Suction curettage for incomplete and inevitable abortion an emergency medicine procedure?
Explore the source record for details and available documents.
Abortion, Incomplete↗
SEARCH · PubMed Health
Results for “Abortion, Incomplete”
Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Misoprostol and illegal abortion in Fortaleza, Brazil.
Misoprostol, a prostaglandin E1 analogue indicated for ulcer treatment, has been widely used as an abortifacient by women in Brazil, where abortion is legal only in cases of rape or incest, or to save the woman's life. Because misoprostol is an inefficient abortifacient, many women who use it have incomplete abortions and need uterine evacuation. We reviewed the records of women admitted to the main obstetric hospital of Fortaleza, capital of Ceará state, Brazil, between January, 1990, and July, 1992, for uterine evacuation after induced abortion. The number of incomplete abortions induced by misoprostol increased substantially during the first half of 1990, and declined thereafter. Of the 593 cases in 1991, 75% were related to misoprostol, 10% to the use of other specified drugs, and 6% to unspecified drugs. For the remaining 9% the procedure used was not recorded; these included 3% in whom abortion had been induced by a clandestine abortionist. The number of uterine evacuations per month fell from 89 in August, 1990, to 62 in July, 1991, when sales of misoprostol in Ceará state were suspended. The fall continued after the sale of misoprostol ceased, to about 20 cases in December, 1991; numbers remained around this level until June, 1992, sustained by clandestine sales. The lack of access to contraception is the main reason for the large numbers of unplanned pregnancies and is a major public health issue for Brazilian women. The prohibition of abortion creates a void in which misuse of medicines is one extra complication, mainly because of the poor control of drug marketing.
Abortifacient Agents↗
Self-reports of induced abortion: an empathetic setting can improve the quality of data.
OBJECTIVES: This study estimated the proportion of incomplete abortions that are induced in hospital-based settings in Tanzania. METHODS: A cross-sectional questionnaire study was conducted in 2 phases at 3 hospitals in Tanzania. Phase 1 included 302 patients with a diagnosis of incomplete abortion, and phase 2 included 823 such patients. RESULTS: In phase 1, in which cases were classified by clinical criteria and information from the patient, 3.9% to 16.1% of the cases were classified as induced abortion. In phase 2, in which the structured interview was changed to an empathetic dialogue and previously used clinical criteria were omitted, 30.9% to 60.0% of the cases were classified as induced abortion. CONCLUSIONS: An empathetic dialogue improves the quality of data collected among women with induced abortion.
Abortion, Illegal↗
Serum level of pregnancy associated alpha2-globulin in patients with spontaneous abortions.
Pregnancy associated alpha2-globulin serum levels have been measured in abortion-cases. In cases of incomplete abortion with placental destruction and missed abortion this alpha2-globulin level significantly decreased, but no changes could be found when the placenta remained intact. The prognostic value of this pregnancy protein is discussed.
Abortion, Incomplete↗
[The comparative value of ultrasound examinations and quantitative determinations of chorionic gonadotropin in the differential diagnosis of the disturbed early pregnancy (author's transl)].
The diagnostic value of ultrasound examinations is compared to the diagnostic value of determinations of the chorionic gonadotropin (HCG) excretion in normal and abnormal early pregnancy. 330 pregnancies between 5 and 16 weeks gestation were examined. there were 78 cases of normal early pregnancy, 131 cases of threatened abortion, 29 cases of missed abortion and 92 cases of incomplete abortion. the diagnostic accuracy of ultrasound examination was 95,5% in 582 determinations, the HCG excretions showed a diagnostic accuracy of 87,1%. The combined accuracy of both methods reduced the diagnostic error to 0,58%. The results in the different groups of patients were compared. Errors in ultrasound diagnosis decrease with increasing gestational age. Diagnostic errors were especially observed in cases of uterine retroversion, obesity or unknown menstrual history. The diagnostic accuracy of the HCG excretion is improved by serial determinations.
Abortion, Incomplete↗
Fatal septic abortion in the United States, 1975-1977.
In 1975 through 1977, 36 women in the United States died of septic abortion (12 legal, 15 spontaneous, 8 illegal, and 1 unclassified). The respective estimated death-to-case rates for septic abortion are 0.4 and 0.6 deaths per 100,000 legal and spontaneous abortions. Unmarried teenagers who undergo incomplete abortion at 16 weeks' gestation or more by intrauterine placement of a foreign body appear to have the highest risk of death from infection after legal abortion. Three of these risk factors (gestational age at the time of abortion, method, and completeness of abortion) can be influenced by medical personnel. Complete abortion by safe techniques early in pregnancy can help eliminate deaths from infection after legal abortion.
Abortion, Incomplete↗
Critically ill obstetric and gynaecological patients in the intensive care unit.
OBJECTIVES: To document mortality among critically ill obstetric and gynaecological patients requiring intensive care unit (ICU) admission and to investigate whether any poor prognostic features could allow for earlier and more aggressive intervention. STUDY DESIGN: A retrospective study of all obstetric and gynaecological patients admitted to the ICU of Johannesburg Hospital between 1985 and 1996. Sixty-one patients were analysed both as a group and as two subgroups--those with incomplete abortions and those with other pregnancy-related diagnoses. RESULTS: Derangements in platelet counts, serum creatinine levels and prothrombin international normalised ratio (INR) were present in all patients on the day of admission to hospital. In the group with incomplete abortions absolute levels of these parameters may be used to identify those patients with a worse outcome. The mortality rate was 38%. CONCLUSION: Early ICU admission and aggressive surgical intervention are strongly recommended in patients with septic incomplete abortions presenting with more than a single organ dysfunction.
APACHE↗
Clinical trial on termination of early pregnancy with RU486 in combination with prostaglandin.
Termination of early pregnancy was performed in 1572 healthy women with RU486 (mifepristone, 600mg orally once), followed 36-60 hours later by administration of methyl ester of dl-15-methyl-PGF2 alpha (PG05, 1mg vaginal suppository). Complete abortion was accomplished in 91.2% (1433/1571), incomplete abortion in 4.8% (76/1571), and continued pregnancy in 3.9% (62/1571). The time elapsed between RU486 intake and complete expulsion was 2.4 +/- 1.3 days. Expulsion took place on the third day in 935 women (72%), and on the 4th day in 273 women (21.0%). Uterine bleeding occurred on the second or third day after RU486 intake in 1256 women (88.8%), and lasted 11.7 +/- 6.4 (SD) days, range 2-55 days. One subject had blood transfusion due to excessive bleeding. The main side effects were nausea/vomiting (22.3%), abdominal pain (10.2%), headache/dizziness (4.1%) and diarrhea (2.8%). Fatal side effects have not been reported in this study. About 73% of subjects with complete abortion assessed the treatment as good to excellent. Even in the failed cases, 25-42% of subjects considered the treatment as good. Further studies are needed to determine the optimal dose of the RU486 regimen. It should be emphasized that the treatment must be used under close medical supervision in order to monitor the uterine bleeding.
Abortion, Incomplete↗
Histological analysis of the products of conception following first trimester abortion at Jordan University Hospital.
OBJECTIVE: To evaluate the value of histopathological examination of products of conception in first trimester abortion. SETTINGS: University hospital. DESIGN: Retrospective record review over 2 years, from January 1999 to January 2001. PATIENTS: A total number of 293 patients with the diagnosis of first trimester abortion were admitted and their abnormal pregnancy evacuated. RESULTS: The highest type of abortion among the studied group was incomplete abortion, 140 patients (48%), and surgical evacuation was the most common method of termination, 202 patients (69%). The histopathology reports confirmed the pregnancy in all patients and revealed partial mole in 51 patients (17%), undiagnosed abnormality in 8 patients (2.7%), suggesting the possible cause for recurrent pregnancy loss in 4 patients (1.4%). CONCLUSION: Histopathological assessment for the products of conception proved to be an important tool in detecting molar pregnancy and hydropic changes that necessitate special follow-up protocol and unmasking ectopic pregnancies for further management.
Abortion, Habitual↗
Cost-effectiveness of managing abortions: manual vacuum aspiration (MVA) compared to evacuation by curettage in Tanzania.
Cost effectiveness of managing 107 incomplete abortions by manual vacuum aspiration (MVA) is compared with management of 92 incomplete abortions by evacuation by curettage (E by C) at Muhimbili Medical Centre (September-November 1992). Pre-evacuation waiting times, duration of procedures and duration of hospital stay were less for MVA as compared to E by C. The total pre-evacuation waiting time, the durations of the procedure and hospital stay were 15.59 days (55.11%), 10.96 (46.41%) hours and 21.23 (40.53%) days less for MVA as compared to E by C. The direct costs revealed a cost differential of MVA over E by C of Tshs 776.9 (US$2.6). MVA is more cost effective than contemporary E by C and its introduction on a wider scale in our health care delivery system is recommended.
Abortion, Incomplete↗
Post-abortion-hysteroscopy--a method for early diagnosis of congenital and acquired intrauterine causes of abortions.
OBJECTIVE: A prospective study was conducted on the incidence of intrauterine pathology diagnosed by hysteroscopy. STUDY DESIGN: A hysteroscopy was performed in 53 women 6-12 weeks after a dilatation and curettage for incomplete abortions or missed abortions. RESULTS: Uterus malformations were found in 11 patients, submucous myoma in two and a corpus polyp in one. The main findings were intrauterine adhesions in 16 cases. The incidence of intrauterine adhesions was about the same after incomplete abortions and after missed abortions, but in patients with recurrent abortions the incidence was significantly higher than in patients after first abortion (47.6% versus 18.8%). CONCLUSION: Post-abortion-hysteroscopy is a simple and useful method for early diagnosis of acquired and congenital intrauterine pathology after abortions.
Abortion, Habitual↗
Induction of abortion with mifepristone and misoprostol in early pregnancy.
OBJECTIVE: To investigate the clinical efficacy of the combination of mifepristone and an orally active prostaglandin, misoprostol, for early medical termination. DESIGN: Women with amenorrhoea < or = 56 days were given 200 mg mifepristone. 48 h later, 600 micrograms misoprostol was given orally. SETTING: Medical Termination Unit, Simpson Memorial Maternity Pavilion, Edinburgh. SUBJECTS: 100 women requesting medical termination of pregnancy. INTERVENTIONS: Evacuation of uterus for incomplete abortion or on-going pregnancies. RESULTS: One woman had an incomplete abortion prior to administration of misoprostol. 92 (93%) out of 99 women had complete abortion following administration of misoprostol. There were three on-going pregnancies (3.0%, 95% confidence limits (CL) 0.6-8.6) and four incomplete abortions with this regimen (4.0%, 95% CL 1.1-10.0). 24% women vomited and 7% had diarrhoea following administration of misoprostol. 62% did not require any analgesia. CONCLUSIONS: The combination of misoprostol with mifepristone is inexpensive, simple, effective, noninvasive and an acceptable alternative to current regimens for medical termination.
Abortion, Induced↗
Comparison of the footpump suction evacuator with the manual vacuum aspirator for uterine evacuation.
OBJECTIVE: To compare the efficacy of a novel footpump suction evacuator with the manual vacuum aspirator in the management of women with incomplete abortions requiring uterine evacuation. DESIGN: A prospective comparative analysis of women allocated to either manual vacuum aspiration of the uterus or footpump suction evacuation, following first- or second-trimester incomplete abortion. SETTING: The gynaecology casualty theatre, Groote Schuur Hospital, Cape Town. PATIENTS: 121 women with first- or second-trimester abortions. Patients with signs of septic abortion were excluded from the study. INTERVENTIONS: Uterine evacuation under general anaesthesia by means of a manual vacuum aspirator or a novel footpump suction evacuator. OUTCOME MEASURES: Endpoints assessed included duration of the procedures, ease of evacuation, estimated blood loss, volume of products of conception obtained, postoperative complications of the procedures and amount of analgesia required postoperatively. RESULTS: The manual vacuum aspirator and footpump suction evacuator appeared equally effective for uterine evacuation. There were no significant differences in the endpoints assessed. CONCLUSIONS: Both methods appear equally effective for uterine evacuation.
Abortion, Incomplete↗
The functioning of a short-stay emergency gynaecological unit.
Admissions to a small constantly staffed emergency gynaecological unit over a two month period are reported. Of 408 patients seen, 230 were in hospital for less than 36 hours and of these 128 were not admitted to a hospital ward. Of a yearly total of 2000 emergency admissions about 1000 did not need admission to a hospital ward. Full staffing of such a unit for 24 hours each day would thus allow a considerable number of beds to be released for elective work. The referring diagnosis of incomplete abortion proved to be incorrect in 100 of 203 patients. Clinical features and management in these patients are discussed. Pain is an unreliable guide, but opening of the cervix is not often seen unassociated with incomplete abortion.
Abortion, Incomplete↗
Termination of early pregnancy with RU 486 (mifepristone) in combination with a prostaglandin analogue (sulprostone).
The antiprogestin RU 486 (mifepristone) has been shown to induce abortion when administered in early pregnancy, but the rate of incomplete abortion is high, around 40%. As blockage of the progesterone receptor increases the myometrial sensitivity to prostaglandins, a combination of RU 486 and a prostaglandin E2-analogue was tested for termination of pregnancy. One hundred and sixteen women, with a gestational length of less than 49 days from the first day of the last menstrual period, were treated with a daily dose of 50 or 100 mg RU 486 for 3 to 6 days, complemented with an intramuscular dose of 0.25 mg sulprostone (16-phenoxy-PGE2-sulfonylamide) on the last day of RU 486 treatment. The results confirmed that a reduction of treatment duration to 3 days is just as effective for inducing abortion (91% complete abortion) as a 4-6-day treatment regimen (95% complete abortion). Six patients had an incomplete abortion and in one the pregnancy continued unaffected. Side effects included intense uterine pain after the prostaglandin administration (16%), vomiting associated with the antiprogestin intake (9%) and after the prostaglandin administration (9%). One woman needed emergency curettage due to heavy bleeding. Six percent of the treated patients had a decrease in hemoglobin exceeding 20 g/l during the first week but no patient needed blood transfusion. No serious side effects were recorded.
Abortifacient Agents↗
Complications of unsafe abortion in sub-Saharan Africa: a review.
The Commonwealth Regional Health Community Secretariat undertook a study in 1994 to document the magnitude of abortion complications in Commonwealth member countries. The results of the literature review component of that study, and research gaps identified as a result of the review, are presented in this article. The literature review findings indicate a significant public health problem in the region, as measured by a high proportion of incomplete abortion patients among all hospital gynaecology admissions. The most common complications of unsafe abortion seen at health facilities were haemorrhage and sepsis. Studies on the use of manual vacuum aspiration for treating abortion complications found shorter lengths of hospital stay (and thus, lower resource costs) and a reduced need for a repeat evacuation. Very few articles focused exclusively on the cost of treating abortion complications, but authors agreed that it consumes a disproportionate amount of hospital resources. Studies on the role of men in supporting a woman's decision to abort or use contraception were similarly lacking. Articles on contraceptive behaviour and abortion reported that almost all patients suffering from abortion complications had not used an effective, or any, method of contraception prior to becoming pregnant, especially among the adolescent population; studies on post-abortion contraception are virtually nonexistent. Almost all articles on the legal aspect of abortion recommended law reform to reflect a public health, rather than a criminal, orientation. Research needs that were identified include: community-based epidemiological studies; operations research on decentralization of post-abortion care and integration of treatment with post-abortion family planning services; studies on system-wide resource use for treatment of incomplete abortion; qualitative research on the role of males in the decision to terminate pregnancy and use contraception; clinical studies on pain control medications and procedures; and case studies on the provision of safe abortion services where legally allowed.
Abortion, Incomplete↗
The midwife's role in abortion care.
Clandestine or unhygienic abortion is one of the five primary causes of maternal mortality, causing up to 200,000 deaths annually. The medical complications of unsafe abortion are exacerbated by the standard use of sharp curettage for uterine evacuation and by the need to transfer women to the highest level of the health system for treatment. Three ways in which midwives can begin to reverse this trend and improve the quality and accessibility of abortion care are to perform vacuum aspiration to treat incomplete abortion or for early induced abortion; to recognise the warning signs of incomplete abortion, provide emergency stabilisation and resuscitation, and offer appropriate and timely referral for uterine evacuation; and to provide family planning counselling and services, particularly to women who have experienced abortion and may be at high risk for future unintended pregnancies but are otherwise not reached by family planning programmes.
Abortion, Illegal↗
Misoprostol alone--a new method of medical abortion?
Misoprostol shows promise for early termination of pregnancy. The drug is widely available, inexpensive, and easy to administer. Current evidence on the efficacy of potential regimens for early abortion, though, is hard to decipher and often contradictory. Research on a safe, effective, acceptable regimen of misoprostol alone for early abortion is underway. Available data show a wide range in efficacy of various regimens, and additional research is needed to understand this variability. A framework for additional research on misoprostol alone for medical abortion is presented with a focus on the need to evaluate benefits and risks of new regimens in the context of women's options for termination of pregnancy. We discuss the potential usefulness of a regimen with less efficacy than approved medical abortifacients. Research is needed as well on women's ability to self-diagnose incomplete abortion or ongoing pregnancy and the potential for misoprostol to be used as treatment for incomplete abortion in order to evaluate the benefits and risks of misoprostol-alone regimens.
Abortifacient Agents, Nonsteroidal↗