugs with misoprostol alone. Ÿ To compare Induction to abortion time intervals. Ÿ To evaluate the Safety. This is a prospective observational study conducted at Government Victoria hospital, Department of Obstetrics &amp; Gynaecology,Andhra Medical College,Visakhapatnam,and Andhra Pradesh Total no.of patients – 100 No.of women who were given Mifepristone &amp; Misoprostol combination 50 No.of women received Misoprostol alone -50 Observations of this study 1.Maternal age was compared in both the groups.Majority of patients belongs to 21 to 25 years age group. 2.Majority are multigravida in both groups 3.Majority (64%) have opted for termination before 45days in mifepristone +misoprostol group,where as in misoprostol group 60% between 45-63 days 4.In both major indication for termination is unwanted pregnancy. 5. In mifepristone and misoprostol group 46 cases had complete abortion whereas 4 cases required electric vacuum aspiration 6.when comparing induction and abortion interval mifepristone and misoprostol group mean interval is 4.31 hours whereas misoprostol group is 16.18 hours and p value is &lt;0.0001 showing induction abortion interval is less in mifepristone and misoprostol group 7.Unwanted symptoms were noted in both groups but significantly more with misoprostol only group but the p value was not significant. 8.There were no statistically significant major complications in both groups,none required blood transfusion 9. Although Mifepristone and Misoprostol combination is costly but more effective with higher rate of complete expulsion,should be preferred over Misoprostol alone where cost is not a restraining factor. CONCLUSION Based on findings from this study it can be concluded that 1. Mifepristone plus vaginal misoprostol combination group is associated with shorter induction abortion interval and 96% success rate when compared to misoprostol group alone. 2. Mifepristone plus vaginal misoprostol combination group is associated with complete abortion rate compared to misoprostol alone group.Vaginal misoprostol alone group is cost effective. 3. Routine use of Mifepristone-Misoprostol combination is an effective option for early MTP where cost is not a consideration and is ideal for home management. 4.Complication are less in Mifepristone-Misoprostol combination The only confounding factor is the cost involved which is about 20 times that of Misoprostol alone

Placement of an intrauterine device within 48 hours after early medical abortion—a randomized controlled trial

Intrauterine devices are safe, well-tolerated, and known to reduce the risk of unwanted pregnancies. At medical abortion, intrauterine devices are placed at a follow-up visit. Patients who miss this visit risk being left without contraception. This study aimed to investigate if placement of an intrauterine device within 48 hours of completed medical abortion at up to 63 days' gestation leads to higher user rates at 6 months after the abortion compared with placement at 2 to 4 weeks after abortion. Furthermore, we aimed to compare continued use of intrauterine devices, safety, and patient satisfaction between groups. We performed an open-label, randomized, controlled, multicenter, superiority trial (phase 3). A total of 240 patients requesting medical abortion at up to 63 days' gestation and opting for an intrauterine device were allocated to placement within 48 hours of complete medical abortion (intervention group) or at 2 to 4 weeks after abortion (control group). We defined the abortion as complete after bleeding with clots and cessation of heavy bleeding following the use of misoprostol. Patients answered questionnaires at 3, 6, and 12 months. The primary outcome was use of intrauterine device at 6 months postabortion. Secondary outcomes included expulsion rate, pain at placement, adverse events and complications from the abortion, acceptability, and pregnancies and their outcomes. Differences in nonparametric continuous variables were analyzed with the Mann-Whitney U test and differences in dichotomous variables with the chi square or Fisher exact tests. A P value of <.05 was considered statistically significant. In the intervention group, 91 of 111 (82%) participants used an intrauterine device at 6 months after the abortion vs 87 of 112 (77.7%) in the control group, with a difference in proportion of 4.3% (95% confidence interval,-0.062 to 0.148; P=.51). Attendance rate and rate of successful intrauterine device placement were similar between the groups. Patients in the intervention group had lower pain scores at placement of the intrauterine device (mean pain score [visual analogue scale], 32.3; standard deviation, 29) compared with the control group (mean pain score [visual analogue scale], 43.4; standard deviation, 27.9; P=.002). Patients preferred their allocated time of placement significantly more often in the intervention group (83/111, 74.8%) than in the control group (70/114, 61.4%; P=.03). Use of ultrasound at intrauterine device placement (because of doubts concerning complete abortion) was more common in the intervention group (43/108, 39.8%) than in the control group (15/101, 14.9%; P<.001), and in one patient in the control group a retained gestational sac was found. Three patients in the intervention group and 2 in the control group had a vacuum aspiration. No difference was found in intrauterine device expulsion rates between the groups. Expulsion during the first 6 months after abortion was experienced by 9 of 97 (9.3%) patients in the intervention group and 4 of 89 (4.5%; P=.25) in the control group. There were no perforations or infections requiring antibiotic treatment. Placement of an intrauterine device within 48 hours after medical abortion at ≤63 days' gestation does not lead to higher user rates at 6 months after the abortion compared with intrauterine device placement at 2 to 4 weeks after abortion. When compared with placement at a follow-up visit after 2 to 4 weeks, intrauterine device placement within 48 hours after early medical abortion seems safe, is preferred by patients, and is associated with lower pain scores.

Cervical vasovagal shock: A rare complication of incomplete abortion case report.

Introduction and importanceCervical vasovagal shock is termed as stimulation either by instruments or products of conception at cervical os results into bradycardia and hypotension. In primary care settings cervical vasovagal shock can occur during insertion of an intrauterine device (IUD) or any cervical stimulation during physical examination. This case we highlight an uncommon complication of incomplete abortion which is the rare cause of cervical vasovagal shock.Case presentationA 42-year-old Gravida 3 Para 2 Living 2 with Gestational age of 12 weeks presented with vaginal spotting for 2 days. Initial examination she was conscious with normal vital signs. However, after initiation of medical management of incomplete abortion, she had increased per vaginal bleeding with hypotension and bradycardia. Speculum examination was done; this revealed products of conceptus in cervical os and a diagnosis of cervical vasovagal shock was made. Patient was then counselled for evacuation and informed consent was sought. She was taken for evacuation; suction and gentle curettage was done. Post evacuation patients' vitals returned to normal ranges, and patient taken to the ward to continue with post procedure management.Clinical discussionBleeding in the first trimester is a common presentation in up to 30 % in early pregnancies and more than 50 % of those will go on to have a normal pregnancy. Most patients with incomplete abortion present at emergence department with shock, this will commonly be due to sepsis, hypovolemia, or haemorrhage. In this case report with discuss a rare cause of shock in women with incomplete abortion.ConclusionCervical vasovagal effect of the products of conception passing through the cervix causes a reflex bradycardia. It is crucial as physician attending women with incomplete abortion to make sure all the product of conception are passed out and in situation if there is remaining products of conception in the cervix should be removed using a sponge-holding forceps to prevent vasovagal stimulation in the cervix.

Comparison of vacuum suction ureteroscopic laser lithotripsy and traditional ureteroscopic laser lithotripsy for impacted upper ureteral stones.

To compare a novel vacuum suction ureteroscopic laser lithotripsy (VS-URS) with traditional ureteroscopic laser lithotripsy (T-URS) for impacted upper ureteral stones and to better define the potential benefits of VS-URS. Between May 2019 and March 2021, 158 patients with impacted upper ureteral stones underwent ureteroscopic holmium-YAG laser lithotripsy. Of these, 76 underwent VS-URS and 82 underwent T-URS. In VS-URS procedures, the vacuum suction device is composed of a 5F ureteral catheter and a tee joint. The ureteral catheter is linked to the vacuum aspirator by the sidearm of the tee joint, and a 200μm fiber is inserted through the tee joint and the ureteral catheter into the stone site for lithotripsy. When compared to the T-URS group, the VS-URS group had a shorter mean operation time (38.18 ± 6.37min vs. 46.65 ± 5.66min;P = 0.000), lower fever rate (3.9% vs. 14.6%; P < 0.022), less stone retropulsion (5.3% vs. 18.3%; P = 0.012), lower extra management rate (6.58% vs. 21.95%; P = 0.006), and a higher stone-free rate of the first postoperative day (88.2% vs. 72.0%;P = 0.011). There were no significant differences in stone-free rates 1month after surgery between groups (94.7% vs. 92.7%; P = 0.748). VS-URS is an effective modality for impacted upper ureteral stones, and has a shorter operating time, lower fever rate, less stone retropulsion, and a higher primary stone-free rate compared with T-URS.

Cerebral Venous Sinus Thrombosis Treated with Vacuum Aspiration Thrombectomy without Thrombolysis: A Descriptive and Retrospective Study of 5 Years’ Experience at a Single Center

PurposeCerebral venous sinus thrombosis (CVST) is a rare but life-threatening condition. Mechanical thrombectomy is a treatment option for patients who deteriorate or do not improve despite anticoagulation treatment or those who have a major contraindication to anticoagulation. The purpose of this study was to describe the authors’ 5 years of experience in treating CVST with vacuum aspiration thrombectomy without thrombolysis. Materials and MethodsFor this retrospective study, data were collected from consecutive patients with CVST who received anticoagulation as initial medical treatment and were treated with vacuum aspiration thrombectomy without thrombolysis. Patients were followed up at 3 months and after 1 year. ResultsThe 9 patients included in the study had a median age of 37 years, and 5 were women. All 9 patients had headaches at presentation; 7 had focal neurologic deficits, and 7 had intracranial hypertension. Risk factors for CVST were identified in 8 patients, and poor prognostic factors were identified in 7 patients. In the 9 patients, 24 CVST locations were treated; complete (70.8%) or partial (29.2%) recanalization was achieved in all CVST locations. No procedure-related complications occurred. One patient died of parenchymal hemorrhagic transformation of CVST and vasogenic edema, 6 hours after the procedure. Two patients required neurosurgical intervention. After 1 year (range, 13–30 months), all 8 surviving patients had good functional outcomes (modified Rankin Scale score 0–2). ConclusionsFor appropriately selected patients with CVST, vacuum aspiration thrombectomy without thrombolysis seemed to be an effective therapy.

Measurement of aspiration pressure in cannula brain tumour biopsy and its correlation with ultrasonographic elastography

BackgroundStereotactic brain biopsy is to perform the manual aspiration tissue biopsy using a cannula on a syringe under stereotactic guidance to provide histological confirmation. Excessive vacuum aspiration increases the risk of haemorrhage. Manual aspiration relies on the surgeon’s experience while the minimum vacuum pressure is unknown. Objectives1. To assess the aspiration vacuum pressure range in cannula brain tumour biopsy;2. To understand the correlation of ultrasound elastography data with the aspiration pressure. MethodsThis prospective study has recruited 10 patients for stereotactic brain tumour biopsy. With the use of ultrasound elastography, strain ratio of the lesion was assessed in real time before biopsy. Vacuum aspiration pressures were recorded using a T-connector pressure sensor during the stereotactic biopsy. ResultsA total of 11 biopsies were taken from 10 patients, including a bilateral biopsy for a patient with bifrontal lesions. The diagnostic yield was 100% in all the 10 patients with no symptomatic haemorrhage (but 2 subclinical haemorrhages in CT scan) nor infection. The vacuum pressures ranged from 40.34 to 65.61 kPa and the strain-ratio ranged from 0.405 to 2.74. Strain ratio of the lesion at the lower range required a lower range of aspiration pressure, whereas lesions of Strain ratio over 0.45 required a higher range of aspiration pressure. ConclusionA vacuum pressure of 40 to 66 kPas is safe and adequate for biopsy of various types of tumours with heterogenous elastographic characters. Ultrasonographic elastography may be a real-time guide for the minimum vacuum pressure required for biopsy.

Efficacy of Manual Vacuum Aspiration Vs Conventional Evacuation and Curettage

OBJECTIVES: To evaluate the safety and efficacy of Manual Vacuum Aspiration (MVA) compared to Conventional Evacuation and Curettage (E &amp; C) in managing first-trimester miscarriage. METHODOLOGY: A total of 160 patients were enrolled in this comparative study. Patients were categorized into two groups (Group A undergoing MVA) and (Group B undergoing E&amp;C). Each group had 80 cases randomly selected. Stable patients with miscarriages ­&lt; 12 wks of gestation and no comorbid were included in the study. Data was recorded on pre-designed proforma, and analysis was done by SPSS Software. RESULTS: Efficacy of MVA was 97.5% and 92.5% in E&amp;C, with a 7.5% vs 30% complication rate in MVA and E&amp;C Group, respectively. The mean duration of the procedure was 9 minutes in the MVA group versus 18.8 minutes in the E&amp;C group. The hospital stay was 14.2 hours vs 20.3 hours in MVA and E&amp;C Group. 16.25% vs 46.25% of women in MVA vs E&amp;C Group reported post-op pain. 93.75% of women were satisfied with MVA, whereas only 50% of women were satisfied with E&amp;C. 81.25% 91.25% required Anesthesia/Analgesia in MVA and E&amp;C Group, respectively. CONCLUSION: MVA is a more effective and rapidly performing outpatient procedure with a lower complication rate. In this study efficacy of MVA is 97.5% compared to the E&amp;C group, i.e., 92%. Its safety, cost-effectiveness and efficacy advocate its extended use as an alternative to the conventional surgical method of miscarriage

Early Pregnancy Loss: Manual Vacuum Aspiration (MVA) Vs. Conventional Evacuation and Curettage

Objective: The purpose of this study is to assess the effectiveness of manual vacuum aspiration vs standard evacuation and curettage in the case of early pregnancy loss: HMC hospital, Peshawar, gynecologic and obstetrics department Study Design: A Single-center study Duration and place of study: From January 1st, 2017, to January 30th, 2020, the study was carried out in the gynecological and obstetrics unit B of the HMC hospital, Peshawar. Patient Methodology: One thousand and sixty-three (603) patients were studied. According to the inclusion criteria, all patients who experienced an early miscarriage (18-42 years old) were recruited for the research. The lottery approach was used to split the patients into two groups. Those in Group A who had been treated by MVA Group B were individuals who had traditional surgical evacuation and curettage. Age and BMI were obtained after obtaining written consent from the patient. The patient's entire blood picture, blood group, hepatitis serology, and coagulation profile were analyzed as part of a baseline assessment. Ultrasound and the starting day of the last menstrual cycle were used to determine gestational age. Two hours before the surgery, misoprostol 400mcg was used to ripen the cervical lining. Aseptic procedures were followed during the process. Ultrasound was used to verify that both methods had successfully evacuated the uterus. Results Group A had a mean age of 27 years, while Group B had a mean age of 29 years, both with a standard deviation of 7.55 years in Group A. Approximately 40% of the patients in Group A were mono para, and 60% of the patients in Group B were multipara. Forty-two percent of patients in Group B were first-time paras, whereas 58 percent of patients in Group B were second-time paras. In Group A, 40% of the patients were first-time mothers, whereas 60% were multiple mothers. There were 42 percent primi gravida and 58 percent multi gravida in Group B. Aspiration using manual vacuum and conventional evacuation and curettage were equally successful for 92% and 82% percent of patients, respectively. Keywords: Early Pregnancy Loss, M .V. A, Conventional Evacuation And Curettage

Cesarean Scar Pregnancy: Report of Two Cases

Cesarean section scar ectopic pregnancy is rare pregnancy complication. They have become common due to an increase in cesarean sections worldwide. The following report outlines two cases of scar pregnancy in women; both women had a history of two previous cesarean sections. Both were type 2 scar pregnancies as they protruded from the uterine myometrium towards the uterine serosa.1 The first woman initially received suction evacuation. The products, however, could not be entirely evacuated. As a result, laparotomy was performed. The second patient also underwent laparotomy due to her symptoms. Obstetricians need to keep a high index of suspicion while managing women with risk factors for an ectopic scar pregnancy. Failure to detect and pledge rapid treatment can lead to uterine rupture, massive hemorrhage, and maternal death. In the following report, presentations, and management of these two cases are discussed followed by a review of published literature.

Abortions in Germany - Current data from the statistics on terminations of pregnancy.

Unwanted pregnancies and abortions are experiences shared by many women. In light of the fact that some general framework conditions are currently changing in Germany, and that the Corona pandemic represents a particular challenge for the care of women with unwanted pregnancies, current data from the statistics on terminations of pregnancy of the Federal Statistical Office are outlined. Compared to Europe, Germany has a low proportion of induced abortions. In 2021, 94,596 abortions were reported. The number of abortions as well as the abortion rate and the abortion ratio have decreased since 2001. 95.8% of abortions took place according to the so-called counselling provision. In more than half of the abortions (52.1%) vacuum aspiration was used, in 11.4% curettage, 32.3% were medical abortions using mifepristone. There are large regional differences in the method used.

Comparison of Feasibility, Efficacy and Patient Acceptability of Manual Vacuum Aspiration Vs Sublingual Misoprostol in Early Pregnancy Loss

Objective: To compare feasibility, efficacy and patient acceptability of manual vacuum aspiration with sublingual Misoprostol in early pregnancy loss.&#x0D; Study Design: Comparative prospective study.&#x0D; Place and Duration of Study: Gynecology and Obstetrics Department, Combined Military Hospital Okara Pakistan, from Aug 2019 to Apr 2020.&#x0D; Methodology: 200 Patients with early pregnancy loss (missed, incomplete abortion) at gestational age 6 to 12 weeks were randomly allocated to Manual vacuum aspiration (group A) and oral Misoprostol (group B) by lottery methods. Manual vacuum aspiration was done in the outpatient department. While in Group B, oral Misoprostol was given with a protocol 600 micro gram sublingual stat observe for 1 hour for any complication. Afterwards, they were given Misoprostol 600 micrograms sublingual, 3 hourly total of 2 doses. Patients from both groups were called for follow-up after one week.&#x0D; Results: Efficacy, feasibility and patient acceptability was 88%; p-value &lt;0.001, 95%; p-value &lt;0.001 and 97% respectively in manual vacuum aspiration group as compared to 64%, 68% and 70% in sublingual Misoprostol group. There were fewer systemic side effects and fewer visits in manual vacuum aspiration group 1 vs 3 in the sublingual Misoprostol group.&#x0D; Conclusion: Manual vacuum aspiration is more effective than Misoprostol as it has no systemic effects. Both options are cheap and can be achieved in outpatient settings. However, manual vacuum aspiration provides complete evacuation and is a good option for low resource settings and a developing country like Pakistan with frequent electricity disruptions. It offers a substantial saving on resources, cost and...

Effectiveness and safety of a direct-to-patient telehealth service providing medication abortion targeted at rural and remote populations: Cross-sectional findings from Marie Stopes Australia

ObjectivesWe assessed the safety and effectiveness of direct-to-patient telehealth provision of medication abortion in Australia. Study designWe included all medication abortions (January 2017–December 2018) from Marie Stopes Australia's patient management and adverse event reporting systems. We defined effectiveness as whether the patient had a continuing pregnancy, incomplete abortion, and/or subsequent vacuum aspiration or procedural abortion and safety as whether the patient experienced any adverse event. ResultsDirect-to-patient telehealth was more effective than in-clinic provision (97.2% vs 95.4%). The proportion of adverse events did not differ between groups. ConclusionsThis direct-to-patient telehealth service is safe and effective.

OCCURRENCE, MANAGEMENT AND OUTCOME OF MOLAR PREGNANCIES IN TERTIARY CARE CENTRE, GMCH

Molar pregnancies represent a signicant burden of disease on the spectrum of gestational trophoblastic disease. The incidence varies widely in different parts of the world. The objective of this study is to determine the occurrence, management, and outcome of molar pregnancies at our institution. During the study period of 1 year, a total of 36 cases were diagnosed with GTD, giving an incidence of 2.6 per 1000 pregnancies, 2.7 per 1000 deliveries and 2.8 per 1000 livebirths in the department of Obstetrics and Gynaecology, GMCH. Vaginal bleeding was the commonest symptoms (66.66%) apart from amenorrhea. Suction evacuation was the primary mode of treatment (91.66%) and only 4 patients (11.11%) underwent hysterectomy. Chemotherapy was administered in 12 patients. During the follow up period, 5 patients (13.88%) were diagnosed with GTN, 4 of them being invasive mole and 1 being choriocarcinoma. Use of routine rst trimester ultrasonography has led to early diagnosis and majority of cases are cured by simple surgical intervention. Longer follow up protocol attribute to poor compliance. A multi-centered study is essential in India to determine the true incidence and overall outcome of molar pregnancy that will help in the understanding of the burden of the disease.

The efficacy of different treatments for type 2 cesarean scar pregnancy

To study the efficacy of 3 treatment options for type 2 cesarean scar pregnancy (CSP) and establish an optimal treatment strategy for type 2 CSP. Retrospective cohort study. A tertiary hospital. The study examined 160 women with type 2 CSP. Ultrasound-guided vacuum aspiration after local injection of lauromacrogol, ultrasound-guided vacuum aspiration after uterine artery embolization (UAE), and transabdominal resection or hysteroscopy combined with laparoscopic resection. The success rates, duration of hospitalization, hospitalization cost, amount of blood loss, recovery time, and menstruation resuming after recovery. The success rates of the UAE, lauromacrogol, and surgical groups were 87.1%, 92.5%, and 95.5%, respectively, with no significant differences. The cost and duration of hospitalization in the lauromacrogol group were significantly lower than those in the UAE and surgical groups. Analysis of the causes of treatment failure revealed a significant difference in the gestational age. The area under the receiver operating characteristic curve was 0.660 (95% confidence interval, 0.533-0.788). When the gestational age was 48.5 days, Youden index was the highest. Furthermore, when the diagnostic thresholds were selected as 49, 56, and 63 days of pregnancy, the corresponding areas under the receiver operating characteristic curve were 0.652, 0.541, and 0.510, respectively. Ultrasound-guided vacuum aspiration after local injection of lauromacrogol is recommended for patients with type 2 CSP at <49 days of gestation. Laparotomy or laparoscopy combined with hysteroscopy is suitable for patients with gestation of >49 days, especially for those with >56 days of gestation.

Ultrasound-guided Manual Vacuum Aspiration is an optimal method for obtaining products of conception from early pregnancy loss for cytogenetic testing.

The culture failure rate of conventional karyotyping in products of conception evacuated from early pregnancy loss by traditional electrical vacuum aspiration and/or dilation & curettage remains high. We aim to determine whether obtaining products of conception from early pregnancy loss via another evacuation approach, ultrasound-guided manual vacuum aspiration, could decrease the culture failure rate of karyotyping. For patients with early pregnancy loss, ultrasound-guided manual vacuum aspiration (Case group) and traditional electrical vacuum aspiration and/or dilation & curettage (Control group) were applied as surgical methods for pregnancy loss management respectively. The evacuated products of conception were subjected to cytogenetic karyotyping analysis. The primary outcome was the culture failure rate of karyotyping. Secondary outcomes included the chromosomal abnormality spectrum, maternal cell contamination, and complications from the manual vacuum aspiration procedure. For the case group, 132 products of conception were genetically analyzed by conventional karyotyping. The culture failure rate was significantly lower than that of the control cohort (2.3% vs 7.4%, p=0.027). 65.2% of cases were abnormal within the detection scope of karyotyping. The euploid female to male ratio was 0.82 (18:22), suggesting a lower likelihood of maternal cell contamination. The efficacy in achieving complete evacuation was 99.6%. There were no significant complications from the procedure. Ultrasound-guided manual vacuum aspiration approach significantly decreased the culture failure rate of karyotyping and decreased maternal cell contamination tendency, enabling a high and accurate cytogenetic diagnosis. It is especially crucial when the cytogenetic analysis is required in the early pregnancy loss clinics.

Safety and efficacy of manual vacuum aspiration under local anesthesia compared to general anesthesia in the surgical management of miscarriage: a retrospective cohort study

BackgroundIn Japan, dilatation & curettage (D&C) has been performed under general anesthesia as a surgery for an early pregnancy miscarriage for a long time. In 2016, manual vacuum aspiration (MVA) under general anesthesia was introduced at our hospital and has been used as a surgical treatment for first-trimester pregnancy miscarriage, with its utility to date being reported here. In July 2018, our hospital introduced the MVA procedure under local anesthesia. In this study, we evaluated the efficacy and safety of MVA under general and local anesthesia in first-trimester pregnancy miscarriage surgery in Japanese women.MethodsIn this retrospective observational cohort study, we enrolled 322 pregnant women at less than 12 weeks of gestation, who underwent MVA surgery under local anesthesia (n = 166) or conventional general anesthesia (n = 156). The duration of surgery, blood loss volume, quantity of anesthesia, presence or absence of retained products of conception, and clinical complications were evaluated. In addition, the intraoperative pain and treatment satisfaction were assessed using the visual analog scale (VAS).ResultsThe duration of surgery was significantly shorter in the local anesthesia group. No significant differences were observed between both groups in terms of the blood loss volume and incidence of retained products of conception. In addition, no serious complications were observed in either group. No significant differences were noted between the two groups in the VAS scores for pain and treatment satisfaction.ConclusionsIn this retrospective study, the use of MVA under local anesthesia for early pregnancy miscarriage surgery was found to be equally safe and effective when performed under conventional general anesthesia. This technique allowed the achievement of appropriate pain control with excellent patient satisfaction.

COMPLEX ENDOSCOPIC TREATMENT OF STAPLE LINE FAILURE IN BARIATRIC SURGERY

he authors set a goal to improve the results of treatment in patients with staple line failure after bariatric surgery using various endoscopic techniques. Based on four clinical cases an algorithm for the sequence of actions was created. The authors used vacuum aspiration, stent placement, as well as sealing the organ defect with bioglue. In all four cases, it was possible to successfully cope with the staple line failure and prevent the progression of peritonitis. As a result of the study, the authors conclude that several endoscopic treatments can be considered in tandem or in combination. The treatment of this category of patients should be interdisciplinary and include an adequate timing.