Vacuum Aspiration Research Articles

Anesthesia Consideration of an Impending Thyroid Storm Patient undergoing Emergency Suction Evacuation for Bleeding Molar Pregnancy

Anesthesia Consideration of an Impending Thyroid Storm Patient undergoing Emergency Suction Evacuation for Bleeding Molar Pregnancy

Primary hyperparathyroidism, presenting with acute kidney injury in the first trimester of pregnancy; a case report

Primary hyperparathyroidism (PHPT) is the leading cause of hypercalcemia. Total serum calcium level >3.5 mmol/L is associated with a high risk of a hypercalcemic crisis, manifesting with nausea, vomiting, dehydration, myalgia’s, abdominal pain, acute pancreatitis, acute kidney injury (AKI), cardiac rhythm disorders and disturbances of consciousness. We report here a case of PHPT, manifested with hypercalcemic crisis during pregnancy. A 30-year-old woman in the first trimester of pregnancy admitted complaining on loss of appetite, nausea, vomiting, lower abdomen pain, weakness, and leg pain during the last 10 days. She had a history of two uncomplicated pregnancies, and two episodes of renal colic, her kidney function was normal 2 weeks prior to admission. Work-up showed hypochloremia, hypokalemia, hyponatremia, total serum calcium was 5.34 mmol/L, and serum creatinine 226 µmol/L, and she underwent urgent hemodialysis (HD). Her parathyroid hormone (PTH) was 948 pg/mL, and imaging revealed missed miscarriage 9-10 weeks, soft tissue mass 30x20x33mm near the lower pole of the left lobe of the thyroid gland, small stones in renal calices, and polysegmental pneumonia. She received antibiotics, calcimimetics, and every-day hemodiafiltration (HDF), and underwent vacuum aspiration of uterine cavity and surgical removal of the parathyroidoma. Her PTH shortly returned to the reference level, and serum creatinine dropped to 140 µmol/L after kidney replacement therapy (KRT) secession. Pathology confirmed the diagnosis of parathyroid adenoma. PHPT should be included in the diagnostic algorithm of AKI in pregnancy along with vomiting of pregnant, sepsis, pre-eclampsia and other causes. Successful management of PHPT complications in pregnancy demands multidisciplinary team.

Diagnostic value of fetal autopsy after early termination of pregnancy for fetal anomalies.

BackgroundIn early terminations of pregnancy for fetal anomaly (TOPFA) without identified cytogenetic abnormality, a fetal autopsy is recommended for diagnostic purposes, to guide genetic counseling. Medical induction, which allows analysis of a complete fetus, is generally preferred over surgical vacuum aspiration. Our objective was to assess the diagnostic value of fetal autopsies in these early terminations, relative to the first-trimester ultrasound, overall and by termination method.MaterialsFor this retrospective study at the Port Royal Maternity Hospital, we identified all TOPFA performed from 11 weeks to 16 weeks diagnosed at the first-trimester ultrasound in cases with a normal karyotype. The principal endpoint was the additional value of the autopsy over /compared to the ultrasound and its impact on genetic counseling, globally and by termination method. The secondary objective was to compare the complication rate by method of termination.ResultsThe study included 79 women during period of 2013–2017: 42 with terminations by medical induction and 37 by aspiration. Fetal autopsy found additional abnormalities in 54.4% of cases, more frequently after medical induction (77.5%) than after aspiration (21.4%, p < .01). Genetic counseling was modified in 20.6% of cases, more often after induction (32.5% vs 3.6%, p < .01). The length of stay was significantly longer and a secondary aspiration was required in 16,7% of case in the medical induction group (p < .01).ConclusionMedically induced vaginal expulsion appears preferable and can change genetic counseling for subsequent pregnancies.

Clinical Analysis of Molar Pregnancy

Background: Molar pregnancies represent a significant burden of disease on the spectrum of gestational trophoblastic diseases. Molar pregnancy is one of the causes of maternal morbidity and mortality among women in the reproductive age group. However the magnitude, clinical features and risk factors are not well documented in our country .This study was conducted to describe these aspects of the disease entity in one tertiary level hospital. Objective: to determine the frequency and evaluate the current clinical characteristics of patients with molar pregnancy in Bangladesh. Study design: this was a cross sectional observational study. Study place and period: Department of Obstetrics and Gynaecology in BSMMU, Dhaka. Study period from January 2015 to June 2015. Study population: Patients with molar pregnancy admitted in the department of Obstetrics and Gynaecology in BSMMU during the study period. Outcome variables: Varieties of clinical presentation, diagnosis and treatment modalities. Results: The incidence of molar pregnancy was 7.3 per thousand pregnancies in BSMMU hospital during the study period. The age of the patient ranged from 18-47 years, with maximum 65% between 21-40 years age group. Only 5% patients were above the age of 40. Majority 65% of patients were multigravida while 35% were primigravida. Maximum 85% of all were from low socio-economic group. In 40% patient's blood group was B+ve and A+ve in 25% patients. Abnormal vaginal bleeding was the commonest presenting symptoms in 60% patients. Other than that 15% patients came with vaginal bleeding and passage of vesicles, 12.5% with lower abdominal pain, 7.5% patients had no symptom except amenorrhea diagnosed incidentally and other 5% had amenorrhea with exaggerated sign symptom of pregnancy. More than two third (80%) of the patients had uterus more than the period of gestation. USG, serum ß-hCG and CBC was done in all the cases. Chest X- ray was done in 60% cases. Serum ß- hCG level was found above the level of 50000 in 80% cases. Different modalities of treatment such as suction evacuation, D&amp;C and hysterectomy were used for the patients with molar pregnancy. Suction evacuation was the first line treatment in 87.5% patients of molar pregnancy &amp; follow up should be done at least for 6 months. Conclusion: Molar pregnancy is the disease of women in their reproductive years. It was commonly found in young multipara women of below average income group. Most common clinical manifestation was vaginal bleeding. Diagnosis was confirmed by ultrasonography and serum ß-hCG. Patients with molar pregnancy have the risks of developing persistent gestational trophoblastic disease (GTD) and should be followed up. It is now indispensible to set up a nationwide accepted protocol for the early detection and management of patient with molar pregnancy as well as to initiate a structured follow up programme to observe the prognosis of the disease.

Performing percutaneous nephrolithotomy under modified local anesthesia.

ObjectiveThis pilot study aimed to assess the practicability and effectiveness of percutaneous nephrolithotomy (PCNL) with vacuum-assisted nephrostomy sheaths for patients under modified local anesthesia (m-LA).MethodsPCNL with a vacuum-assisted nephrostomy sheath under m-LA was performed in 83 patients between November 2020 and May 2021. An 18F or 20F ClearPetra Nephrostomy Sheath connected vacuum aspiration was used in surgery to keep low pressure in the renal pelvis. For LA, lidocaine and ropivacaine hydrochloride were 1:1 mixed and instilled under ultrasound guidance through the percutaneous nephrolithotomy channel directed toward the design calix. Demographic characteristics, stone characteristics, visual analogue scale (VAS) score, vital signs, operation time, complications, and stone clear rate were recorded and analyzed.ResultsAll operations were completed. The mean VAS score was 3.9 ± 1.0. The mean operation time was 55.1 ± 23.6 min. The changes for systolic blood pressure, diastolic blood pressure, and heart rate were 3 ± 21 mmHg, 1 ± 14 mmHg, and −6 ± 14 beats/min, respectively. The change for hemoglobin was −10.7 ± 10.9 g/L. The change for C-reactive protein was 5.39 ± 43.1 mg/L. The total stone-free rate was 69.9% (93.8% for simple stones and 54.9% for complex stones).ConclusionPerforming PCNL with vacuum-assisted nephrostomy sheaths under modified local anesthesia under ultrasound guidance was found to be strongly practical and effective.

Pain Management during Surgery for Spontaneous Abortion in Early Pregnancy: Paracervical Block

The World Health Organization (WHO) recommends using vacuum aspiration as a surgical treatment for spontaneous and surgical abortion in early pregnancy. They also state that dilatation and curettage (D &amp; C) should be avoided from the perspective of safety and effectiveness and to prevent the risk of endometrial injury as it can cause thinning of the endometrium and Asherman syndrome. Maintaining a good endometrial environment is important for improving the chance of pregnancy. Manual vacuum aspiration (MVA) was developed in the 1970s. For spontaneous abortion in the first trimester, MVA reduces the risk of endometrial injury, leading to less intra- and postoperative pain and simplification of anesthesia during surgical treatment for spontaneous abortion. The WHO recommends administering standard pain relief during surgical treatment for medication-induced and spontaneous abortion but does not recommend using routine general anesthesia during MVA and D &amp; C procedures. At our hospital, we perform MVA alone under local anesthesia using a paracervical block for the surgical treatment for spontaneous abortion in early pregnancy, and the safety and effectiveness of this has been previously reported. Here, we will describe the pain management strategy used at our hospital for spontaneous abortion in early pregnancy using MVA.

Treatment of chronic esophageal-pleural fistula as a result of spontaneous rupture of the esophagus (Boerhaave’s syndrome) in patient with achalasia cardia using an endoscopic vacuum therapy

A patient with achalasia cardia after surgery for spontaneous rupture of the lower third of the esophagus developed failure of surgical suturing and a chronic esophago-pleural fistula. A control computed tomography of the chest with contrasting of the pleural cavity through the drainage revealed a filiform bronchial fistula. After the completion of endoscopic vacuum aspiration therapy, which consisted of four sessions, positive dynamics was noted in the form of the absence of air and fluid inflow through the drainage, as well as a significant decrease in the fistula orifice according to the endoscopic examination. A positive result was confirmed by X-ray, fistulography and computed tomography with contrasting—no contrast agent was received outside the esophagus and into the left bronchus. 5 months after discharge from the hospital, the patient underwent a combined course of endoscopic balloon dilatation with a good effect due to stage 3 achalasia cardia. According to computed tomography, endoscopic and X-ray examinations, there is no recurrence of the fistula.

A Review of Hyperhidrosis Treatment Methods

Context: Hyperhidrosis is known to cause numerous individual and social problems with sweating more than the body’s physiological needs. Researchers have discussed the causes of this disease so far; however, factors such as heredity, nervous system defects, infections, and drugs have been introduced as the causes. Evidence Acquisition: Firstly, 127 articles were identified from different databases. After categorizing and removing duplicate papers and reviewing the abstracts and full texts, we selected 50 articles to review and include in this study. Results: Hyperhidrosis is a burdening disorder leading to physical and social problems. Hyperhidrosis patients are not able to efficiently use specific tools such as metallic and electronic devices. Limitations of this disorder show great concern about the performance of military personnel, too. Therapeutic methods such as topical antiperspirants, anticholinergic drugs, surgery, and Botox injections are the therapeutic measures used to treat this disease; each of these treatments is prescribed at different stages of the disease, and the effect of each is observed. Topical treatment is at the forefront of treatment methods for this disease, followed by oral anticholinergic drugs. Iontophoresis is one of the methods considered in the treatment of hyperhidrosis. Besides surgery, Botox injection is one of the effective methods in treating this disease, especially in the palm. Conclusions: This review presents standard treatment methods used in treating hyperhidrosis with particular attention to iontophoresis as an engineering solution to solve health problems. Based on the severity of sweating and the region of hyperhidrosis incidents, there are different solutions to treat hyperhidrosis. Topical and anticholinergic therapies are the most common treatment options. However, there are other more effective treatment methods, such as iontophoresis and Botox delivery. Iontophoresis is effective and has a long-term effect on preventing sweating with fewer side effects. Suction curettage surgery is an invasive method to treat patients with hyperhidrosis.

Assessing Factors Contributing to Unsafe Abortion Practice among Women of Reproductive Age

The aim of the study was to investigate the factors contributing to unsafe abortion practices among women of reproductive age. Being a case study, this study used a mixed methodology approach which embraces the best of both qualitative and quantitative approaches, as this approach provides the researcher with both “breadth and depth in” obtaining a holistic understanding of social phenomena. The target population of this study comprised adolescent girls, that is, girls and women aged between 18 years and 25 years who are either in school or have dropped out after falling pregnant. This study used both qualitative and quantitative methods and relied on both quantitative and qualitative techniques of data analysis. The results indicate that reforming laws that regulate a highly stigmatized action takes time and may follow years of using multidisciplinary strategies to highlight the public health consequences and costs of unsafe abortion. Zambia is similar to other countries in the region with restrictive abortion laws in that many countries spell out the grounds for when abortion is not punishable in national penal codes. The recommendations are that the government should lift the most egregious barriers to legal services, such as requirements that multiple physicians authorize abortions and that only physicians can provide them. All healthcare professionals who provide abortion must be trained in WHO-recommended techniques, and the use of dilation and curettage must be discontinued. This invasive method should be completely replaced by either medication abortion or vacuum aspiration. Keywords: Abortion, Government, Health, Medical, NGOs.

Surgical Removal of Foreign Material by Suction Curettage After Injection Rhinoplasty: Patient-Reported Outcomes.

Though generally safe, injection rhinoplasty with synthetic non-hyaluronic fillers may lead to various deformities, which impose a psychological burden on the patients. As the injected material is technically hard to be fully cleared in the nose, the surgery is primarily chosen to address the patients' psychological distress caused by injection. Unfortunately, there is a paucity of data regarding patient-reported outcomes of this procedure. From August of 2017 to June of 2021, the authors retrospectively reviewed all cases who underwent the foreign material removals by suction curettage after injection rhinoplasties. The relevant demographic, treatment characteristics and complication details were collected. The modified Rhinoplasty Outcome Evaluation (ROE) questionnaires were prospectively completed before and 6 months after the surgery. Of the 46 patients, four cases developed minor surface irregularities on the nasal dorsum postoperatively; two cases who had recurrent nasal dorsum redness and swelling before the surgery still exhibited the redness with a less degree after the surgery; no patients needed secondary revision. There was a significant improvement in any of patient-reported outcomes at 6-month follow-up, relative to the preoperative baseline scores. The injected foreign material in the nose could be effectively removed by suction curettage with minimal complications. The patients' satisfaction and quality of life, which was severely impaired preoperatively, could be significantly improved after the surgery. Therapeutic study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Vaginal misoprostol vs intramuscular carboprost in first trimester abortion

Background: A number of conditions demands first trimester abortions including medical and social causes. This study was mainly undertaken in order to compare the oral misoprostol with the intramuscular carboprost for cervical ripening in suction evacuation for medical termination of pregnancy up to 12 weeks of gestation. Material and methods: A randomized controlled trial was undertaken to determine the safety and efficacy of misoprostol over carboprost in first trimester abortions for cervical ripening. A total 120 pregnant women were randomized in to two equal groups where one group received oral misoprostol and another group received intramuscular carboprost. Two groups were studied and compared for the baseline characteristics, induction abortion interval, cervical dilation, blood loss and complications. Results: The mean age of misoprostol group was 26.2 years and carboprost group was 25.8 years. There was no statistically significant difference in marital status, gravidity, parity and gestational age in this study. Incomplete abortion was the common cause of abortion in both the groups. The induction abortion interval was 195.2 minutes in misoprostol group and 89.9 minutes in carboprost group. The mean cervical dilation was 8.35 minutes in misoprostol group and 9.31 minutes in carboprost group.

Clinical analysis of high-intensity focused ultrasound (HIFU) combined with hysteroscopy-guided suction curettage (HGSC) in patients with 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.

Comparison of high-intensity focused ultrasound ablation and uterine artery embolization in the management of cervical pregnancy.

BackgroundCervical pregnancy (CP) is an uncommon type of ectopic pregnancy with a rising risk to life. Currently, there is no universal protocol for the safe and effective management of CP. This study aimed to investigate the clinical efficacy of high-intensity focused ultrasound ablation (HIFU) vs. uterine artery embolization (UAE) in the management of CP to develop a standard for the treatment of CP.MethodsFrom January 2015 to October 2021, 36 patients with CP were diagnosed, treated, and followed up at the Department of Gynecology of Third Xiangya Hospital of Central South University. A total of 11 patients were treated with HIFU followed by suction curettage under hysteroscopic guidance, and 25 patients were treated with UAE followed by suction curettage under hysteroscopic guidance. Medical records and pregnancy outcomes were retrospectively analyzed.ResultsCompared to the UAE group, the HIFU group had a shorter interval time (1.5 ± 0.21 days vs. 2.6 ± 0.26 days), shorter duration of hospitalization (5.5 ± 0.31 days vs. 6.6 ± 0.21 days), shorter recovery time of menstruation (30.6 ± 7.09 days vs. 36.9 ± 5.54 days), fewer adverse reactions (0/11 vs. 9/25), and fewer postoperative complications (1/11 vs. 8/25). There were no significant differences in age, gravidity, parity, abortion, gestational age, cardiac pulsation, admission symptoms, hemoglobin level, largest diameter of the sac/mass, serum human chorionic gonadotropin (hCG) level at admission, hospitalization expenses, hospitalization days, blood loss during curettage, degree of hCG decline, residue after curettage, fertility requirement, and pregnancy outcomes.ConclusionBoth HIFU and UAE are safe and effective in the treatment of patients with CP. Compared to UAE, HIFU treatment for CP is a safer and more effective therapeutic schedule owing to the advantages of being more minimally invasive, shorter interval time, shorter hospitalization days and recovery time of menstruation, fewer adverse reactions, and fewer postoperative complications.

A Case of Persistent Intrauterine Molar Pregnancy with Final Diagnosis of Heterotopic Molar Pregnancy: A Very Rare Entity

Introduction: Gestational trophoblastic disease (GTD) includes hydatiform mole, choriocarcinoma, placental site trophoblastic tumor, and epithelial trophoblastic tumor. Also, molar pregnancy can happen as an ectopic pregnancy. The coincidence of these complicated pregnancies seems to occur extremely rarely. Case presentation: Here, we presented a 26-year-old woman, nulli gravida with the first presentation of intrauterine complete molar pregnancy; she underwent suction curettage but was prompted to Gestational Trophoblastic Neoplasm (GTN) and she received chemotherapy. During chemotherapy, she had severe abdominal pain and underwent laparotomy, and found an ectopic molar pregnancy in the fallopian tube. Salpingectomy was done and followed up with serum human chorionic gonadotropin (hCG) level and again due to improper decrease of hCG levels, she was diagnosed as a heterotopic post-molar GTN and received methotrexate (MTX) in multiple doses, but she did not respond to MTX, so we started actionomycine-D (Act-D) for her. She was cured after receiving 5 courses of Act-D and now she is on her monthly follow-up with an hCG level. Conclusions: It is important to notice the likelihood of ectopic molar pregnancy or a heterotopic molar pregnancy in the case of managing molar pregnancy, especially when we encounter a case’s poor response to medical or surgical therapy.

The timing of intravenous oxytocin administration is crucial to minimize perioperative blood loss during first-trimester suction curettage for missed abortion.

Oxytocin is commonly used to reduce blood loss during suction curettage for missed abortion. However, the potential of oxytocin to mitigate blood loss in early pregnancy remains controversial. Based on the hypothesis that the "timing" of oxytocin administration may be a critical factor, we investigated whether the timing of intravenous (IV) administration is associated with reduced perioperative blood loss during first-trimester suction curettage for missed abortion. The medical charts of 146 patients with ultrasound-confirmed first-trimester missed abortion who underwent suction curettage with IV oxytocin administration were retrospectively reviewed. Among the patients, 67 received 10 IU of IV oxytocin before suction curettage (early-oxytocin administration group), while 79 patients received 10 IU of IV oxytocin after suction curettage (late-oxytocin administration group). The demographic features between the two groups did not significantly differ. However, there was a lower proportion of nulliparous patients in the early-oxytocin administration group than in the late-oxytocin administration group (38.8% vs 60.8%, p = 0.006). The perioperative blood loss amount was significantly lower in the early-oxytocin administration group than in the late-oxytocin administration group (60 [range: 50-100] vs 100 [range: 30-250] mL, p = 0.001). Moreover, the multivariate logistic regression analysis showed that the early-oxytocin administration group had a lower risk for a perioperative blood loss amount of ≥100 mL than the late-oxytocin administration group (0.23 [range: 0.10-0.55], p = 0.001); a gestational age of 9-12 weeks ( p = 0.009) was found to be associated with an increased risk for a perioperative blood loss amount of ≥100 mL. Compared with late-oxytocin administration, early-oxytocin administration could reduce perioperative blood loss during first-trimester suction curettage for missed abortion. However, the results require further investigation.

Management of caesarean scar pregnancy with ultrasound guided suction curettage followed by foley balloon catheter placement

ObjectiveCaesarean scar pregnancy (CSP), which is a direct consequence of caesarean delivery, can lead to serious complications such as placenta acreta spectrum (PAS). The aim of this study is to assess the effectiveness of ultrasound-guided suction curettage followed by foley balloon tamponade for the management of CSP in the first trimester of pregnancy. Study designA retrospective evaluation of 32 women who were managed with ultrasound-guided suction curettage and foley balloon catheter insertion to the CSP region was performed. The primary outcome of the study was the rate of successful termination of CSP without need of additional surgical intervention. Secondary outcomes were the rate of haematocrit decrease, duration of hospitalization and need for transfusion. ResultsThe described procedure was performed successfully without need for additional interventions for all patients. Median decrease in the haematocrit level post-operatively was 4% (2.25–5). Median hospitalization time was 1 day (1–2). ConclusionsUltrasound-guided suction curettage followed by foley balloon tamponade is an effective and safe method for the management of CSP. Direct comparative studies with other methods are required for a more precise conclusion.

Analysis of the influencing factors on fine-needle aspiration biopsy results of the thyroid.

ObjectiveThe objective of the study is to analyze the influencing factors on the results of thyroid fine-needle aspiration biopsy (FNAB).MethodA total of 339 patients who underwent FNAB in our hospital from December 2018 to July 2021 were retrospectively selected. The patients were chosen according to the gender ratio, age, and thyroid ultrasound characteristics and were divided into three groups: (1) a 22G needle vacuum aspiration group (Group 1, n = 85), (2) a 22G biopsy needle non-vacuum aspiration group (Group 2, n = 50), and (3) a 25G biopsy needle non-vacuum aspiration group (Group 3, n = 204). Patients in these groups were evaluated for determining the FNAB dissatisfaction rate of pathological samples. A bivariate regression analysis of independent risk factors related to the unsatisfactory pathological diagnosis of samples was performed.ResultsThe specimen dissatisfaction rates of the three groups were 22/85 (25.9%), 15/50 (30%), and 18/186 (9.7%), respectively. The overall sample dissatisfaction rate was 55/339 (16.2%), and the sample satisfaction rate of Group 3 was higher than that of Groups 1 and 2 (P < 0.05). Logistic bivariate regression analysis showed that the age of the patients and the capillary sampling needles and aspiration methods were two independent risk factors for determining the dissatisfaction rate of FNAB pathological samples.ConclusionA 25G capillary sampling aspiration biopsy needle was selected to perform FNAB in thyroid nodules without vacuum aspiration, which could effectively improve the accuracy of FNAB results with a high specimen satisfaction rate.

Striving for Egg-Cellence: Step-by-Step Guide to Oocyte Pick Up

Background: Oocyte pick up (OPU) involves the suction aspiration of ovarian follicles following controlled ovarian stimulation, via an ultrasound guided needle through the vaginal fornices 1 . There is international recognition of a lack of training tools in OPU, highlighting opportunity for technology and simulation to be further developed 1 . Aim: Here we provide a step-by-step approach to performing transvaginal ultrasound guided OPU with supporting video demonstration. Result: Interviews and procedural observation was undertaken with four fertility specialists performing OPU at a single IVF centre. Routine practice was combined with tips and tricks into a step-by-step guide to OPU. Step one covers procedural planning, patient identification and vaginal preparation. Step two discusses the gentle and steady techniques for optimal follicle aspiration, Step three highlights the important steps required for the care of the oocyte to ensure the best outcomes. Conclusion: A meticulous approach to the retrieval of oocyte is paramount to maintaining their quality; maximising training tools for technique is therefore essential 1 .

Manual Vacuum Aspiration During Early Pregnancy Failure: A Comparison of Sublingual and Vaginal Misoprostol for Pain Management

Objective: compare sublingual and vaginal misoprostol in terms of mean pain score during manual vacuum aspiration in cases of early pregnancy failure. Methodology: A total of 100 women with missed abortions, blighted ovaries, and 9 gm/dl haemoglobin were investigated at Wateem Medical and Dental College, Rawat, Rawalpindi. Complete medical history, physical, and obstetrical exam. Same doctor used ultrasound to determine pregnancy. Grouping of patients was done randomly (based on table of random numbers). Group (A)(n=50) was evaluated two hours after sublingual misoprostol. Group (B) (n=50) got 400 g misoprostol in their vaginal posterior fornix and were evaluated 4 hours later. Before surgery, all patients were given ibuprofen and antibiotics. Pre-measurements included blood pressure, heart rate, and temperature. Manual vacuum suction was aided by a 10ml paracervical lidocaine block. During surgery, the patient was given a VAS. All women received paracetamol after operations (two 500 mg pills). Results: Group-A and B patients' mean ages were 25.87+5.16 and 25.17+4.32 years, respectively. In Group-A, the mean gestational age was 7.17+2.54 weeks and in Group-B, 6.85+3.93. In Group-A, mean parity was 3.09+2.34 and in Group-B, 4.45+2.63. Comparing sublingual and vaginal misoprostol in terms of mean pain score during manual vacuum aspiration in early pregnancy failure demonstrates a significant difference (p 0.0001). Conclusion: We found that the average pain score during manual vacuum aspiration was much lower in cases of early pregnancy failure when misoprostol was administered vaginally as opposed to sublingually. Keywords: Early pregnancy failure, manual vacuum aspiration, misoprostol, sublingual and vaginal, efficacy

Cesarean scar pregnancy - a retrospective analysis of cases in the years 2012-2021.

With the increasing number of caesarean sections, the number of cesarean scar pregnancies (CSP) is also increasing. This is a relatively new entity of an ectopic pregnancy, which is risky mainly because of its possible association with placenta accreta spectrum. CSP is thought to represent about 6% of the total number of ectopic pregnancies in all women who have a history of at least one caesarean section. The estimated incidence of CSP is about 1/1,688 of all pregnancies and about 1/2,000 of all caesarean sections. Retrospective analysis of individual cases of cesarean scar pregnancies managed in our health care facility in the years 2012-2021. In total, we managed 16 cases of pregnancy in the caesarean scar in 15 women. In one woman, we recorded CSP twice. The mean age of the women was 36.6 years (27-41). The mean number of caesarean sections was 1.6 (1-3) and gestational week was 7 (4-10). The average time since the caesarean section was 3.6 years (2-11). The management was methotrexate administration once, hysteroscopic resection once and 11times primarily vacuum aspiration only, when in two cases we had to attach laparoscopic uterine artery ligation due to postoperative bleeding. We performed primary ligature of uterine arteries twice before performing vacuum aspiration. In pregnancies above 10 weeks of gestation, we observed more bleeding complications requiring surgical management. Bleeding complications were also related to the presence of fetal cardiac action. Early correct dia-gnosis is essential in the management of CSP. Pregnancies up to the 10th week of gestation are managed by simple vacuum aspirations under ultrasound guidance. If the pregnancy is over the 10th week of gestation and especially with cardiac activity, we add laparoscopic uterine artery ligation before vacuum aspiration. All patients are subsequently advised to undergo laparoscopic resuturing of the lower uterine segment.