Curettage Procedures Research Articles

Omental incarceration secondary to uterine perforation after dilatation curettage: Conservative approach in sub-saharan Africa.

Complications of uterine perforation and herniation of intra-abdominal organs into the perforated area may occur after gynecological operations. They can be treated with a conservative approach, especially in cases whose vital signs are stable, laboratory values are within normal limits and their general condition is suitable. We aim to present the conservative treatment without using surgical and medical methods as it is the first case in the literature. Uterine perforation is a rare but potentially serious complication of curettage for gynecologic or obstetric reasons especially during and after operative procedures and the application of intrauterine contraceptive devices. The incidence of uterine perforation during gynecological operations is between 0.002-1.7. A 30-year-old multiparous case with a 7-week 4-day pregnancy was diagnosed with incomplete abortion at an external center due to vaginal bleeding. The case underwent suction curettage. After 24 h, revision suction curettage was performed due to the finding of rest in the endometrium during the ultrasonographic control, and the case was diagnosed with uterine perforation and omental herniation due to this. We highlighted the importance of a thorough gynecological assessment following a dilated suction curettage (D&C) procedure that includes a careful clinical examination and a detailed ultrasound evaluation.

The value of cesarean scar diverticulum in diagnosis of adverse events during dilatation and curettage in patient with cesarean scar pregnancy.

The aim of the present study was to explore the relationship between the size of cesarean scar diverticulum (CSD) measured on preoperative magnetic resonance imaging (MRI) and adverse events during dilatation and curettage (D&C) procedure in patients with cesarean scar pregnancy (CSP). The MRI of 197 CSP patients from October 2019 to August 2023 were retrospectively reviewed. The volume, area, and depth of CSD, residual myometrium thickness (RMT), and gestational sac diameter were recorded and tested for correlation with intraoperative estimated blood loss (EBL), and operation time and for any association with the intraoperative adverse events (intraoperative massive hemorrhage [39 cases] and D&C procedure failure [15 cases]). The Spearman test was used to characterize the correlation between the five MRI variables and both the EBL and operation time. The correlation between the five MRI variables and intraoperative adverse events was evaluated with student's t test and Mann-Whitney U test. Diagnostic power of the MRI variables was evaluated by the area under receiver operating characteristic curve (AUC). The volume, area, and depth of CSD and gestational sac diameter were positively correlated with both EBL and operation time, with the CSD volume having the highest correlation with them (r = 0.543 and 0.461, respectively). Conversely, the RMT displayed a negative correlation with the EBL and operation time. All five MRI variables were significantly associated with both intraoperative massive hemorrhage and D&C failure (all P < 0.001). The CSD volume demonstrated the highest AUC for diagnosing intraoperative massive hemorrhage and D&C failure at 0.893 (95% CI: 0.82-0.92) and 0.901 (95% CI: 0.85-0.94), respectively. The optimal cutoff values for CSD volume in predicting massive hemorrhage and D&C failure were determined to be 5.41 and 8.92 cm3, respectively, with corresponding sensitivities/specificities of 92.31/74.68 and 93.33/82.42, respectively. Quantifying the size of CSD based on preoperative MRI could aid in evaluating risk during D&C in CSP patients, with CSD volume possessing higher diagnostic efficacy than the other four MRI indicators.

Exploring versatile applications of a vacuum-assisted bone harvester in orthopedic surgery

BackgroundOrthopedic procedures often require removing bone or pathological tissue, with traditional methods involving instruments like curettes and rongeurs. However, these methods can be time-consuming and lead to increased blood loss. To mitigate these side effects, vacuum-assisted tools have been developed to aid in tissue removal. These devices enable surgeons to suction tissue without discarding it, potentially improving outcomes in conditions such as osteomyelitis or tumor removal while enabling collection of the material for downstream applications. Despite limited research, vacuum-assisted devices show promise beyond bone marrow harvesting. This study assesses infection and clearance rates, estimated blood loss, and total procedure time associated with the use of vacuum-assisted tissue removal, with a goal to understand if these devices can be used for tissue removal across a variety of pathologic conditions.MethodsA retrospective cohort study was conducted on patients undergoing orthopedic procedures with the Avitus® Bone Harvester repurposed from its original design from December 1, 2021, to July 1, 2023. Procedures were categorized into oncology, and debridement for infection cases. Infection cases were further categorized into those secondary to trauma and those involving primary infections (osteomyelitis and periprosthetic joint infection). Clinical variables, including demographics, intraoperative details, complications, and follow-up, were reviewed. Statistical analysis included descriptive statistics computed with R Studio.ResultsThe study included 44 patients, with debridement for infection cases being the most common (primary infection: 45.5%; infection secondary to trauma: 18.1%), followed by oncology cases (36.4%). In all oncology cases, a definitive diagnosis was established using the device, and no post-operative infections were reported. The infection clearance rate was 85.0% for primary infection cases and 50.0% for cases of infection following trauma. Across the entire cohort, the average blood loss was 314.52 mL (sd: 486.74), and the average total procedure time was 160.93 min (sd: 91.07). The overall reoperation rate was 47.7%, with an unplanned reoperation rate of 11.4%.ConclusionThe vacuum-assisted bone harvester was effectively utilized in a wide range of debridement and curettage procedures across diverse orthopedic surgeries. In oncology cases, the device enabled effective tissue removal with comparable recurrence rates, demonstrating its potential to minimize contamination while preserving tissue for accurate diagnoses. Additionally, a high rate of osteomyelitis eradication was observed in debridement for primary infection cases (85%). Despite the relatively high reoperation rate of 47.7%, it is crucial to interpret this figure within the context of the varied reasons for reoperation. Many of these reoperations were planned as part of a staged approach to treatment or were unrelated to the device's performance. It is crucial to acknowledge that isolating the device's contribution to these results can be difficult. The utilization of the device should be guided by considerations of cost-effectiveness and patient-specific risk factors.

Reproductive and transcriptome characteristics of endometrium at the window of im-plantation in patients after fertility-sparing treatment of endometrial intraepithelial neoplasm or cancer

BackgroundProgestin therapy is an option for patients with endometrial carcinoma (EC) or endometrial intraepithelial neoplasm (EIN) who fit specific criteria of fertility-sparing treatment. However, the implantation rate remains low among females receiving in vitro fertilization (IVF) even after the complete reversal of endometrial lesions. MethodsHere, ten patients with EC/EIN achieved complete regression (CR) in histology. Their relevant metabolic and IVF parameters were collected. An endometrial sampling at the window of implantation (WOI) and transcriptome analysis were conducted among them, and four healthy controls were analyzed to analyze endometrial receptivity. ResultsOn average, it took ten patients five months to achieve CR after four curettage procedures. The interquartile range of endometrium thickness on trigger day was between 8.8 and 10.0 mm, while the range was 15.2–18.5 mm for controls. Five patients got pregnant after a frozen-embryo transfer. According to ERA analysis, the endometrial sampling at WOI showed pre-receptive status in four cases. In total, 1458 differential expression genes were identified, and 70 belonged to the ERA genes. ImmuneScore indicated decreased NK cells in the endometrium, affecting endometrial receptivity. ConclusionsEven after EC/EIN reversal in histology, endometrial receptivity has already been compromised regarding altered WOI and immune microenvironment, leading to a low pregnancy rate.

Current practice of ultrasound in the management of postpartum hemorrhage: a secondary analysis of a national survey.

Although frequently employed in the delivery room, current guidelines do not recommend the use of ultrasound in the setting of postpartum hemorrhage (PPH). The aim of this survey was to evaluate the routine use of ultrasonography during PPH. A questionnaire, composed by a series of questions that assess participant characteristics and ultrasound use during PPH, was sent to members of the Italian Society of Ultrasound in Obstetrics and Gynecology currently employed in obstetrical units. Answers were subsequently grouped based on participant characteristics. Based on the responses of 200 participants it was found that ultrasound was routinely employed by 67 % of participants during PPH, by 85 % if Retained Products of Conception (RPOC) was suspected, by 67 % during Bakri balloon placement and by 69 % during curettage procedures. Routine ultrasound use was higher amongst participants working in hospitals with a higher number of deliveries, by those with more years of experience using ultrasound in labor, and by those that had attended specific postgraduate training courses. Despite the lack of recommendations in thecurrent guidelines, the results of this survey show thatultrasound seems to be commonly employed by maternal fetal medicine practitioners in the management of PPH.

Impact of first-trimester mechanical cervical dilatation during curettage on maternal and neonatal outcomes: A retrospective comparative study

ObjectiveEarlier studies have indicated a potential link between dilatation and curettage (D&C) and subsequent preterm delivery, possibly attributed to cervical damage. This study examines outcomes in pregnancies subsequent to first-trimester curettage with and without cervical dilatation. MethodsA retrospective cohort study was conducted on women who conceived after undergoing curettage due to a first trimester pregnancy loss. Maternal and neonatal outcomes of the subsequent pregnancy were compared between two groups: women who underwent cervical dilatation before their curettage and those who had curettage without dilatation. The primary outcome assessed was the rate of preterm delivery at the subsequent pregnancy, and secondary outcomes included other adverse maternal and neonatal outcomes. Univariate analysis was performed, followed by multiple logistic regression models to calculate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). ResultsAmong the 1087 women meeting the inclusion criteria during the study period, 852 (78.4 %) underwent first-trimester curettage with cervical dilatation, while 235 (21.6 %) opted for curettage only. No significant maternal or neonatal different outcomes were noted between the study groups, including preterm delivery (5.5 % vs. 3.5 %, p = 0.16), fertility treatments, placental complications, and mode of delivery. However, deliveries following D&C were associated with higher rates of small for gestational age neonates (7.6 % vs. 3.8 %, p = 0.04). Multivariate analysis revealed that cervical dilation before curettage was not significantly linked to preterm delivery [adjusted odds ratio 0.64 (0.33–1.26), p = 0.20]. ConclusionThe use of cervical dilatation during a curettage procedure for first trimester pregnancy loss, does not confer additional risk of preterm delivery. Further studies are needed to reinforce and validate these results.

EFFECT OF KECEMCEM (Spondias pinnata) EXTRACT ON ANGIOGENESIS OF GINGIVA AFTER CURETASE OF WISTAR RATS

Background: Curettage procedure cause wounds that require adjuvant therapy. One of adjuvant therapies used is hyaluronic acid. However, recently, several studies have focused on antioxidant and anti-inflammatory properties of various natural products such as the bark of kecemcem tree (Spondias pinnata) which has protective effect against oxidative and inflammatory changes occurs during development of mucositis. Based on this, researchers were interested examining effect of giving kecemcem bark extract on formation of new blood vessels (angiogenesis) in gingiva after curettage. Materials and Methods: Wistar rats were divided into 3 groups, negative control, positive control, and treatment group. Previously, rats had induced periodontal pockets by tying silk threads on mandibular incisors and after that they were curettage using a gracey curette. Negative control group was given CMC-Na, positive control group was given hyaluronic acid and treatment group was given 70% kecemcem bark extract gel. Rats were sacrificed on day 3, 5 and 7 and then histological preparations were made. Results and discussion: Average number of new blood vessels in the treatment group was higher than control group and positive control with two-way ANOVA test showed that average number of new blood vessels in each group had significant difference (p&lt;0.05). This supports hypothesis that compounds found in the bark of the kecemcem tree such as beta-sitosterol, phenols, and flavonoids have effect on increasing angiogenesis in gingival wounds after curettage of Wistar rats. Conclusion: 70% kecemcem bark extract gel has effect on increasing angiogenesis in gingival wounds after curettage of Wistar rats.

Evaluation of whether there is residual polyp tissue after hysteroscopic morcellation at Cam and Sakura City Hospital: a retrospective cohort study

BackgroundIn polypectomy with mechanical hysteroscopic morcellators, the tissue removal procedure continues until no polyp tissue remains. The decision that the polypoid tissues were removed completely is made based on visual evaluation. In a situation where the polyp tissue was visually completely removed and no doubt that the polyp has been completely removed, short spindle-like tissue fragments on the polyp floor continue in most patients. There are no studies in the literature on whether visual evaluation provides adequate information at the cellular level in many patients in whom polypoid tissues have been determined to be completely removed. The aim of the present study was to analyze the pathological results of the curettage procedure, which was applied following the completion of polyp removal with operative hysteroscopy, and to evaluate whether there was residual polyp tissue in the short spindle-like tissue fragments that the mechanical hysteroscopic morcellator could not remove. The secondary aims of this study were to compare conventional loop resection hysteroscopy with hysteroscopic morcellation for the removal of endometrial polyps in terms of hemoglobin/hematocrit changes, polypectomy time and the amount of medium deficit.MethodsA total of 70 patients with a single pedunculate polypoid image of 1.5-2 cm, which was primarily visualized by office hysteroscopy, were included in the study. Patients who had undergone hysteroscopic polypectomy were divided into two groups according to the surgical device used: the morcellator group (n = 35, Group M) and the resectoscope group (n = 35, Group R). The histopathological results of hysteroscopic specimens and curettage materials of patients who had undergone curettage at the end of operative hysteroscopy were evaluated. In addition, the postoperative 24th hour Hb/HCT decrease amounts in percentage, the polypectomy time which was measured from the start of morcellation, and deficit differences were compared between groups.ResultsIn total, 7 patients in the morcellator group had residual polyp tissue detected in the full curettage material. The blood loss was lower in the morcellator group than in the resectoscope group (M, R; (-0.07 ± 0.08), (-0,11 ± 0.06), (p < 0.05), respectively). The deficit value of the morcellator group were higher (M, R; (500 ml), (300 ml), (p < 0.05), respectively). The polypectomy time was shorter in the morcellator group (M, R; mean (2.30 min), (4.6 min), (p < 0.05)).ConclusionsEven if the lesion is completely visibly removed during hysteroscopic morcellation, extra caution should be taken regarding the possibility of residual tissue. There is a need for new studies investigating the presence of residual polyp tissue.

Favorable surgical and obstetrical outcomes in pre- and postconceptional laparoscopic abdominal cerclage: a large multicenter cohort study

BackgroundCervical incompetence is an important cause of extreme preterm delivery. Without specialized treatment, cervical incompetence has a 30% chance of recurrence in a subsequent pregnancy. Recently the first randomized controlled trial showed significant superiority of the abdominal cerclage compared to both a high and low vaginal cerclage in preventing preterm delivery <32 weeks of gestational age and fetal loss in patients with a prior failed vaginal cerclage. Objective(s)To assess surgical and obstetric outcomes in patients with pre- and postconceptional laparoscopic abdominal cerclage placement. Furthermore, to perform subgroup analysis based on the indication for cerclage placement in order to identify patients that benefit the most from an abdominal cerclage. Study designA retrospective multicenter cohort study with consecutive inclusion of all eligible patients from 1997 onwards in the Dutch cohort (104 patients) and from 2007 onwards in the Boston cohort (169 patients) was conducted. Eligible patients suffered from at least one second- or third-trimester fetal loss because of cervical incompetence and/or a short or absent cervix after cervical surgery. This includes loop electrosurgical excision procedure (LEEP), conization or trachelectomy. Patients were divided into subgroups based on the indication for cerclage placement: 1) prior failed vaginal cerclage 2) prior cervical surgery 3) other indications. This third group consisted of patients with a history of multiple second- or early third-trimester fetal losses based on cervical incompetence (without a failed vaginal cerclage) and/or multiple dilation and curettage procedures. The primary outcome measure was delivery at ≥34 weeks of gestation with neonatal survival at hospital discharge. Secondary outcome measures included surgical and obstetric outcomes, such as pregnancy rates after preconceptional surgery, obstetric complications and fetal survival rates. ResultsA total of 273 patients were included; 250 patients in the preconceptional cohort and 23 patients in the postconceptional cohort. Surgical outcomes of 273 patients were favorable with six minor complications (2.2%). In the postconceptional cohort we had one patient (0.4%) with hemorrhage of 650 ml, resulting in conversion to laparotomy. After preconceptional laparoscopic abdominal cerclage (n=250) the pregnancy rate was 74.1% (n=137) with a minimal follow-up of 12 months. Delivery at ≥ 34 weeks of gestation occurred in 90.5% of all ongoing pregnancies. Four patients (3.3%) suffered from a second-trimester fetal loss. The indication for the cerclage in all four patients was a prior failed vaginal cerclage. The other subgroups showed fetal survival rates of 100% in ongoing pregnancies with a total fetal survival rate of 96%. After postconceptional placement, 94.1% of all patients with an ongoing pregnancy delivered at ≥ 34 weeks of gestation with a total fetal survival rate of 100%. Thus second-trimester fetal losses did not occur in this group. Conclusion(s)Pre- and postconceptional laparoscopic abdominal cerclage is a safe procedure with favorable obstetric outcomes in patients with an increased risk of cervical incompetence. All subgroups show high fetal survival rates. Second-trimester fetal loss only occurred in the group of patients with a cerclage placed for the indication prior failed vaginal cerclage, but also in this group the chance was low.

Tubercular Dactylitis in a 5-Year Girl: A Case Report on Uncommon Presentation of Skeletal Tuberculosis

Tuberculosis of the spinal cord, which is known as tubercular spondylitis is the most manifested musculoskeletal TB. Tuberculosis also affects the hip joint, knee joint, wrist, and elbow joint in descending order. Tubercular Dactylitis is a less common form of extra-pulmonary tuberculosis, which involves the small bones of the hand and feet. Tuberculosis causes granuloma formation in short tubular bones resulting in spindle shaped swelling, which is Spina Ventosa. A5 years old Bangladeshi girl presented to the orthopaedics department with a history of pain-free gradual expansion of the middle phalanx of the left index finger for 3 consecutive months. Findings of physical and radiographic examination were in line with tubercular dactylitis. Curettage and allogenic bone grafting procedure was performed. Then tubercular dactylitis was ensured by histo-pathological examination. The patient was further treated with Anti-TB drugs for 12 months. Clinical and functional outcomes were satisfactory and there was no recurrence after 2 years of follow-up. As tubercular dactylitis is an infrequent presentation of skeletal tuberculosis, diagnosis, and management decision was difficult. Our experience in treating the patient with curettage and allogenic bone grafting along with 12 months anti-tubercular medications was excellent. So, this can be recommended as one of the best modalities of treatment of tubercular dactylities in children.

The Sudden Death of a Pregnant Woman With Takotsubo Cardiomyopathy Following a Legal Abortion: A Case Report

Background: Takotsubo cardiomyopathy (TCM) is characterized by left ventricular dysfunction and apical ballooning due to physical or mental stress in the absence of coronary artery disease. This transient heart disorder is rare in pregnancy. It may affect women of reproductive age. Case Presentation: The case was a 38-year-old woman in the first trimester of pregnancy with a history of TCM diagnosis one year ago, admitted to the hospital for a legal abortion. At the time of hospitalization, echo cardiography, echo cardiography, and clinical tests results were normal; however, due to stressful factors, such as the cancellation of the dilation &amp; curettage (D&amp;C) procedure, despite being transferred to the operating room (due to the absence of a gynecologist), receiving misoprostol for two consecutive days, the prolongation of surgery time, as well as the absence of a psychiatrist to reduce stress during the operation, suffered from recurrent TCM and eventually expired. In the autopsy, the cause of death was a massive pulmonary embolism. Conclusion: In pregnant women, there is a possibility of TCM recurrence due to changes in hormonal levels and emotional and physical stress caused by pregnancy. Therefore, when performing a surgical procedure such as D&amp;C, a team consisting of gynecologists, cardiologists, and psychiatrists should be present to avoid dangerous complications such as sudden death.

Utility of Office Hysteroscopy in Diagnosing Retained Products of Conception After Early Pregnancy Loss After In Vitro Fertilization.

To evaluate the utility of office hysteroscopy in diagnosing and treating retained products of conception in patients with infertility who experience early pregnancy loss (EPL) after in vitro fertilization (IVF). We evaluated a retrospective cohort of 597 pregnancies that ended in EPL in patients aged 18-45 years who conceived through fresh or frozen embryo transfer at an academic fertility practice between January 2016 and December 2021. All patients underwent office hysteroscopy after expectant, medical, or surgical management of the EPL. The primary outcome was presence of retained products of conception at the time of office hysteroscopy. Secondary outcomes included incidence of vaginal bleeding, presence of intrauterine adhesions, treatment for retained products of conception, and duration of time from EPL diagnosis to resolution. Log-binomial regression and Poisson regression were performed, adjusting for potential confounders including oocyte age, patient age, body mass index, prior EPL count, number of prior dilation and curettage procedures, leiomyomas, uterine anomalies, and vaginal bleeding. Of the 597 EPLs included, 129 patients (21.6%) had retained products of conception diagnosed at the time of office hysteroscopy. The majority of individuals with EPL were managed surgically (n=427, 71.5%), in lieu of expectant management (n=140, 23.5%) or medical management (n=30, 5.0%). The presence of retained products of conception was significantly associated with vaginal bleeding (relative risk [RR] 1.72, 95% CI 1.34-2.21). Of the 41 patients with normal pelvic ultrasonogram results before office hysteroscopy, 10 (24.4%) had retained products of conception detected at the time of office hysteroscopy. When stratified by EPL management method, retained products of conception were significantly more likely to be present in individuals with EPL who were managed medically (adjusted RR 2.66, 95% CI 1.90-3.73) when compared with those managed surgically. Intrauterine adhesions were significantly less likely to be detected in individuals with EPL who underwent expectant management when compared with those managed surgically (RR 0.14, 95% CI 0.04-0.44). Of the 127 individuals with EPL who were diagnosed with retained products of conception at the time of office hysteroscopy, 30 (23.6%) had retained products of conception dislodged during the office hysteroscopy, 34 (26.8%) chose expectant or medical management, and 63 (49.6%) chose surgical management. The mean number of days from EPL diagnosis to resolution of pregnancy was significantly higher in patients who elected for expectant management (31 days; RR 1.18, 95% CI 1.02-1.37) or medical management (41 days; RR 1.54, 95% CI 1.25-1.90) when compared with surgical management (27 days). In patients with EPL after IVF, office hysteroscopy detected retained products of conception in 24.4% of those with normal pelvic ultrasonogram results. Due to the efficacy of office hysteroscopy in diagnosing and treating retained products of conception, these data support considering office hysteroscopy as an adjunct to ultrasonography in patients with infertility who experience EPL after IVF.

Sharp Versus Electric Suction Curettage in Gynecologic Patients Undergoing Evaluation for Abnormal Uterine Bleeding

Suction curettage is preferred over sharp curettage in obstetric settings. We compare the quality of operative tissue sampling between sharp curettage and suction curettage using electric vacuum aspiration for non-obstetric abnormal uterine bleeding in reproductive-aged women. Retrospective cohort study. Community hospital in Long Island, New York. Women ages 21-45 years (n=257) who underwent operative curettage procedure for non-obstetric abnormal uterine bleeding. Independent ratings of specimens from suction curettage using electric vacuum aspiration and sharp curettage by two pathologists blinded to method of tissue collection. The primary outcome was percentage of organized tissue, indicative of a higher quality pathology specimen. Specimens obtained by electric suction curettage (p<.001) had a significantly higher percentage of organized tissue (M=66.28, SD=20.33) than sharp curettage (M=55.51, SD=24.17). There were no differences between the curettage groups for operative time, blood loss, intraoperative complications, or pathology diagnosis. Specimens obtained with suction curettage contained more organized tissue with similar pathologist satisfaction and confidence scores compared to sharp curettage. We suggest clinicians consider electric suction curettage in the diagnostic work-up of abnormal uterine bleeding in reproductive-aged women. In addition, patient-centered benefits include no increase in operative time, blood loss or complication rate compared to sharp curettage.

Effectiveness of Self-Managed Medication Abortion Between 9 and 16 Weeks of Gestation.

To evaluate abortion completion after self-managed medication abortion in pregnancies at or beyond 9 weeks of gestation. We conducted a prospective observational cohort study in which we recruited callers to three abortion-accompaniment groups in Argentina, Nigeria, and Southeast Asia who were initiating a self-managed medication abortion. Participants completed a baseline survey over the phone before taking pills and then two follow-up phone surveys 1 and 3 weeks after taking pills. The primary outcome was abortion completion; secondary outcomes included physical experiences and health care seeking and treatment. Between 2019 and 2020, we enrolled 1,352 participants, 19.5% (264/1,352) of whom self-managed a medication abortion at 9 or more weeks of gestation: 75.0% (198/264) at 9-11 weeks, 19.3% (51/264) at 12-14 weeks, and 5.7% (15/264) at 15-22 weeks. Participants were aged 26 years on average (SD 5.6 years); 56.4% (149/264) used the combined regimen (mifepristone+misoprostol), and 43.6% (115/264) used misoprostol only. At the last follow-up, 89.4% (236/264) had a complete abortion without procedural intervention, 5.3% (14/264) had a complete abortion with manual vacuum aspiration or dilation and curettage procedure, 4.9% (13/264) had an incomplete abortion, and 0.4% (1/264) participants did not report an abortion outcome. Some participants (23.5%, 62/264) sought health care during or after the self-managed medication abortion, most commonly to confirm completion (15.9%, 42/264); 9.1% (24/264) needed further medical intervention (procedural evacuation, antibiotics, additional misoprostol, intravenous fluids, blood transfusion, or overnight stay in the facility). Those who were 12 or more weeks pregnant were more likely to seek care at a clinic or hospital than those who were 9-11 weeks pregnant (adjusted relative risk 1.62, 95% CI 1.3-2.1). People who self-managed an abortion with medication between 9 and 16 weeks of gestation had high levels of abortion completion and accessed health care to confirm completion or to treat potential complications. ISRCTN, ISRCTN95769543.

Surgical treatment for pelvic bone metastatic disease from renal cell carcinoma.

Pelvic bone metastases from renal cell carcinoma (RCC) are challenging due to their destructive pattern, poor response to radiotherapy and hypervascularity. The purpose of our study was to review a series of patients undergoing surgical treatment with the aim to investigate: 1) survival; 2) local disease control; and 3) complications. A series of 16 patients was reviewed. A curettage procedure was performed on 12 patients. In eight the lesion involved the acetabulum; a cemented hip arthroplasty with cage was performed in seven; a flail hip in one. Four patients received a resection; in two cases with acetabular involvement, reconstruction was performed with a custom-made prosthesis and with an allograft and prosthesis. Disease-specific survival accounted for 70% at 3 years and 41% at 5 years. Only one local tumor progression after curettage occurred. Revision surgery (flail hip) was necessary for deep infection of the custom-made prosthesis. A prolonged survival in patients affected by bone metastatic disease from RCC can justify also major surgical procedures. Due to a low local progression rate after intralesional procedures, curettage, cement and a total hip arthroplasty with cage, when feasible, should be considered as an alternative to more demanding surgeries like resections and reconstructions. Level 4.

Focal-occult placenta accreta: a clandestine source of maternal morbidity

Focal-occult placenta accreta spectrum is known to cause adverse obstetrical morbidity outcomes, however, direct comparisons with previa-associated placenta accreta spectrum morbidity are lacking. We sought to compare the baseline characteristics, surgical and obstetrical morbidity, and subsequent pregnancy outcomes of patients with focal-occult placenta accreta spectrum with those of patients with previa-associated accreta. A retrospective review was conducted of all pathologically confirmed placenta accreta spectrum cases from 2018 to 2022 at a tertiary care center. The baseline characteristics, surgical, obstetrical, and subsequent pregnancy outcomes were recorded. Cases of focal-occult placenta accreta spectrum was compared with cases of previa-associated placenta accreta spectrum across a range of morbidity characteristics including hemorrhagic factors, interventions, postdelivery reoperations, infections, and intensive care unit admission. Statistical comparison was performed using Kruskal-Wallis or chi-square tests, and a P value of <.05 was considered significant. A total of 74 cases were identified with 43 focal-occult and 31 previa-associated placenta accreta spectrum cases. Of those, 25.6% of the patients with focal-occult placenta accreta spectrum and 100% of the patients with previa-associated placenta accreta spectrum underwent a hysterectomy. One case of focal-occult placenta accreta spectrum and 29 cases of previa-associated placenta accreta spectrum were diagnosed antenatally. Patients with focal-occult placenta accreta spectrum did not differ from those with previa-associated placenta accreta spectrum in mean maternal age (33.0 vs 33.1 years), body mass index, or the incidence of previous dilation and curettage procedures (16.3% vs 25.8%). Patients with focal-occult placenta accreta spectrum were significantly more likely to have a lower mean parity (1.5 vs 3.6 gestations), higher gestational age at delivery (36.1 vs 33.9 weeks' gestation), and were less likely to have had a previous cesarean delivery (12/43, 27.9% vs 30/31, 96.8%). In addition, patients with focal-occult placenta accreta spectrum had less previous cesarean deliveries (mean, 0.5 vs 2.3), were more likely to have undergone in vitro fertilization (20.9% vs 3.2%), and less likely to have anterior placentation. When contrasting the clinical outcomes of patients with focal-occult placenta accreta spectrum with those with previa-associated placenta accreta spectrum, the postpartum hemorrhage rates (71.0% vs 67.4%), mean quantitative blood loss (2099 mL; range, 500-9516 mL vs 2119 mL; range 350-12,220 mL), mean units of red blood cells transfused (1.4 vs 1.7), massive transfusion rate (9.3% vs 3.2%), and intensive care unit admission rates (11.6% vs 6.5%) were not significantly different, but there was a nonsignificant trend toward higher morbidity among patients with focal-occult accreta. Patients with focal-occult accreta had a higher incidence of reoperations or return to the operating room (30.2 vs 6.5%; P=.01). When comparing focal-occult with previa-associated placenta accreta spectrum, the composite outcomes, including hemorrhagic morbidity (77.4% vs 74.4%), any maternal morbidity (83.9% vs 76.7%), and severe maternal morbidity (64.5% vs 65.1%), were not significantly different between the groups. Nine focal-occult placenta accreta spectrum patients had a subsequent pregnancy, and 3 of those had recurrent placenta accreta spectrum. Focal-occult placenta accreta spectrum presents with fewer identifiable risk factors than placenta previa-associated placenta accreta spectrum but may be associated with an in vitro fertilization pregnancy. Patients with focal-occult placenta accreta spectrum was observed to have a higher incidence of reoperation when compared with patients previa-associated placenta accreta spectrum, and no other statistically significant differences in morbidity outcomes were observed. The absence of differences in morbidity outcomes may be attributable to a lack of antenatal detection of focal-occult accreta and merits further investigation.

Emergency physician gender is associated with early pregnancy loss management: a multisite retrospective cohort study

BackgroundPatients experiencing early pregnancy loss often first present to the emergency department (ED) where they can be managed non-operatively through expectant or medical management, or surgically by the obstetrical team....

The effect of online video-assisted teaching program on medical students learning procedure of fractional curettage

ObjectivesSince 2020, with the entire world in crisis over the coronavirus pandemic (COVID-19), medical students have adapted to hybrid and distance learning. This study aims to compare the learning outcomes of students learning the procedure of fractional curettage in an online video-assisted teaching program to those of students learning the procedure in a traditional class.MethodsA quasi-experimental study was conducted among fourth-year medical students who rotated to Obstetrics and Gynecology courses between April 2021 and October 2021. Participants in the first two rotations were enrolled in traditional classes, and the online video-assisted teaching program was introduced in the subsequent two rotations. Both study groups took OSCEs (objective structured clinical examinations), a pre-test and post-test with MCQs (multiple choice questions), and a confidence and satisfaction level questionnaire.ResultsA total of 106 fourth-year medical students, 54 in the traditional group and 52 in the online video-assisted teaching program, were recruited. The online video-assisted group showed a statistically better mean OSCE score (85.67 ± 11.29 vs. 73.87 ± 13.01, p < 0.001) and mean post-test MCQ score than the traditional group (4.21 ± 0.87 vs. 3.80 ± 0.98, p = 0.0232). Moreover, the mean difference between the two groups' pre and post-test MCQ scores was significantly different (0.96 ± 1.37 vs. 1.79 ± 1.50 in traditional and online video-assisted teaching program groups, respectively, P = 0.0038). The participants in the experimental group reported significantly greater confidence (P < 0.001) in performing the fractional curettage procedure. However, the mean satisfaction score was significantly higher in the control group (p = 0.0053).ConclusionThe online video-assisted teaching program on the fractional curettage procedure, a necessary and skill-demanding procedure, is an effective and advantageous education tool that improves skills, knowledge, and confidence in fourth-year medical students. We recommend that the video-assisted teaching program is another effectively procedural teaching method for medical students.

Combined Intrauterine Lignocaine Injection and Paracervical Block Gives More Pain Relief Than Either Method Alone in Dilatation and Curettage Procedure

Combined Intrauterine Lignocaine Injection and Paracervical Block Gives More Pain Relief Than Either Method Alone in Dilatation and Curettage Procedure

A Case Report of Spontaneous Regression of grade 3 Clear Cell Endometrial Cancer

Spontaneous remission of cancer (SR) is a rare, defined as a complete or partial, temporary, or permanent disappearance of all or at least some relevant parameters of a soundly diagnosed malignant disease without any medical treatment or with treatment that is considered inadequate to produce the resulting regression. We present the case of a 43-year-old woman who initially received a diagnosis of high- grade squamous intraepithelial lesion (HSIL) on a Pap smear, further examination and MVA (Manual Vacuum Aspiration) curettage biopsy revealing poorly differentiated clear cell adenocarcinoma of the endometrium, stage 1a3 and subclinical hypothyroidism. The patient was prescribed thyroid tablet replacement but chose not to pursue any cancer treatment. Following two consecutive MVA curettage procedures, she returned for a hysteroscopic examination and the third MVA curettage biopsy, the histological report indicated the absence of any malignancy. Throughout the course of her illness, the patient underwent a total of ten sessions of MVA endometrial curettage and received thyroid replacement therapy for her subclinical hypothyroidism. Despite our initial reservations, we continue to provide care and support to her throughout whole course of this illness. We demonstrated that a patient's autonomy in refusing medical treatment is a fundamental ethical and legal principle in healthcare. Conclusion: We report the 8 cases of spontaneous remission (SR) in endometrial cancer. Given the infrequent occurrence of such cases, it is imperative to involve in a comprehensive and in-depth discussion.