Uterine Evacuation Procedures Research Articles

Prophylactic antibiotics for uterine evacuation procedures to treat miscarriage

Prophylactic antibiotics for uterine evacuation procedures to treat miscarriage

The implementation of routine procedural transvaginal sonography to decrease retained products of conception: a quality improvement initiative

BackgroundRetained products of conception (POC) following uterine evacuation can lead to adverse sequelae, including hemorrhage, endometritis, intrauterine adhesions, and reoperation. Use of procedural transvaginal sonography (TVUS) in the operating room has been proposed to help decrease retained POC.MethodsA retrospective review of all first trimester uterine evacuation procedures from 1/2015 to 2/2017 was performed, noting use of transabdominal ultrasonography, retained products of conception, and complications. A practice change was implemented in May 2018, in which routine intra-procedural TVUS use was initiated. A second retrospective chart review was conducted to assess for post-implementation incidence of retained POC, re-operation, and associated complications.ResultsPrior to intra-procedural TVUS implementation, 130 eligible procedures were performed during the specified timeframe, with 9/130 (6.9%) incidence of retained products of conception. TAUS was performed in 59/130 (45.4%) of procedures, and 4/9 (44.4%) of those with retained products. There were eight re-operative procedures in seven patients, and two patients were treated with misoprostol. Complications included hemorrhage, Asherman’s syndrome and endometritis. Following implementation, 95 first trimester procedures were performed with transvaginal sonography, with 0 (0%) cases of retained POC (p = 0.01), no incidences of re-operation (p = 0.02), and one case of Asherman’s syndrome. TVUS findings led to additional focused suction curettage in 20/95 (21.0%) of procedures. The endometrium was measured on procedure completion in 64 procedures, with a mean thickness of 5.5 mm (1–12 mm).ConclusionImplementation of routine TVUS during uterine evacuation may reduce the incidence of retained POC and associated reoperation rates. Further multi-center trials are needed to confirm this finding.

A double-blind randomized trial comparing lidocaine spray and placebo spray anesthesia prior to cervical laminaria insertion

ObjectiveTo compare pain during laminaria insertion after lidocaine spray versus placebo spray anesthesia in women about to undergo a surgical abortion procedure. Study designA double blind, randomized, placebo-controlled trial of women at 12–24 weeks gestation one day prior to surgical uterine evacuation procedure. Participants received lidocaine 10% or placebo (saline 0.9%) spray to the endocervix and ectocervix two minutes before laminaria insertion. The primary outcome was participants’ pain score immediately after initial laminaria insertion, measured using a 10 cm visual analog scale (VAS). Secondary outcomes included scores at speculum removal and 15 min after speculum insertion. ResultsFrom 7/2016 through 8/2018, we enrolled 68 and 66 women to the lidocaine and placebo groups, respectively. Baseline characteristics were similar in both groups. The primary outcome did not differ between lidocaine and placebo groups (median VAS 2.0 vs. 2.0 respectively, p = 0.69). Reported VAS after speculum removal and 15 min from speculum insertion were similar in the lidocaine and placebo groups (median 2.0, p = 0.99; median 1.0 vs. 1.5 respectively, p = 0.32). In multivariate analyses, lidocaine use was associated with decreased VAS score at 15 min from speculum insertion [95%CI −0.96 (−1.74 to −0.18), p = 0.016]. Reported VAS ≥7 at 1st laminaria insertion did not differ between lidocaine and placebo groups (5.88% vs. 10.61% respectively, p = 0.362). ConclusionIn women scheduled for laminaria insertion prior to surgical uterine evacuation at 12–24 weeks gestation, topical application of lidocaine spray to the cervix before insertion did not result in lower reported pain as compared with placebo. ImplicationsOur results imply that physicians should not use topical application of lidocaine spray to the cervix before laminaria insertion to reduce women’s pain. Continued efforts must be made to find means to relieve pain by using simple, effective analgesia or adjusting the technique, and not using a tenaculum whenever possible.

Intra-procedural Transvaginal Sonography to Decrease Retained Products of Conception [35A

INTRODUCTION: Retained products of conception (POC) following uterine evacuation can lead to adverse sequelae, including hemorrhage, endometritis, intrauterine adhesions, and reoperation. Incidence of retained POC range from 1.5–3.7%. Use of procedural transvaginal sonography (TVUS) in the operating room has been proposed to help decrease this. METHODS: A retrospective review of first trimester uterine evacuation procedures from 1/2015–2/2017 was performed, noting use of transabdominal ultrasonography (TAUS), retained products of conception (sonographic findings requiring surgical or medical intervention), and complications. A practice change was implemented in May 2018, in which intra-procedural TVUS was routinely performed. A second retrospective chart review was conducted to assess for post-implementation incidence of retained POC, reoperation, and associated complications. Fisher's exact test was performed. RESULTS: Prior to implementation, 130 eligible procedures were performed during the specified timeframe, with 9/130 (6.9%) incidence of retained products of conception. TAUS was performed in 59/130 (45.4%) of procedures, and 4/9 (44.4%) of those with retained products. There were eight re-operative procedures in seven patients, and two patients were treated with misoprostol. Complications included hemorrhage, Asherman's and endometritis. Following implementation, 94 first trimester procedures were performed with transvaginal sonography, with 0 (0%) cases of retained POC (P=.01), no incidences of re-operation (P=.02), and one case of Asherman's. TVUS led to additional focused curettage in 20/94 (21.3%) of procedures. The endometrium was measured in 64 procedures, with a mean thickness of 5.5 mm (1–12 mm). CONCLUSION: Implementation of routine TVUS during uterine evacuation appears to reduce the incidence of retained POC and associated reoperation rates.

Maternal and procedural factors associated with estimated blood loss in second trimester surgical uterine evacuation: a retrospective cohort analysis

BackgroundPrior studies examining bleeding with uterine evacuation have focused on high-volume centers performing over 1100 procedures annually. The aim of this study was to examine associations between blood loss and patient and procedural characteristics in a center performing fewer than 50 procedures annually. MethodsThis retrospective cohort study, with institutional review board approval, utilized procedural codes to identify patients undergoing uterine evacuation procedures between 14 weeks’ and 24 weeks’ gestational age across a 50-month period. The primary outcome was estimated blood loss; secondary outcomes were hemorrhage, transfusion and hospital re-admission. Associations between blood loss and other variables were examined using linear regression models. ResultsCharts of 161 women met inclusion criteria. Median estimated blood loss was 400 mL (IQR 300 mL) with 37% of patients having blood loss of ≥500 mL. In univariate analyses, increased blood loss was associated with later gestational age (P <0.001) and pregnancy termination (P <0.001). In a multiple linear regression model, both remained significant. Each one-week increase in gestational age was associated with a 7.1% mean increase in estimated blood loss (95% CI 2.47% to 11.9%; P=0.003). Patients whose uterine evacuation was indicated for pregnancy termination had an 80.6% increase in blood loss compared with those with pre-operative fetal demise (95% CI 37.5% to 137.2%; P <0.001). Rates of peri-operative transfusion and re-admission for bleeding were <4%. ConclusionWhile blood loss may be greater in low volume centers, our transfusion and re-admission rates were low following second trimester uterine evacuation.

Abortion training in US obstetrics and gynecology residency programs

Nearly 15 years ago, 51% of US obstetrics and gynecology residency training program directors reported that abortion training was routine, 39% reported training was optional, and 10% did not have training. The status of abortion training now is unknown. We sought to determine the current status of abortion training in obstetrics and gynecology residency programs. Through surveying program directors of US obstetrics and gynecology residency training programs, we conducted a cross-sectional study on the availability and characteristics of abortion training. Training was defined as routine if included in residents' schedules with individuals permitted to opt out, optional as not in the residents' schedules but available for individuals to arrange, and not available. Findings were compared between types of programs using bivariate analyses. In all, 190 residency program directors (79%) responded. A total of 64% reported routine training with dedicated time, 31% optional, and 5% not available. Routine, scheduled training was correlated with higher median numbers of uterine evacuation procedures. While the majority believed their graduates to be competent in first-trimester aspiration (71%), medication abortion (66%), and induction termination (67%), only 22% thought graduates were competent in dilation and evacuation. Abortion procedures varied by clinical indication, with some programs limiting cases to pregnancy complication, fetal anomaly, or demise. Abortion training in obstetrics and gynecology residency training programs has increased since 2004, yet many programs graduate residents without sufficient training to provide abortions for any indication, as well as dilation and evacuation. Professional training standards and support for family planning training have coincided with improved training, but there are still barriers to understand and overcome.

Prior Uterine Evacuation and the Risk of Short Cervical Length: A Retrospective Cohort Study.

To determine whether a prior uterine evacuation procedure is associated with an increased risk of short cervical length (≤20 mm) in women without prior spontaneous preterm birth. This work was a retrospective cohort study from January 2012 to December 2014 of singletons without prior spontaneous preterm birth with cervical length screening between 18 weeks and 23 weeks 6 days. Women with a prior miscarriage/abortion were excluded if management (medical, surgical, or expectant) was not specified. Prior uterine evacuation was defined as dilation and curettage or dilation and evacuation of a spontaneous or induced abortion. The primary outcome was the risk of short cervical length (≤20 mm) among women with and without 1 of more prior uterine evacuations at any gestational age, assessed by the odds ratio and adjusted odds ratio for confounders. Of 2672 women included, 714 (27%) had at least 1 prior uterine evacuation. The overall incidence of short cervical length in the cohort was 1% (n = 27). Women with at least 1 prior uterine evacuation were more likely to be African American (64% versus 41%; P < .001), smoke (14% versus 8%; P < .001), have a higher body mass index (mean ± SD, 28.1 ± 7.1 versus 26.8 ± 7.1 kg/m2 ; P < .001), and have had prior full-term delivery (60% versus 41%; P < .001). Women with at least 1 prior uterine evacuation had a significantly higher incidence of short cervical length (2% versus 0.7%; P = .003; odds ratio, 2.99 [95% confidence interval, 1.40-6.40]). After adjustment for confounders, prior uterine evacuation remained a source of increased risk of short cervical length (adjusted odds ratio, 2.63 [95% confidence interval, 1.19-5.80]). Although the overall incidence of short cervical length is low (1%-2%), women with at least 1 prior uterine evacuation have at least a 2-fold increased risk of a short second-trimester cervical length compared to women without a prior uterine evacuation.

Enhancing Family Planning Training at a Catholic OBGYN Residency Program

OBJECTIVE: Residents in Catholic hospitals face restrictions in family planning training based on the Ethical and Religious Directives. Our objective was to create a rotation that addresses ACGME competencies in family planning and abortion training for the OBGYN residency program at Saint Joseph Hospital. METHODS: In July 2016, a family planning grant was awarded to the OBGYN residency program at Saint Joseph Hospital to create a family planning rotation to improve on-site family planning curricula at Saint Joseph Hospital and provide planned, off-site abortion and contraception training at a family planning clinic affiliated with a nearby academic center. All residents participated in family planning didactic sessions, simulation sessions, and annual values clarification workshop. Residents who participated in the family planning rotation were assigned readings (American College of Obstetricians and Gynecologists publications and journal articles), an e-learning curriculum (LEARN module), and trained in providing contraception and uterine evacuation procedures. Residents who chose to opt-out of performing uterine evacuation procedures were considered partial participators. EVALUATION: We will compare pre- and postmean test scores for LEARN modules and median number of family planning procedures before and after the family planning rotation. Participating residents will complete rotation evaluations and comments will be evaluated using thematic codes. Preliminary data suggest residents gain more experience in uterine evacuations and LARC contraception procedures after the rotation. DISSEMINATION: Our family planning rotation can serve as a model for other faith-based residency programs to improve training. REFLECTIVE CRITIQUE: The family planning rotation provides an opportunity to improve training in our Catholic hospital-based program.

Clinicohistological Correlation and Cost-effectiveness of routinely performed Histological Examination of Pregnancy Tissues obtained at Uterine Evacuation Procedure: Five-year Experience at a Secondary Care Hospital of Karachi, Pakistan

ABSTRACT Aim To assess clinicohistological correlation and costeffectiveness of routinely performed histological examination of pregnancy tissue samples collected at surgical uterine evacuation Materials and methods In this retrospective study, medical record of patients admitted for incomplete miscarriage, missed miscarriage, and anembryonic miscarriage in the first trimester from January 2010 to August 2014 were reviewed. Histopathologic diagnosis of the tissue samples obtained via surgical uterine evacuation in these patients was compared with the preevacuation diagnosis. Results Specimens of 711 patients were sent after uterine evacuation. Histopathologic examination revealed normal product of conception in 681 patients (95.7%), while partial hydatidiform mole was diagnosed in 14 patients (1.9%). Complete hydatidiform mole was detected in only three cases (0.42%). Decidual tissue without chorionic villi was reported in 13 patients (1.8%). The diagnosis of complete mole was suspected in all three cases and in six cases of partial mole before procedure. Conclusion Findings of study did not show any diagnostic and financial benefit from routine histological examination of tissue removed at termination of pregnancy or emergency uterine evacuation. We recommend that histopathological examination be performed in cases where the diagnosis is uncertain, fewer tissues obtained during evacuation, when molar pregnancy is suspected, or when patients are considered at high risk for trophoblastic disease. How to cite this article Memon Z, Anjum N, Sheikh SS. Clinicohistological Correlation and Cost-effectiveness of routinely performed Histological Examination of Pregnancy Tissues obtained at Uterine Evacuation Procedure: Five-year Experience at a Secondary Care Hospital of Karachi, Pakistan. J South Asian Feder Obst Gynae 2017;9(1):1-4.

How Does OBGYN Resident Training at Restrictive Faith-based Institutions Impact Subsequent Provision of Reproductive Healthcare for Women? A Qualitative Analysis

Local Mentor: Stephanie Teal, MD, MPH ASL Advisor: Nancy Hueppchen, MD, MSc PURPOSE: To understand how institutional restrictions at faith-based hospitals impact OBGYN trainees who subsequently provide care for women at secular institutions. BACKGROUND: OBGYN residency prepares trainees to become experts in women's healthcare. Trainees at faith-based hospitals may not receive adequate training in family planning services. METHODS: We set out to conduct semi-structured individual interviews with recent graduates from 10 faith-based hospitals who are generalists at secular institutions. Participants were queried about their experiences, perceived deficiencies, and current provision of family planning services. Three researchers independently coded transcripts using grounded theory; overarching themes and discrepancies were subsequently resolved. RESULTS: 15/31 graduates from 7 hospitals participated; we reached thematic saturation after analysis of these interviews. None of the participants cited a preference to match at their program based on restrictive family planning policies. All participants reported reproductive healthcare training deficiencies that were partially attenuated by didactic educational activities, variations in on-site restrictions, and off-site training. Participants expressed frustration about inadequate on-site training in postpartum tubal ligations; upon graduation they either avoided provision or required mentorship from partners to achieve competency. A few participants who sought off-site training now provide outpatient D&amp;Cs and/or inpatient D&amp;Es. All participants proposed that faith-based programs improve family planning training by providing routine, opt-out opportunities. DISCUSSION: OB-GYNs trained at faith-based institutions feel that religion-based policies negatively impact training experiences and the range of health services they subsequently can provide. Forming collaborations with off-site facilities, particularly for tubal ligation and outpatient uterine evacuation procedures, may improve the reproductive care these physicians provide to women.

Atención humanizada del aborto incompleto: Tres técnicas de manejo ambulatorio, reducción de costos y panificación familiar postaborto

OBJETIVO :Precisar diferencias clínicas entre tres procedimientos de evacuación uterina para el manejo ambulatorio del aborto incompleto, precisar indicadores de calidad y costo de recursos humanos y materiales, y determinar la frecuencia de aceptabilidad para uso de anticonceptivos ofertados en postaborto inmediato. DISEÑO: Se hizo un estudio prospectivo involucrando 759 pacientes calificadas de tener un aborto incompleto no complicado atendidas en el Departamento de Ginecoobstetricia del Hospital María Auxiliadora separadas al azar para recibir tratamiento con legrado uterino instrumental o aspiración manual o eléctrica. De este modo 348 pacientes integraron el grupo de legrado uterino, 211 el grupo de aspiración manual endouterina y 200 el grupo de aspiración eléctrica. Se registró la existencia de complicaciones. A todas se les ofreció consejería y anticoncepción. Al alta se citó a la paciente a los 30 días y si no regresó se hizo entrevista en domicilio. RESULTADOS: En los tres predominó el uso de analgesia + sedación para efectuar el procedimiento. EI sangrado fue significativamente mayor en el grupo del legrado y el dolor fue mayor en los procedimientos de aspiración. Las pacientes de legrado tuvieron 7,31% de complicaciones, las de aspiración manual 2,78% y las de aspiración eléctrica 5,37% (P:NS). La eficacia del procedimiento de aspiración manual fue del 100%, del legrado 99,19% y de la aspiración eléctrica 98,21%. La duración promedio de la estancia hospitalaria fue 6 horas para la aspiración manual, 6 horas 37 minutos para el legrado y 6 horas 54 minutos para la aspiración eléctrica. El costo promedio fue: 12,77 dólares americanos para el legrado, 12,45 para aspiración manual y 12,41 para la aspiración eléctrica. El 99,5% de las pacientes recibió consejería, y de ellas 578 (76,2) escogieron algún método anticonceptivo: medroxiprogesterona 33,2%, DIU 18,7% y píldora 15,7%. A nivel de entrevista domiciliaria se comprobó que de las que recibieron píldora el 60% las continuaban usando, entre las medroxiprogesterona el 61% y entre las DIU el 89%. CONCLUSIONES: Clínicamente el procedimiento de aspiración manual es más ventajoso. El periodo postaborto es un buen momento para la administración de anticonceptivos.

Costs of postabortion care in public sector health facilities in Malawi: a cross-sectional survey.

BackgroundHealth systems could obtain substantial cost savings by providing safe abortion care rather than providing expensive treatment for complications of unsafely performed abortions. This study estimates current health system costs of treating unsafe abortion complications and compares these findings with newly-projected costs for providing safe abortion in Malawi.MethodsWe conducted in-depth surveys of medications, supplies, and time spent by clinical personnel dedicated to postabortion care (PAC) for three treatment categories (simple, severe non-surgical, and severe surgical complications) and three uterine evacuation (UE) procedure types (manual vacuum aspiration (MVA), dilation and curettage (D&C) and misoprostol-alone) at 15 purposively-selected public health facilities. Per-case treatment costs were calculated and applied to national, annual PAC caseload data.ResultsThe median cost per D&C case ($63) was 29 % higher than MVA treatment ($49). Costs to treat severe non-surgical complications ($63) were almost five times higher than those of a simple PAC case ($13). Severe surgical complications were especially costly to treat at $128. PAC treatment in public facilities cost an estimated $314,000 annually. Transition to safe, legal abortion would yield an estimated cost reduction of 20 %-30 %.ConclusionsThe method of UE and severity of complications have a large impact on overall costs. With a liberalized abortion law and implementation of induced abortion services with WHO-recommended UE methods, current PAC costs to the health system could markedly decrease.

Development of a novel task trainer for second trimester ultrasound-guided uterine evacuation.

Second trimester surgical termination of pregnancy by dilation and evacuation (D&E) is a procedure that the Obstetrics and Gynecology (OB/GYN) Residency Review Committee requires training programs to offer to their residents and that many residents desire to learn. However, because of limited numbers of credentialed providers, clinical training opportunities may be limited or not available at their training institutions. Simulated procedures may allow for residents and other learners to be more prepared and capable at the time of their first clinical procedures or advanced skill acquisition. We describe the construction of a low-cost task trainer for simulation of ultrasound-guided second trimester uterine evacuation procedures using a preserved pig heart and fetal pig. Residents of OB/GYN used the task trainer and completed a survey to determine its effectiveness as a teaching tool. With the use of a 5-point Likert scale survey (1 inferior, 5 superior), 13 OB/GYN trainees felt that the task trainer reliably reproduced fetal extraction (4.08), would improve their clinical skills (4.46), and would allow them to obtain the skills required to perform the task in real life (4.38). The similarity of ultrasound images to real-life images had a mean score of 3.69. Additional comments about the usefulness of this task trainer in learning the skills necessary for D&E procedures from the participants were overall positive. The task trainer for ultrasound-guided second trimester uterine evacuation showed excellent face validity. This low-cost task trainer provides residents and other trainees with a tool to practice ultrasound-guided fetal extraction skills and improve proficiency with D&E outside the operating room. In addition, it increases their confidence in being able to perform the procedure on patients.

How risky are second trimester clandestine abortions in Cameroon: a retrospective descriptive study.

BackgroundComplications of clandestine abortions increase with gestational age. The aim of this study was to identify complications of second trimester clandestine abortions (STA) and those of first trimester clandestine abortions (FTA).MethodsThis retrospective descriptive study was conducted between March 1st and August 31st, 2012 in the University Teaching Hospital and the Central Hospital, Yaoundé (Cameroon). The files of women with clandestine abortions carried out outside our units, but received in our settings for some complications were reviewed. Variables studied were maternal age, parity, marital status, gestational age at the time of abortion, the abortion provider and the method used, the duration of antibiotic coverage, the time interval between abortion and consultation, the complications presented and the duration of hospital stay. Data of 20 women with STA (≥13 weeks 1 day) and those of 74 women with FTA (≤13 complete weeks) were analyzed and compared. The t-test was used to compare continuous variables. P value <0.05 was considered statistically significant.ResultsWomen with STA had high parities (P = 0.0011). STAs were mostly performed by nurses and were usually done by dilatation and curettage or dilatation and evacuation, manual vacuum aspiration, intramuscular injection of an unspecified medication, transcervical foreign body insertion, amniotomy and misoprostol. STA complications were severe anemia, hypovolemic shock, uterine perforation and maternal death.ConclusionsClandestine abortions, especially second trimester abortions, are associated with risks of maternal morbidity and mortality especially when done by nurses. Therefore, women should seek for help directly from trained health personnel (Gynecologists & Obstetricians). Moreover, nurses should be trained in uterine evacuation procedures. They should also refer women who want to carry out STA to Gynecologists and Obstetricians. Finally, to reduce the prevalence of abortion in general, the government should make contraception available to all women, as well as use public media to sensitize women on the dangers of abortion and on the need to use family planning services.

Availability and characteristics of abortion training in US ob-gyn residency programs: a national survey

ObjectiveTo assess the availability and characteristics of abortion training in US ob-gyn residency programs. MethodsWe surveyed fourth-year residents at US residency programs by email regarding availability and type of abortion training, procedural experience and self-assessed competence in abortion skills. We conducted multivariable, ordinal logistic regression with general estimating equations to determine individual-level and resident-reported, program-level correlates of quantity of uterine evacuation procedures done during residency. ResultsThree hundred sixty-two residents provided data, representing 161 of the 240 residency programs contacted. Access to training in elective abortion was available to most respondents: 54% reported routine training—where abortion training was routinely scheduled; 30% reported opt-in training—where training was available but not routinely integrated; and 16% reported that elective abortion training was not available. Residents in programs with routine elective abortion training and those who intended to do abortions before residency did a greater number of first-trimester manual uterine aspiration and second-trimester dilation and evacuation procedures than those without routine training. Similarly, routine, integrated training, even for indications other than elective abortion, correlated with more clinical experience (all p<.01, odds ratio and confidence interval shown below). ConclusionThere is a strong independent relationship between routine training and greater clinical experience with uterine aspiration procedures.

Testing the Safe Abortion Care model in Ethiopia to monitor service availability, use, and quality

Objective To implement the Safe Abortion Care (SAC) model in public health facilities in the Tigray region of Ethiopia and document the availability, utilization, and quality of SAC services over time. Methods The project oriented providers in 50 public health facilities in Tigray to the SAC model. Changes in SAC indicators between baseline and endline were assessed using a retrospective review of procedure logbooks at baseline and prospective monitoring of procedure logbooks for facility performance after introduction of the SAC model. Results Availability of SAC services increased from 39% to 86% of the recommended number of 5 facilities per 500 000 population, primarily as a result of functional improvements at health centers. Decentralization was accompanied by a 94% increase in the annualized number of women who received services. The proportion of uterine evacuation procedures for induced abortion rose from 7% to 60% ( P < 0.01), and the proportion performed with recommended technology increased from 30% to 85% ( P < 0.01). The proportion of abortion patients who received modern contraception also increased from 31% to 78% ( P < 0.01). Discussion While widespread service delivery improvements were recorded using the SAC monitoring approach, the project design was built around existing programmatic activities of the local health authority and reflects some related research limitations. For example, there was no comparison group of facilities, timing did not allow for prospective collection of the baseline data before the intervention, and facilities received different levels of monitoring support. Conclusion Using the SAC model, public health facilities tracked progress and made needed adjustments, which improved service delivery. Continued focus on critical safe abortion care elements should increase the availability, quality, and use of life‐saving care to reduce preventable abortion mortality in the region.

Aetiology, clinical features and treatment outcome of Intrauterine adhesion in Ilorin, Central Nigeria

Intrauterine adhesion is a cause of menstrual disorder and reproductive failure. It could be a long term sequelae of unsafe abortion which is a common reproductive health problem in developing countries. To determine the predisposing factors, mode of presentation and outcome of management of intrauterine adhesion in University of Ilorin Teaching Hospital. The record of patients with intrauterine adhesion newly diagnosed and managed in the Hospital over a five-year period was analyzed for their age, parity, predisposing factors, clinical presentation, methods of diagnosis and treatment outcome. A total of 136 patients were newly diagnosed and managed for intrauterine adhesion during the period under review. This constituted 1.3% of new gynaecological patients and 4.0% of consultations for infertility. Endometrial curettage on account of pregnancy complications accounted for 92 (67.6%) patients, and this was mostly for induced abortion. Hypomenorrhoea and secondary amenorrhoea were the commonest presenting menstrual abnormalities occurring in 48 (35.3%) and 53 (39.0%) patients respectively. Normal menstruation resumed in 99 (72.8%) patients following treatment. The incidence of intrauterine adhesion among gynaecological patients in this study is lower than those from previous reviews elsewhere in the country. However, dilatation and curettage for induced abortion still remains the commonest cause in our center. Measures to prevent unwanted pregnancy are needed and there should be increased advocacy for the use of manual vacuum aspiration for uterine evacuation procedures.

Initial Loss of Productive Days and Income Among Women Seeking Induced Abortion in Cambodia

The study describes the loss of productive time and income related to abortion care and care-seeking among 110 women presenting at public and private sector abortion providers in Cambodia. Data were collected through women's exit interviews, and descriptive analysis was used to examine lost time and income against a number of explanatory variables, such as gestational age of pregnancy, type of abortion provider and facility, type of uterine evacuation procedure, number of health visits, and the woman's occupation. Results indicate that lost time and earnings increase with the number of visits to obtain the termination, gestational age, and selection of a private physician or non-governmental organization clinic. Lost time and earnings also vary by the woman's type of employment. The study underscores the need for safer, accessible, and more affordable abortion services in order to ensure that these services are available for all women. Even in the Cambodian context, where abortion is unrestricted during the first trimester of pregnancy, the study findings show that the process of searching for and obtaining high-quality abortion care was unnecessarily complicated and costly to women and their household members.

An assessment of postabortion care in three regions in Ethiopia, 2000 to 2004

ObjectiveTo assess postabortion care services in 3 regions in Ethiopia following provider training and service improvements between 2000 and 2004. MethodsData on availability and quality of services were collected at 119 facilities in 3 regions of Ethiopia before and after postabortion care (PAC) provider training in 42 of the sites; supervision, supplies, and equipment were also provided. Changes over time, changes attributable to the training intervention, and overall self-reported improvements in PAC were assessed for outcomes of interest, including availability of uterine evacuation services, postabortion contraceptive methods and supply availability (including manual vacuum aspiration [MVA]), and minimum-skilled providers. ResultsBetween 2000 and 2004, the capacity for offering uterine evacuation increased from 57% to 79% among intervention facilities, while remaining relatively constant among the comparison facilities. The training intervention was significantly associated with improvements in the availability and use of MVA, the availability of a minimum number of skilled providers and availability of postabortion contraceptive services. The proportion of uterine evacuation procedures performed with MVA increased among comparison facilities, but increased even more among intervention facilities, from 14% to 50% of procedures. ConclusionsTraining and supporting providers in comprehensive PAC effectively improve women's access to PAC services in Ethiopia, but more attention must be paid to training midlevel providers, extending services into health centers, pain management, and provision of postabortion contraceptives.

Surgical methods for first trimester termination of pregnancy.

Different surgical methods for termination of pregnancy have evolved over the years: Dilatation and curettage, power operated vacuum aspiration, manual vacuum aspiration (MVA) or hysterotomy. Local or general anaesthesia is used for all methods. Preabortion medical or mechanical cervical preparation may reduce the incidence of cervical or uterine injuries. To compare the safety and efficacy of different surgical methods for first trimester abortion. The Cochrane Controlled Trials Register has been searched. A search of the reference lists of identified trials was performed. An additional MEDLINE search was done using the Internet search service Pub Med. Randomised controlled trials comparing different surgical methods for first trimester abortion were eligible. Trials under consideration were evaluated for methodological quality and appropriateness for inclusion. Three trials were included, resulting in 2 comparisons: vacuum aspiration versus dilatation and curettage and flexible versus rigid vacuum aspiration cannula. Results are reported as odds ratio for dichotomous data and weighted mean differences for continuous data. There were no reports of maternal deaths and cases of uterine perforation in the trials identified. Vacuum aspiration versus dilatation and curettage: There were no statistically significant differences for excessive blood loss, blood transfusion, febrile morbidity, incomplete or repeat uterine evacuation procedure, re-hospitalisation, post operative abdominal pain or therapeutic antibiotic use. Duration of operation was statistically significantly shorter with vacuum aspiration compared to D&C in both gestational age subgroups : < 9 weeks: weighted mean difference (WMD) -1.84 minutes, 95% confidence interval (CI) [-2.542,-1.138]; =/> 9 weeks: WMD -0.600 minutes, 95% CI [-1.166,-0.034]). Flexible versus rigid vacuum aspiration cannula: There were no statistically significant differences with regard to cervical injuries, febrile morbidity, blood transfusion, therapeutic antibiotic use, or incomplete or repeat uterine evacuation procedure. The included studies do not indicate a preference of providers for one or the other method. The trials included are small and lack power to to present meaningful differences for rare outcomes between the groups. outcomes such as women's satisfaction, the need for pain relief or surgeons preference for the instrument have been inadequately addressed. No data outcomes, such as fertility after surgical abortion, are available.