Dilatation And Curettage Research Articles

Avoiding unfavourable outcomes in liposuction

The origin of liposuction can be traced to an adverse event by Dujarrier in 1921 when he used a uterine curette to remove fat from the knees of a ballerina ending in an amputation secondary to damage of the femoral artery. The history of liposuction since then has been one of avoiding complications and optimising outcome. After this adverse event, liposuction was abandoned until the 1960's when Schrudde revived the practice using small stab incisions and sharp curettage with the secondary suction to aspirate the freed tissue. This technique was associated with a high incidence of complications especially seroma and skin necrosis. Illouz then replaced the curette with a blunt cannula connected to vacuum pump thus avoiding the complications of a sharp curette. Despite the presence of various techniques for liposuction, suction assisted liposuction (SAL) is still the standard technique of liposuction. This article aims to discuss literature regarding the various aspects of liposuction (SAL) and to highlight the salient points in the literature and in the senior author's experience in order to avoid unfavourable outcomes in liposuction. A literature review on avoiding complication is in liposuction including some of the seminal papers on liposuction. Liposuction is generally a safe procedure with reproducible outcome. Just like any surgical procedure it should be treated with the utmost care. Illouz published 10 commandments for liposuction in 1989 and we review these commandments to demonstrate how liposuction has evolved.

The efficacy of uterine artery chemoembolization for Cesarean scar pregnancy

Objective To explore the efficacy and safety of uterine artery chemoembolization in the treatment of Cesarean scar pregnancy.Methods 42 women with Cesarean scar pregnancy were randomly divided into group A or B.Group A received uterine artery chemoembolization 3 days before ultrasoundguided dilatation and curettage.Group B received methotrexate and mifepristone and then ultrasoundguided dilatation and curettage as β-HCG level declined to less than 200IU/L.Length of hospital stays,intraoperative blood loss,β-HCG,and menstrual recovery were observed in both groups.Results In group A,length of hospital stay was (11.2 ± 1.7)days,intraoperative blood loss was (35.2 ± 18.4)ml,time to reduction of β-HCG to normal level was (21.2 ± 3.5)days,and time to menstrual recovery was (30.0 ± 4.0)days; while in group B,length of hospital stay was (20.6 ± 5.6)days,intraoperative blood loss was (225.7 ± 125.6)ml,time to reduction of β-HCG to normal level was (36.0 ± 9.9)days,and time to menstrual recovery was (49.8 ± 7.7)days,with significant statistical differences (P＜0.05).Conclusions Uterine artery chemoembolization combined with ultrasound-guided dilatation and curettage can significantly shorten length of hospital stay and reduce intraoperative hemorrhage due to curettage,and is less invasive.Patients have rapid recovery and can preserve reproductive function..This therapy is the best approach for Cesarean scar pregnancy. Key words: Uterine artery chemoembolization; Cesarean scar pregnancy; Dilatation and curettage

A comparative study of cost of care and duration of management for first-trimester abortion with manual vacuum aspiration (MVA) and sharp curettage

This study compared the hospital charges, duration of in-hospital procedures, clinical course and complications between manual vacuum aspiration (MVA) and sharp curettage. A prospective observational study was conducted during the May 2007-April 2008 period in Songklanagarind Hospital, Thailand. Forty cases of pregnancy ≤9 weeks of gestation, with conditions of an incomplete abortion, a blighted ovum or missed abortion were treated with either MVA or sharp curettage. Both groups were compared in terms of demographic and obstetric data, hospitalization cost, clinical course and complications. The obstetric data of both groups showed that the median parity was two, with a median gestation age of 8 weeks. The median total hospital expenditure was 54.67 USD for patients using the MVA technique and 153.97 USD for the sharp curettage group (p < 0.01). The median duration of in-hospital care in the MVA group was significantly less than that of the sharp curettage group, 4 versus 20 h, respectively (p < 0.01). 90 % of patients in the MVA group had only one visit compared with 72.5 % in the sharp curettage group (p = 0.04). No complications needing further curettage or treatment in either group were noted. The use of MVA in the management of a first-trimester abortion is practical, safe, cheap and time-saving.

Clinical, surgical, and histopathologic outcomes following failed medical abortion

ObjectiveTo address the consequences of surgical curettage following failed medical abortion. MethodsA retrospective case–control study was performed in a tertiary gynecologic department. The case group comprised 104 women who underwent surgical curettage following failed medical abortion; the control group included 104 women who underwent early surgically induced abortion. Clinical characteristics and surgical findings were examined. The extent of inflammation was quantified following immunohistochemical staining for cell-surface markers characteristic of T lymphocytes, B lymphocytes, and macrophages. The extent of necrosis was evaluated morphologically. ResultsAbnormal findings during surgical curettage were significantly more prevalent among women in the case group than in the control group (10.6% versus 1.9%; P=0.019). The most frequent abnormality in the case group was the presence of intimately adherent products of conception, necessitating sharp curettage. The extent of inflammation (represented by increased numbers of T and B lymphocytes) was greater in the case group than in the control group (P=0.046 and P=0.001, respectively), as was the extent of necrosis (P<0.05). ConclusionCurettage following failed medical abortion harbors particular difficulties, which may be attributed to an inflammatory response. The long-term consequences of curettage following failed medical abortion warrant further investigation.

Fabric-Based Exocervical and Endocervical Biopsy in Comparison With Punch Biopsy and Sharp Curettage

Fabric-based endocervical and exocervical biopsy tools were compared with exocervical punch biopsy and sharp endocervical curettage. We compared the level of pain reported by the patient and the amount of bleeding rated by the physician relative to the type of biopsy used. This was a 2-center institutional review board-approved study of patients undergoing colposcopy. One center randomized patients to undergo either conventional (punch biopsy, sharp endocervical curettage) or fabric-based biopsy of the endocervix and exocervix, and a second center enrolled nonrandomized controls. The patient and physician subjectively rated bleeding (exocervical) and pain (endocervical and exocervical) from the biopsy procedure(s), which were compared using the nonparametric Wilcoxon test. Exocervical and endocervical biopsies from 55 patients were compared. Fabric-based biopsies were abundant full-thickness curettage and showed statistically significant less pain and bleeding than the conventional biopsy methods (p < .0001). Fabric-based biopsies are significantly less traumatic than conventional biopsies. The benefits of a less-invasive biopsy could increase the willingness to perform multiple biopsies, increase disease detection, and improve patient satisfaction, which could impact future gynecologic health-seeking behavior and compliance with colposcopy recall.

Comparison of efficacy of modified electric vacuum aspiration with sharp curettage for the treatment of incomplete abortion: Randomized controlled trial

The aim of this study was to compare the efficacy of modified electric vacuum aspiration (mEVA) and sharp curettage (SC) for treatment of incomplete abortion. A randomized controlled trial was conducted between 1 March 2005 and 15 December 2009. Ninety-four women with incomplete abortion were randomly allocated into two groups, group A (n = 47) underwent mEVA and group B (n=47) underwent SC. The procedures were performed using the paracervical block with 20 mL of lidocaine. Successful management and complication were assessed. Successful management was defined as complete uterine evacuation with no need for the second surgical procedure. There were differences in women characteristics between groups. The successful rate of management was 100% for both groups. However, the operative time and estimated blood loss were less in the mEVA group than in the SC group. Severe pain was significantly less prevalent in group A than group B. Suspected endometritis was found in two (4.3%) patients in each group. The efficacy of mEVA was the same as that of SC in successful management of incomplete abortion, but pain was experienced more often in the SC group.

Two cases of intestinal perforation during dilatation and curettage in postpartum

자궁경부개대 및 소파수술은 임신 제1분기 인공유산에서 가장 많이 시행되는 술기이며, 부인과적으로는 진단과 치료의 목적으로 시행되는 술기이다. 이 술기의 사망률과 이환율은 매우 낮으며, 자궁천공과 같은 합병증 발생 또한 드물다. 그러나 산욕기의 크고 부드러운 자궁에 소파수술을 시행할 경우 천공의 위험성이 높고 오히려 출혈을 조장할 수 있다. 비록 일부의 자궁천공은 문제를 일으키지 않을 수도 있으나, 일부에서는 염증, 출혈, 장기의 손상을 초래할 수 있다. 장천공은 드문 합병증이나 심각한 복막염이나 패혈증을 유발할 수 있다. 저자들은 분만 3-4주 후 잔류 태반으로 시행한 자궁경부개대 및 소파수술 후 발생한 자궁천공으로 인한 소장천공 2예를 경험하였기에 간단한 문헌고찰과 함께 보고하는 바이다.

Abortion practice in Mexico: a survey of health care providers

BackgroundLittle is known about abortion practice in Mexico postlegalization of abortion in Mexico City in 2007. Study DesignIn 2009, we anonymously surveyed 418 Mexican health care providers at the Colegio Mexicano de Especialistas en Ginecologia y Obstetricia meeting using audio computer-assisted self-interview technology. ResultsThe majority of respondents were obstetrician gynecologists (376, 90%), Catholic (341, 82%), 35–60 years old (332, 79%) and male (222, 53%) and worked with trainees (307, 74%). Prior to 2007, 11% (46) and 17% (71) provided medical and surgical abortions; now, 15% (62) and 21% (86) provide these services, respectively. Practitioners from Mexico City were more likely to provide services than those from other areas. Most medical abortion providers (50, 81%) used ineffective protocols. Surgical abortion providers mainly used either manual vacuum aspiration (39, 45%) or sharp curettage (27, 32%). Most abortion providers were trained in residency and wanted more training in medical (54, 87%) and surgical (59, 69%) abortion. Among nonproviders, 49% (175) and 27% (89) expressed interest in learning to perform medical and surgical abortion, respectively. ConclusionGiven the interest in learning to provide safe abortion services and the prevalent use of ineffective medical abortion regimens and sharp curettage, abortion training in Mexico should be strengthened.

Abortion treatment by health professionals in south-eastern Nigeria

Studies assessing the various modes of treatment for abortion and its associated complications remain relevant in the generation of data that will aid policy formulation for abortion management. This descriptive cross-sectional study was undertaken to determine the common methods of, together with the complications associated with, abortion treatment among healthcare practitioners in south-eastern Nigeria. There were 230 males and 207 females, with a mean age of 38.23 + 10.4 years. General practitioners accounted for 214 (49.0%) respondents; nurses, 161 (36.8%); specialist doctors, 56 (12.8%); resident doctors, 5 (1.1%); and community health officers, 1 (0.02%). As high as 388 (88.8%) of the respondents had treated abortion. Manual vacuum aspiration (MVA), and sharp curettage were the commonest methods of treatment accounting for 36.0% and 34.1%, respectively, while medication treatment was employed by 15.0% of the respondents. Only 41.0% of the respondents had been formally trained on the use of MVA. Some 285 (65.2%) of the respondents recorded complications during abortion treatment and these included incomplete evacuation, 30.2%; haemorrhage, 26.0%; and infection, 22.2%. A significantly higher number of complications occurred following sharp metal curretage compared to MVA, and includes incomplete evacuation, 54 (62.5%) vs 33 (38.0%) (p < 0.05); and haemorrhage, 32 (43.2%) vs 15 (20.5%) (p < 0.05). Syncope, 2 (100%) and uterine perforation, 23 (100%) occurred solely from sharp metal curettage. Building capacity of health professionals on the use of MVA, and ensuring the universal access to the equipment will enable safer abortion treatment and reduce maternal morbidity and mortality from abortion-related complications.

Vascular endothelial growth factor expression up-regulated by endometrial ischemia in secretory phase plays an important role in endometriosis

Primary human endometrial cells were exposed to hypoxia preconditioning (HPC), HPC-hypoxia, and hypoxia conditions, and then endometrial tissue treated with ischemia preconditioning (IPC) was transplanted onto the chick embryo chorioallantoic membrane to investigate the role of slight ischemia of endometrium in the pathologic process of endometriosis. IPC up-regulated vascular endothelial growth factor expression and decreased apoptosis of endometrial cells, thus facilitating the endometrial fragments' ectopic implantation.

Hysterotomy for retained placenta with imminent uterine rupture in a preterm angular pregnancy

Sir, A 26-year-old primigravida was wheeled into labor ward at 30 weeks in preterm labor. She had no record of her poorly supervised antenatal period. Soon after she was admitted she delivered a preterm asphyxiated female child. Methylergometrine 0.2 mg was administered intramuscularly at delivery of anterior shoulder. An abnormal lateral bulge was noted at uterine fundus after the delivery owing to the skinny body build of the patient. There was no evidence of placental separation even after 30 minutes and a diagnosis of retained placenta was made. Manual removal was attempted in the operation theatre but failed despite all measures as the placenta remained beyond reach and the cervical os did not yield. Even sharp curettage was attempted but it could not reach placental edge and vaginal bleeding became brisk. Laparotomy was done. Upon exteriorizing uterus a 10 × 10 cm sacculation (Figure 1) in the left cornual region of the uterus was noted. The myometrium overlying the bulge was thinned out to be a mere membrane, with placenta and venous sinuses readily visible underneath and uterine rupture seemed imminent. A coronal incision was done into the myometrium overlying the placenta, which resulted in spontaneous, prompt and complete extrusion of the placental tissue. Exploration of the endometrial cavity revealed no retained placental fragments and a normal cavity. The myometrial incision was sutured in three layers. Postoperative period was uneventful and the patient was discharged on the 5th postoperative day. The lateral sacculation of the uterus at left cornual region with characteristic lateral displacement of left round ligament. Not many obstetricians are aware of the rare clinical entity of angular pregnancy or they often confuse it with interstitial or cornual pregnancy, as it is rarely discussed in textbooks. Angular pregnancy refers to implantation of the embryo just medial to the uterotubal junction, in the lateral angle of the uterine cavity (1), whereas interstitial pregnancy refers to the implantation in the intramural portion of the fallopian tube and is a true ectopic pregnancy (2). The critical differential feature is that the fertilized ovum of an interstitial pregnancy essentially develops in the uterine wall, whereas in an angular pregnancy it develops toward the uterine cavity and that might probably be the reason for a more favorable outcome of a majority of angular pregnancies. Nevertheless angular pregnancy is a potentially dangerous clinical entity and may lead to complications during pregnancy like persistent uterine pain and bleeding, spontaneous abortion, ruptured uterus (3) and rarely retained placenta. On a PubMed search we found only one similar case of angular pregnancy complicated by retained placenta requiring hysterotomy, making it a very rare complication of angular pregnancy. Despite being accurately described earlier, angular pregnancy is yet to be widely acknowledged as a separate clinical entity.

Surgical procedures for evacuating incomplete miscarriage

Incomplete miscarriage is a major problem that should be effectively managed with safe and appropriate procedures. Surgical evacuation of the uterus for management of incomplete miscarriage usually involves vacuum aspiration or sharp curettage. To compare the safety and effectiveness of surgical uterine evacuation methods for management of incomplete miscarriage. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2010). Randomized trials where different surgical methods were used to manage incomplete miscarriage were eligible for inclusion. We extracted population characteristics, settings, and exclusion criteria, in addition to outcomes such as complications of the procedure, duration, need for re-evacuation, blood transfusion, and analgesia/anesthesia. Two trials (involving 550 women) were included. Vacuum aspiration was associated with statistically significantly decreased blood loss (mean difference (MD) -17.10 ml, 95% confidence interval (CI) -24.05 to -10.15 ml), less pain during the procedure (risk ratio (RR) 0.74, 95% CI 0.61 to 0.90), and shorter duration of the procedure (MD -1.20 minutes, 95% CI -1.53 to -0.87 minutes), than sharp metal curettage, in the single study that evaluated these outcomes in 357 women. Serious complications such as uterine perforation and other morbidity were rare and the sample sizes of the trials were not large enough to evaluate small or moderate differences. Although the review indicates that vacuum aspiration is safe, quick to perform, and less painful than sharp curettage, and should be recommended for use in the management of incomplete miscarriage, the results are based on data from only one study. Analgesia and sedation should be provided as necessary for the procedure.

Termination of 10 -14 weeks of gestation in women with scarred uterus by compound mifepristone combined with misoprostol

Objective To explore the efficacy of compond mifepristone in combination with misoprostol for termination of 10 - 14 weeks of gestation in women with scarred uterus. Methods 53 women with scarred uterus at 10 -14 weeks of pregnancy who requested abortion were selected as a study group. 51 women with normal uterus were selected as a control group. Both groups were administered compond mifepristone combined with misoprostol and the efficacy was compared between the two groups, Results There were no significant differences between the two groups in success rate of abortion, time to embryo release, time to vaginal bleeding, and the number of days of menstrual recovery （P〉 0.05）. Abortion-induced vaginal bleeding volumes and 24h after dilatation and curettage were greater in the study group than in the control group （P〈0.05）. Conclusions Compond mifepristone combined with misoprostol has an ideal efficacy in termination of 10 - 14 weeks of pregnancy in women with or without scarred uterus. Key words: Scarred uterus; Compound Mifepristone; Misoprostol

Perimenopausal Amenorrhea with Cervical Atresia and Hematotrachelos

Obstruction of the lower female genital tract leading to proximal dilatation and development of hematotrachelos is most commonly a result of congenital abnormalities such as an imperforate hymen, a complete transverse vaginal septum, or rarely, cervical atresia. Acquired hematotrachelos is rare, and the possible etiology includes iatrogenic trauma to the uterocervix such as cervical surgery, dilation and curettage, obstetric laceration, cervical or endometrial carcinoma, and radiation therapy. We report an unusual case of a patient in who spontaneously acquired hematotrachelos developed in the perimenopausal period. Combined speculum inspection of the cervix and recognition of transvaginal echographic features assisted the diagnosis. In addition, we tried a new treatment method, using the firm plastic end of an Ipas Karman cannula (6 mm diameter and 6 cm length) with nylon fixation retained for I month that resulted in a patent cervical canal.

Value of sonography in thediagnosis of caesarean scar pregnancy

：Objective To explore theefficacy of sonography in the diagnosis and treatment of caesarean scar pregnancy.MethodsEighty-three patients with caesarean scar pregnancy confirmed by surgery and pathologywere reviewed retrospectively.and their clinical features,sonographic appearances,andsonographic assistant treatment were analyzed.Results Eighty-three patients wereclassified into three types:the first type included 35patients with gestational sacimplanted in the caesarean scar,the second type included 13 patients in which thegestational sac mostly located at the uterine cavity and only the inferior part implantedin the caesarean scar,and the third type included 35 patients with abnormal sonographicmass.The main clinical features for the former two types(60.0%and 61.5%)were amenorrheaand vaginal bleeding,and most patients in the third type(82.9%)were presented with vaginalbleeding or abnormal level in serum β-HCG after dilation and curettage or systemicmethotrexate(MTX)injection.Among them,71 patients(85.5%)were diagnosed accurately bysonography.Thirteen patients of the first type,11 patients of the second type and 2patients of the third type underwent suction curettage with the sonographic guidance;and 2patients of the first type,1 patients of the second type and 5patients of the third typereceived intra-amniotic administration of MTX under sonographic guidance.ConclusionsSonography is valuable for the diagnosis and treatment of caesarean scar pregnancy,and italso has an important role in therapies of suction curettage and local MTX injection. Key words: Ultrasonography; Pregnancy; Cicatrix

Trend of Complete Hydatidiform Mole

Complete Hydatidiform mole is one of the most frequent abnormal pregnancies. This review studies the trend of complete mole in Paropakar Maternity and Women's hospital and clinical ability to detect it. This is a retrospective study of 504 cases of complete hydatidiform mole recorded at Paropakar maternity and women's hospital, Kathmandu, during 2058-2065 B.S. Medical records were reviewed and incidence, clinical presentation and method of diagnosis were studied. During the study period, there were 13,9117 births and 504 complete moles, 12 partial moles, 48 persistent gestational tumours, six choriocarcinoma and four invasive moles recorded in the hospital. The incidence of complete mole was one per 276 births. It was prevalent among women younger than 29 years (80%) and among the primigravidae (36.7%). More than 90% women presented in the first half of their pregnancy and vaginal bleeding was the main complaint (68.3%). Suction evacuation, dilation and evacuation followed by sharp curettage and abdominal hysterectomy were performed in 80.6%, 17.6% and 1.2% of the women respectively. Persistent mole and choriocarcinoma developed in 9.5% and 0.4% respectively. Complete mole has the highest incidence. It affects mostly younger women and presents with vaginal bleeding most of the time, usually in the first half of their pregnancy.

Physicians' approaches to post-abortion care in Manila, Philippines

Objective To assess the knowledge and practice of health professionals in Manila, Philippines, regarding methods used for uterine evacuation in post-abortion care (PAC), including the use of misoprostol. Methods A purposive sample of physicians providing PAC services completed questionnaires anonymously about PAC practices. Results Among 45 survey respondents, the primary methods used for first-trimester uterine evacuation in PAC included sharp curettage (n = 45, 100%) and manual vacuum aspiration (MVA; n = 38, 84.4%), which was consistent with their preferences. Misoprostol was prescribed for first-trimester post-abortion uterine evacuation by 55.6% (n = 25) of respondents; dosing regimens ranged from 50 to 200 µg as a single dose or repeated every 4–24 hours. Of the respondents, 91.1% (n = 41) prescribed misoprostol for obstetric indications, including labor induction and postpartum hemorrhage. Conclusions Most respondents used sharp curettage and MVA for first-trimester post-abortion uterine evacuation, and did not express a clear preference for either method. Despite the unregistered status of misoprostol, it was used in obstetrics and PAC by a majority of study respondents. The doses of misoprostol used for post-abortion uterine evacuation are lower than those recommended by evidence-based studies. The results indicate the need to disseminate evidence-based information about safe and effective use of MVA and misoprostol for PAC to physicians in Manila, Philippines.

When Pregnancy Ends Too Soon: What Happens and What Comes Next?

Pregnancy loss is a difficult, but common, experience: About one in four women loses a pregnancy in her lifetime. Defining the Terms Early pregnancy loss means losing a pregnancy earlier than 20 weeks after the first day of your last menstrual period. The medical term for this loss (which occurs without anything being done to cause it) is spontaneous abortion. Because the word “abortion” is associated with a procedure done on purpose to end a pregnancy, early pregnancy losses often have been referred to as miscarriages. Most women become aware that they might be losing a pregnancy when they begin spotting or bleeding, even though they have tested positive for pregnancy. Sometimes a pregnancy loss is suspected during a routine prenatal exam, even when no vaginal bleeding has occurred. In such a case (called a missed abortion), your clinician (doctor, nurse midwife or practitioner, or physician assistant) might find that the fetus no longer has a heartbeat or that your uterus is not enlarging as expected. What Happens Next In the past, women with early pregnancy loss almost always went to a hospital operating room for dilatation and curettage (D&C), in which the doctor opens up the cervix and removes the remaining blood and tissue from the uterus. If you tell an older female relative that you are having a …

The endometrial–myometrial junction: a fresh look at a busy crossing

The endometrial–myometrial junction: a fresh look at a busy crossing

Dilatation and Curettage

Dilatation and Curettage