Vaginal Bleeding Time Research Articles

Efficacy of hysteroscopic levonorgestrel‑releasing intrauterine device fixation in the treatment of adenomyosis: A cohort study.

The present study aimed to investigate the efficacy of hysteroscopic levonorgestrel-releasing intrauterine device (LNG-IUD) fixation surgery in the treatment of adenomyosis through a cohort study. The cohort study was performed at the Affiliated Jinhua Hospital of Wenzhou Medical University (Jinhua, China). A total of 31 women with adenomyosis were initially recruited from June 2020 to June 2022 and divided into an experimental group and a control group. The experimental group underwent hysteroscopic LNG-IUD fixation surgery and the control group underwent conventional implantation of the levonorgestrel-releasing intrauterine system. The assessed efficacy outcomes included the time of LNG-IUD expulsion, postoperative vaginal bleeding time, dysmenorrhea, and the menstrual blood loss score (MBLS). A total of 31 participants completed the research. The LNG-IUD expulsion rate was 6.25 and 60% (P<0.05) in the experimental and control group, respectively. The LNG-IUD in place time was 20.50 months (Q1, 15.75; Q3, 24.00) in the experimental group and 10.00 months (Q1, 6.50; Q3, 15.00) in the control group (P<0.05); the time of vaginal bleeding after surgery in the experimental and control groups were 12.50 days (9.25, 16.25) and 120.00 days (75.00, 120.00), respectively (P<0.05). Multiple-factor Cox regression analysis revealed that the LNG-IUD expulsion in patients with adenomyosis is associated with the hysteroscopic LNG-IUD fixation surgery [hazard ratio (HR), 1954.09], uterine cavity depth (HR, 16.63), MBLS (HR, 1.14), history of gonadotropin-releasing hormone agonist treatment in the previous 6 months (HR, 2.10), history of vaginal delivery (HR, 1.79) and history of cervical laceration (HR, 3.69). In conclusion, hysteroscopic LNG-IUD fixation reduces the rate of LNG-IUD expulsion, prolongs the time of LNG-IUD in the uterine cavity, reduces the time of postoperative vaginal bleeding, relieves the symptoms of dysmenorrhea and reduces the menstrual volume in the patients with adenomyosis. The present trial was retrospectively registered in the Chinese Clinical Trial Registry on 28th December 2023 (registration no. ChiCTR2300079233).

To study the current status of uterine adhesions after fetal residue and the preventive effect of using estrogen and progesterone sequential therapy combined with Foley balloon.

To investigate the current status of uterine adhesions in patients with residual fetus and analyze the preventive effect of estrogen and progesterone sequential therapy combined with Foley balloon. Eighty-six patients with residual fetus were divided into control group and observation group. On the basis of the treatment plan of the control group, the observation group received estrogen and progesterone sequential therapy combined with Floey balloon treatment. Clinical efficacy, postoperative recovery status (abdominal pain duration, vaginal bleeding duration, vaginal bleeding volume, refluid time), the incidence of intrauterine adhesions, uterine hemodynamics (uterine artery systolic maximum blood flow rate [Vmax], end diastolic blood flow rate [Vmin], resistance index [RI]), and the probability of complications were evaluated. Compared with the control group, the observation group achieved higher curative effect (P < .05); the observation group had shorter duration of abdominal pain, vaginal bleeding and refluid time, and lower vaginal bleeding (P < .05); the probability of intrauterine adhesions is lower (P < .05); before treatment, there is little difference in the levels of Vmax, Vmin, RI, and other indicators between the 2 groups (P > .05). After treatment, compared with the control group, the observation group Vmax, Vmin, and other indicators, the level was significantly lower, and the RI level was significantly higher (P < .05); the observation group had a lower probability of complications (P < .05). The likelihood of uterine adhesions after fetal remains is increased. The use of estrogen and progesterone sequential therapy in conjunction with Foley balloon therapy can improve treatment efficacy, improve uterine adhesion prevention, and promote patient recovery after surgery.

Effect of Propofol Intravenous Anesthesia Combined with Press-Needle Therapy on Analgesic Effect during Painless Abortion.

Objective To discover the effect of propofol intravenous anesthesia along with press-needle therapy on analgesic effect during painless abortion. Methods A total of 128 cases who experienced painless abortion in our hospital from January 2019 to August 2021 were recruited as the research subjects. They were categorized into control and observation groups through the haphazard number table approach, with 64 patients in each group. Propofol intravenous anesthesia was given to the control group, and the observation group was given combined anesthesia with press-needle on this basis. Ramsay score, hemodynamic indexes, operation-related indexes, and postoperative recovery were studied between the two groups before anesthesia (T0), at the time of uterine aspiration (T1), promptly following the operation (T2), and at the recovery time of directional force (T3). The stress state and the level of pain mediators in the two groups of sufferers were observed at each time period, and the visual analogue scale (VAS) was employed to assess the degree of postoperative uterine contraction pain. Results Ramsay score at T1 and T2 time points in observation group was lesser than that in control group (P < 0.05). There existed no meaningful discrepancies in operation time and recovery time between both groups (P > 0.05). The total dosage of propofol in the observation group was lesser compared to that in the control group, and the recovery time of directional force was much shorter compared to that in the control group (P < 0.05). There existed no meaningful discrepancies in perioperative diastolic blood pressure (DBP), systolic blood pressure (SBP), and heart rate (HR) between both groups (P > 0.05). The levels of norepinephrine (NE), cortisol (Cor), glucose (GLU) and substance P (SP), prostaglandin E2 (PGE2), and 5-hydroxytryptophan (5-HT) in the observation group were lesser than those in the control group immediately after surgery and 24 hours following the operation (P < 0.05). There existed no meaningful discrepancies in vaginal bleeding time, endometrial thickness 3 weeks after operation, and time to start menstruating between both groups (P > 0.05). The score of VAS for the observation group was lesser than that of the control group at 10 min and 30 min after operation (P < 0.05). There existed no substantial discrepancy in the incidence of negative reactions between both groups (P > 0.05). Conclusion Propofol intravenous anesthesia combined with press-needle therapy can ameliorate the analgesic impacts during painless abortion, reduce postoperative uterine contraction pain, inhibit the release of postoperative pain mediators, and improve the stress state of the body.

Image Analysis Application of Motherwort Total Alkaloid Injection in the Treatment of Postabortion Hemorrhage.

In order to reduce the possibility of postabortion hemorrhage leading to maternal death, the author studied the image analysis of postpartum hemorrhage based on Leonurus total alkaloid injection, combining research results, in order to explore the curative effect of Leonurus injection in treating postpartum hemorrhage. After treatment, the time and volume of vaginal bleeding were significantly lower than those in the control group (P < 0.05); it is suggested that the combination of oxytocin and motherwort can effectively reduce the time and volume of vaginal bleeding after medical abortion, conducive to postoperative recovery. The results show that motherwort injection can effectively reduce the amount of bleeding and reduce the risk of postpartum hemorrhage; in addition, adverse reactions have been reduced, and an image analysis consensus has been formed, which is worthy of promotion.

Clinical Efficacy and Safety Study of Mifepristone with Misoprostol Treatment in Patients with Missed Abortion.

Currently, medication abortion is widely used in clinical practice in China. The aim of this study was to investigate the effect of mifepristone with misoprostol treatment on the efficacy of patients with missed abortion (MA) and the safety of this drug regimen. 95 patients with MA treated in our hospital from February 2019 to April 2021 were collected as the subjects of this study, and the patients were divided into the control and the research groups according to different treatment modalities. Among them, 46 cases in the control group were treated by diethylstilbestrol combined with oxytocin and 49 cases in the research group were treated by mifepristone combined with misoprostol, and both groups underwent curettage after medication. The rates of complete abortion, time of embryo expulsion, time of operation, intraoperative bleeding, time of postoperative vaginal bleeding, amount of vaginal bleeding, rate of one-time curettage, the levels of serum estradiol (E2), progesterone (P), β-chorionic gonadotropin (β-hCG), and interleukin-18 (IL-18), and the incidence of adverse effects in the two groups were examined and compared. Alanine transaminase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), and serum creatinine (Scr) were used as indicators to evaluate the safety of the drug. The results showed that the rates of complete abortion and one-time curettage were significantly higher in the study group than in the control group, while the time of embryo expulsion, operation time, intraoperative bleeding, postoperative vaginal bleeding time, and vaginal bleeding were significantly lower than in the control group. The serum E2, P, and β-hCG levels before curettage in both groups were significantly higher, and IL-18 levels were significantly lower than those at the time of admission, with E2, P, and β-hCG levels increasing more and IL-18 levels decreasing more in the research group. After drug treatment, no abnormal changes in liver and kidney functions were observed in both groups, and the incidence of adverse reactions was at a similar and lower level in both groups. This shows that mifepristone with misoprostol is a safer and more effective drug regimen for the treatment of MA, which can regulate the levels of serum sex hormones and inflammatory factors in the body, promote the shedding of placental tissue, and create conditions for improving the rate of curettage.

Systematic review and Meta-analysis on efficacy and safety of Gongxuening Capsules in treatment of abnormal vaginal bleeding after medical abortion

To systematically evaluate the efficacy and safety of Gongxuening Capsules in the treatment of abnormal vaginal bleeding after medical abortion. CNKI, Wanfang, SinoMed, VIP, PubMed, Cochrane Library and EMbase databases were retrieved to comprehensively collect the clinical randomized controlled trials(RCTs) of Gongxuening Capsules for treatment of abnormal vaginal bleeding after medical abortion from the establishment of the databases to October 10, 2020. Literature screening, data extraction and quality evaluation were conducted independently by two system reviewers according to the inclusion and exclusion criteria. Cochrane Handbook bias risk assessment tool was used for the literature methodology quality evaluation, RevMan 5.3 software was used for Meta-analysis, and the evidence quality of outcomes was evaluated by the evidence quality grading system(GRADE). A total of 16 RCTs were inclu-ded. The results of Meta-analysis showed that as compared with the western medicine treatment alone, the addition of Gongxuening Capsules to the western medicine treatment can reduce the amount of vaginal bleeding(RR=1.23, 95%CI[1.19, 1.27], P&lt;0.000 01), shorten vaginal bleeding time(RR_(≤15 d number of people)=1.39, 95%CI[1.31, 1.48], P&lt;0.000 01; MD_(number ofdays)=-1.20, 95%CI[-1.66,-0.74],P&lt;0.000 01). However, there was no obvious advantage in abortion effect(RR=1.02, 95%CI[0.99, 1.06], P=0.14) and menstrual recovery(MD=-0.35, 95%CI[-0.96, 0.25], P=0.25). The results of GRADE showed that the grading level was low for vaginal bleeding volume and vaginal bleeding time, and extremely low for abortion effect and mens-trual recovery. In terms of safety, 16 studies reported adverse events. Only one study showed no adverse events and the rest showed transient nausea, vomiting, stomach burning, upper abdominal discomfort and other gastrointestinal symptoms. The results show that the addition of Gongxuening Capsules to the application of western medicine in treatment of drug abortion can reduce the amount of vaginal bleeding and shorten vaginal bleeding time, but the abortion effect and menstrual recovery have no obvious advantages. The use of Gongxuening Capsules helps to achieve less adverse reactions and higher safety. Due to the small sample size of the included studies and many methodological quality problems, no conclusions with clinical guidance value can be obtained. Large sample-zise, high-qua-lity randomized controlled trials are still needed for further verification.

Post-abortion contraception: how to make the right choice?

More than 600 thousands abortions are performed annually in Russia. Women presenting for abortion care are often motivated by the pregnancy to use effective contraception; they are also at high risk for repeat unintended pregnancy. Contraceptive counseling and the supply of contraceptive methods are part of post-abortion care and positively influence the subsequent use of contraceptive methods. Oral contraceptives (OCs) following induced abortion offer a reliable method to avoid repeated abortion. Immediate administration of combined OCs after abortion may reduce vaginal bleeding time and amount, shorten the menstruation recovery period, and reduce the risk of complications and unintended pregnancies. Сombination of ethinylestradiol 30 g + drospirenone 3 mg demonstrates the advantages of a low estrogen dose with the antimineralocorticoid activity of drospirenone that is responsible for the drugs significant antiandrogenic and antimineralocorticoid effects, reflected clinically in lower rates of adverse events including less fluid retention. Сombination of ethinylestradiol 30 g + drospirenone 3 mg and Metafolin has similar contraceptive efficacy, side effect, safety and benefits profile to other drospirenone-containing contraceptives. The article presents the results of the latest studies about using of combined OCs (ethinylestradiol 30 g + drosperinone 3 mg and Metafolin) after abortion.

Management for delayed diagnosis in cesarean scar pregnancy with hemorrhage intra‐ or postuterine dilation and curettage

AimThis study aimed to examine the characteristics, management, and outcomes of delayed diagnosis of cesarean scar pregnancy (CSP) with hemorrhage intra‐ or postuterine curettage for early pregnancy termination.MethodsThe retrospective study, cases were identified from the interrogation of the hospital database and clinical data including the success rate of different treatments, vaginal bleeding time, abnormal beta‐human chorionic gonadotropin (β‐hCG) time, and menstrual recovery time, preservation of uterus were analyzed.ResultsMedical records of 80 confirmed CSP cases with dilation and curettage (D&C) as primary treatment were analyzed; among them, 22 were treated with uterine arterial embolization (UAE) + methotrexate (MTX); 32 with UAE + surgery; 26 with only surgery or resection and repair. Treatment with UAE had less intraoperative blood loss (p < 0.05). UAE + surgery treatment had the highest success rate (96.8%, p < 0.05), the least vaginal bleeding duration after treatment (11.9 ± 9.6 days, p < 0.05), and least β‐hCG normalization time (17.4 ± 7.8 days, p < 0.05).ConclusionUAE + surgery treatment is a favorable and effective option to control massive hemorrhage intra‐ or post‐uterine curettage for early CSP termination.

Study on the correlation between vaginal bleeding in first trimester and preterm birth: A birth cohort study in Lanzhou, China.

To investigate the correlation between first trimester vaginal bleeding and preterm birth (PB), and to offer suggestions on the perinatal health care and preterm birth prevention. A birth cohort study was conducted on 10 179 pregnant women. Unconditional logistic regression model was used to evaluate the associations between vaginal bleeding and preterm birth in sub-preterm groups. Of the 10 179 pregnant women included, a total of 1001 women suffered from vaginal bleeding during the first trimester, of which 119 suffered from PB. Any vaginal bleeding increased the risk of PB. Severe bleeding was a high-risk factor of PB, associated with 4.8-fold risk of very PB, 2.7-fold risk of spontaneous PB without PROM (premature rupture of membrane) and 4.6-fold risk of medical induced PB. Bleeding prolonged more than 1 week increased 66% risk of PB and 36% risk of PB on initial episode happened in 5-12 weeks of gestation age, especially in moderate PB, in medical-induced PB and in spontaneous PB with PPROM (preterm premature rupture of membrane which is one cause of PB). Mild bleeding or bleeding within 1 week or initial episode happened within 4 weeks of gestation age possibly had no influence on PB. Vaginal bleeding in the first-trimester was an independent risk factor for PB. The severity, duration and initial time of vaginal bleeding had different effects on different subtypes of PB.

Clinical Observation of Misoprostol before and after Painless Induced Abortion

Background: Though painless abortion is a safe, effective and excellent method of artificial abortion, intravenous anesthesia cannot effectively expand the cervix. Hard and tight cervix often affects the operation and easily inducesabortion complications. Misoprostol can induce uterine contraction and soften the cervix. Objective: To investigate the clinical effect of misoprostol on abortion before and after painless induced abortion. Methods: 600 case pregnant women were divided into three groups: A, B and C, 200 case in each group. All patients were anesthetized. In group A, misoprostol 0.2 ug was placed in the posterior fornix of vagina 2 hours before the operation of induced abortion; in group B, misoprostol 0.2 ug was not only placed in the posterior fornix of vagina 2 hours before the operation of induced abortion but also taken orally 2 hours and 6 hours after the operation; in group C, misoprostol was not used before and after the operation. The operation time, intraoperative bleeding volume, postoperative bleeding, the percentage of cervical relaxation and the rate of incomplete abortion among the three groups were compared. Results: Compared with group A and group B, the operation time of group C was longer and the amount of bleeding was more (P 0.05). The duration of bleeding in group B was less than that in group A (P Conclusion: The use of misoprostol before and after painless induced abortion can not only shorten the time of operation, reduce intraoperative and postoperative vaginal bleeding, but also has not incurred incomplete abortion(primary outcome).

Comparison of the Efficacy of Two Laparoscopic Surgical Procedures Combined with Hysteroscopic Incision in the Treatment of Cesarean Scar Diverticulum

Objective: To investigate the efficacy of two different surgical procedures in combined hysteroscopic and laparoscopic surgery—the “folding suture method” and the “muscle flap filling suture method"—in the treatment of cesarean scar diverticulum (CSD). Methods: The clinical data of 24 patients with CSD who underwent surgery in the Peking University First Hospital from August 2016 to December 2018 were retrospectively analyzed. Results: There was no difference in age, vaginal bleeding time, thickness of the lower uterine segment, operative time and intraoperative bleeding between the two groups. At three months after the operation, the patients of the folding suture and muscle flap groups had an average menstrual period of 6.9 ± 1.8 days and 7.5 ± 3.0 days, respectively, which was 5.8 ± 4.2 days and 4.4 ± 3.8 days, respectively, shorter than that before the operation, as well as a lower segment thickness of the uterus of 6.7 ± 1.8 mm and 6.3 ± 1.7 mm, respectively. Among the patients in the folding suture and muscle flap groups, 8 and 6 cases were cured, and 3 and 6 cases were improved, respectively, resulting in an effective rate of 100%. There was no significant difference in any indicator between the two groups. Conclusion: As two new surgical methods that preserve uterine integrity, the laparoscopic "muscle flap filling suture method" and “folding suture method” combined with hysteroscopic incision are safe and effective treatments for repairing CSD.

Clinical Efficacy of Laparoscopy and Hystroscopic Dilation and Curettage Procedure in Managing Cesarean Scar Pregnancy

Objective: To evaluate the success rate of laparoscopy and hysteroscopic Dilation &amp;amp; Curettage in treating cesarean scar pregnancy.&#x0D; &#x0D; Methods: This cross-sectional study was carried on patients suspicious to CSP referred to Imam Khomeini Hospital, Ahvaz from Jun 2016 to March 2018. Gestational site was carefully evaluated by hysteroscopy and then curettage was carried out under laparoscopic guidance. The primary outcome in the study was time interval from treatment to hCG resolution. Moreover, the secondary outcomes were vaginal bleeding time and residual mass size.&#x0D; &#x0D; Results: In this study, 30 women with intrauterine CSP were evaluated. Of these, 5 had live embryos and 25 had dead fetuses. The success rate of treatment was 100%. Only one patient needed to transfusion. The mean and median duration of Bhcg resolution were 30.9 and 28 days, respectively. Moreover, The mean and median duration of vaginal bleeding were 30.9 and 28 days, respectively. The mean level of residual mass was 9.8 mm3 (ranged from 1 to 25 mm3).&#x0D; &#x0D; Conclusion: Overall, the findings of this study showed that D&amp;amp;C effectively treated CSP patients (100% success rate), reduced the time of Bhcg resolution and also reduced vaginal bleeding time.

Clinical study of hysteroscopic resection for cesarean scar pregnancy

Objective To investigate the clinical effect of hysteroscopic scar excision for cesarean scar pregnancy(CSP) and its effect on serum β-human chorionic gonadotropin(β-HCG). Methods From January 2017 to January 2019, 83 patients with endogenous CSP admitted to the People's Hospital of Wenzhou were divided into observation group(43 cases) and control group(40 cases) according to different surgical methods.The observation group underwent hysteroscopic scar lesion resection, while the control group underwent uterine artery embolization.The success rate, intraoperative bleeding volume, vaginal bleeding time and hospitalization time, postoperative complications and the recovery time of blood β-HCG were compared between the two groups. Results The success rate of operation in the observation group was 97.67%(42/43), which was higher than that in the control group[82.50%(33/40)](χ2=3.875, P 0.05). The recovery time of blood β-HCG in the observation group[(19.54±3.52)d]was shorter than that in the control group[(28.73±6.57)d](t=8.020, P<0.05). The total satisfaction rate of the observation group was 97.67%(42/43), which was higher than 77.50%(31/40) of the control group(χ2=6.170, P<0.05). Conclusion Hysteroscopy-assisted scar excision is effective in the treatment of CSP, and can shorten the recovery time of blood β-HCG. Key words: Hysteroscopy; Cicatrix; Cesarean section; Pregnancy, ectopic; Chorionic gonadotropin, beta subunit, human; Uterine hemorrhage; Postoperative complications; Patient satisfaction

Clinical effect of Huoxue Qing Gong decoction in the treatment of vaginal bleeding after medical abortion

Objective To explore the clinical effect of Huoxue Qing Gong decoction in the treatment of vaginal bleeding after medical abortion. Methods From May 2016 to June 2017, 90 cases of vaginal bleeding after drug abortion in the People's Hospital of Dongping County were divided into the observation group and the control group according to the digital table, with 45 cases in each group.The two groups were all treated with drug abortion to terminate pregnancy, and the control group was treated with metronidazole tablets + carbazochrome tablets after the termination of pregnancy.The observation group was treated with Huoxue Qing Gong decoction on the basis of the control group.The effect of abortion, bleeding time and bleeding volume after drug abortion, the time of menstrual recovery and menstrual duration after treatment in the two groups were observed and compared. Results The total abortion rate in the observation group was 95.6%, which was significantly higher than that in the control group(84.4%), the difference was statistically significant(χ2=5.620, P previous menstrual volume after drug abortion of the observation group was 17.8%, which was significantly lower than that of the control group(44.4%), the difference was statistically significant(χ2=6.375, P<0.05). The period of menstrual recovery of the observation group was (29.5±4.2)d, which was significantly shorter than that of the control group[(37.9±4.3)d](t=5.028, P<0.05). The duration of menstruation in the observation group was (5.0±1.1)d, which was significantly shorter than that in the control group[(6.9±1.2)d], the difference was statistically significant(t=3.229, P<0.05). Conclusion Huoxue Qing Gong decoction in the treatment of vaginal bleeding after drug abortion can significantly shorten the time of vaginal bleeding, reduce the amount of vaginal bleeding, improve the rate of complete abortion, and has no obvious effect on the first menstrual cycle and menstrual period after the drug flow. Key words: Abortion, induced/adverse effects; Uterine hemorrhage; Blood act stasis remov; Huoxue Qing Gong decoction; Abortion rate; Menstrual cycle; menstrual recovery; Termination of pregnancy

Effect of Cihang capsule in treatment of vaginal bleeding after artificial abortion

Objective To investigate the clinical efficacy and safety of Cihang capsule in treatment of vaginal bleeding after artificial abortion, and to provide a reference for the related treatment. Methods From January 2016 to December 2016, 1 000 patients with artificial abortion in the No.2 Hospital of Datong Coal Mine Group Co, Ltd were selected and divided into the control group(488 cases) and the observation group(512 cases) by the random number table method. The patients in the two groups were given doxycycline hyclate enteric-coated capsules to prevent postoperative infection, the observation group was given Cihang capsule at the same time, and the control group was treated with oxytocin. The postoperative vaginal bleeding time, normal menstrual recovery time, blood loss and the adverse reactions in the two groups were observed, the clinical efficacy of the two groups was compared. Results The total effective rate of the observation group was 94.14%, which was higher than 89.55% of the control group (χ2=7.076, P<0.05). The cure rate of the observation group was 56.84%, which was higher than 47.95% of the control group (χ2=7.910, P<0.05). The duration of bleeding and the recovery time in the observation group were (5.26±0.41)d and (27.31±4.03)d, respectively, which were shorter than those in the control group[(8.03±0.57)d and (40.16±5.14)d], the differences were statistically significant(t=88.585, 44.106, all P<0.05). During treatment, the observation group had no adverse reactions, the control group found 5 cases with different degrees of abdominal pain, and the incidence rate of adverse reaction between the two groups had statistically significant difference (χ2=5.272, P<0.05). Conclusion Cihang capsule can effectively shorten bleeding time and normal menstrual recovery time in patients with vaginal bleeding after artificial abortion, reduce the amount of vaginal bleeding, and with less adverse reactions, it is worthy of further clinical application. Key words: Abortion, induced; Vagina; Hemorrhage; Cihang capsule; Oxytocin; Bleeding time

The Effectiveness of Traditional Chinese Medicine for Threatened Abortion: A Systematic Review and Meta - Analysis

Background: Threatened abortion is a common complication during early pregnancy. Conventional managements for the miscarriage include bed rest, hormone therapy and muscle relaxants. Traditional Chinese medicine (TCM) is also the popular option for the women. Evidence to support the efficacy and safety of TCM in treating threatened abortion is still limited. Objective: The study aimed to evaluate the safety and effectiveness of Chinese medicine in the treatment of threatened abortion compared with the hormone therapy t hrough a systematic review and meta - analysis. Methods: The randomized controlled trials (RCTs) were electronically retrieved in the database of China National Knowledge Infrastructure (CNKI), Wan Fang Database (Chinese Ministry of Science and Technology), VIP Data and PubMed between January 1 2008 and December 1 2018 with the pre - designed search strategy. The outcomes included the clinical effectiveness, the clotting time of vaginal bleeding, pain reduction in lower abdomen, and incidences of adverse event s. The software RevMan 5.1 was employed for the meta - analysis. Results: Twenty - three studies were included in the systematic review and meta - analysis, which enrolled 2014 pregnant women (1006 in the treatment group and 1008 in the control). The meta - analys is of clinical effectiveness showed that TCM significantly decreased rate of miscarriage compared with the conventional therapy. In the subgroup analysis of miscarriage rate in women, oral administration of TCM was more effective than either the injected o r oral administration of conventional medications. Further analysis showed that oral TCM was more effective than the injection of progesterone only or combined with hCG, even the oral progesterone. Conclusions: The study indicated that TCM was likely more effective than conventional therapy in treating threatened abortion with unclear adverse events. However, due to the low quality of included studies, larger scales of RCTs and more scientific evidence are needed to prove the efficacy and safety of TC M for threatened abortion.

Effect of Mifepristone and misoprostol combined with hysteroscopic resection of endometrial uterine incision cesarean scar pregnancy

Objective To investigate the clinical effect of mifepristone and misoprostol combined with hysteroscopic resection of endometrial uterine incision cesarean scar pregnancy. Methods A retrospective study was conducted to analyze 135 cases of scar pregnancy of endogenous lower uterine cesarean section from January 2015 to October 2017. According to the treatment methods, they were divided into group A (mifepristone and misoprostol combined with hysteroscopy), group B (methotrexate combined with hysteroscopy), group C (Uterine artery embolization + curettage) .Each group had 45 cases, and the therapeutic effects of the three methods were compared. Results There was no significant difference in gestational sac size and serum human chorionic gonadotropin [beta-human chorionic gonadotropin (HCG)] levels among the three groups before operation (P>0.05). After operation, the operation time, intraoperative bleeding volume, serum beta-HCG dropping to normal time, vaginal bleeding time and hospitalization time in A and C group were significantly lower than that in B group (P>0.05). There was no significant difference between group A and group C in operation time, serum beta-HCG to normal time, vaginal bleeding time and hospitalization time (P>0.05). The menstruation time of group A was significantly shorter than that of group B and group C (P 0.05); The complication rates of A, B and C groups were 2.22%, 13.33% and 4.44% respectively, with no significant difference in the three groups (P>0.05). Conclusions The three methods are effective in the treatment of cesarean scar pregnancy. The mifepristone and misoprostol combined with hysteroscopy have the advantages of less operative trauma and faster postoperative recovery. Key words: Mifepristone/AD; Misoprostol/AD; Hysteroscopy; Pregnancy, ectopic/TH; Cicatrix

Expectant therapy versus curettage for retained products of conception after second trimester termination of pregnancy: analysis of outcomes and complications

To evaluate the prognosis and complications of expectant therapy and curettage for retained product of conception (RPOC) after second trimester termination of pregnancy (TOP). A total of 270 patients with RPOC following second trimester TOP in Nanfang Hospital between January, 2014 and December, 2015 were included in this study. The duration of vaginal bleeding time and menstruation recovery interval were compared between patients receiving expectant therapy and curettage for RPOC, and binary logistic regression was used to assess the risk factors for complications in bivariate and multivariate analyses. The duration of vaginal bleeding time was significantly longer in expectant therapy group than in curettage group (P=0.005), while the menstruation recovery interval did not differ significantly between the two groups. The incidence of vaginal bleeding time for over 42 days was significantly higher in curettage group than in expectant therapy group (P=0.040), and the incidence of a menstruation recovery interval beyond 60 days was comparable between them. The incidence of complications was significantly higher in curettage group than in expectant therapy group either with adjustment of age, gravidity, parity, history of uterine surgery status, gestational age, type of indications, regimens for TOP and induction-abortion interval (OR=18.26 [95% CI: 3.57-93.42], P<0.001) or without adjustment (OR=10.60, [95% CI: 2.36-47.66], P=0.002). Expectant therapy and curettage for RPOC after second trimester TOP have comparable prognosis, but curettage is associated with a significantly higher rate of complications.

Oral contraception following abortion: A systematic review and meta-analysis.

Oral contraceptives (OCs) following induced abortion offer a reliable method to avoid repeated abortion. However, limited data exist supporting the effective use of OCs postabortion. We conducted this systematic review and meta-analysis in the present study reported immediate administration of OCs or combined OCs postabortion may reduce vaginal bleeding time and amount, shorten the menstruation recovery period, increase endometrial thickness 2 to 3 weeks after abortion, and reduce the risk of complications and unintended pregnancies.A total of 8 major authorized Chinese and English databases were screened from January 1960 to November 2014. Randomized controlled trials in which patients had undergone medical or surgical abortions were included. Chinese studies that met the inclusion criteria were divided into 3 groups: administration of OC postmedical abortion (group I; n = 1712), administration of OC postsurgical abortion (group II; n = 8788), and administration of OC in combination with traditional Chinese medicine postsurgical abortion (group III; n = 19,707).In total, 119 of 6160 publications were included in this analysis. Significant difference was observed in group I for vaginal bleeding time (P = 0.0001), the amount of vaginal bleeding (P = 0.03), and menstruation recovery period (P < 0.00001) compared with the control groups. Group II demonstrated a significant difference in vaginal bleeding time (P < 0.00001), the amount of vaginal bleeding (P = 0.0002), menstruation recovery period (P < 0.00001), and endometrial thickness at 2 (P = 0.003) and 3 (P < 0.00001) weeks postabortion compared with the control group. Similarly, a significant difference was observed in group III for reducing vaginal bleeding time (P < 0.00001) and the amount of vaginal bleeding (P < 0.00001), shortening the menstruation recovery period (P < 0.00001), and increasing endometrial thickness 2 and 3 weeks after surgical abortion (P < 0.00001, all).Immediate administration of OCs postabortion may reduce vaginal bleeding time and amount, shorten the menstruation recovery period, increase endometrial thickness 2 to 3 weeks after abortion, and reduce the risk of complications and unintended pregnancies.

Transvaginal management of cesarean scar section diverticulum: a novel surgical treatment.

BackgroundThe aim of this study was to investigate the clinical value of transvaginal management of cesarean section scar diverticulum.Material/MethodsWe evaluated 64 patients receiving transvaginal management of previous cesarean scar defect (PCSD).ResultsThe PCSD was successfully treated by transvaginal surgery, without evident complications. The mean operation time was 33.6±4.1 min, blood loss was 37.9±16.8 ml, and the mean hospital stay after surgery was 6±2.9 days. Symptoms related to the prolonged menstruation in 53 patients were improved after surgery, vaginal bleeding time was reduced by an average of 7.3±2.8 days, and a significant difference was noted between the mean pre- and post-operative duration of menstruation (P<0.01). Of 11 patients with guttate between menstrual periods, guttate was absent in 9 patients and improved in 2. Clinical improvement was observed in 85.9% (55/64).ConclusionsTransvaginal intervention is feasible and safe for the management of PCSD.