Improving care for patients undergoing curettage for incomplete abortion.
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Abortion, Incomplete↗
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Potential pathogens in the lower genital tract at manual vacuum aspiration for incomplete abortion in Korle Bu Teaching Hospital, Ghana.
OBJECTIVES: To determine the carriage rates of potential pathogens in the lower genital tract and factors associated with colonization among women with incomplete abortion. DESIGN: A cross-sectional study. SETTING: The Manual Vacuum Aspiration room of the Korle-Bu Teaching Hospital, Accra, Ghana. SUBJECTS: Two hundred women undergoing Manual Vacuum Aspiration at the Korle-Bu Teaching Hospital. METHODS: Eligible patients were screened for the presence of organisms in the lower genital tract by microscopy and culture of high vaginal and endocervical swabs. RESULTS: Nearly two-thirds of the patients (64.2%) had potential pathogens in the lower genital tract. Bacterial vaginosis alone was present in 47% and a combination of bacterial vaginosis and Candida albicans was present in 17.2%. Residence in an urban slum showed a significant association with the presence of potential pathogens (Odds ratio 2.6; p-value 0.04). CONCLUSION: Organisms responsible for bacterial vaginosis were the most frequently isolated potential pathogens in the cervical canal of patients with incomplete abortion at the Korle-Bu Teaching Hospital. Management of these patients should therefore include antibiotic prophylaxis against bacterial vaginosis.
Abortion, Incomplete↗
Biosocial profile of women with incomplete abortions in Ga-Rankuwa Hospital, Medunsa, RSA.
OBJECTIVES: 1. To obtain information on the nature and extent of the problems of incomplete abortion in Ga-Rankuwa Hospital. 2. To gain a better understanding of women's attitudes regarding abortions in the Ga-Rankuwa community. 3. To identify the predominant biosocial factors that might influence outcome, morbidity, mortality, management and cost among those who induce abortion. DESIGN: Cross sectional descriptive observational study. SETTING: Ga-Rankuwa Hospital which is a tertiary hospital approximately 40 km from Pretoria. SUBJECTS: 355 women of various ages and gestational ages were studied. MAIN OUTCOME MEASURES: It was noted from this study that women in the younger age group, of less parity, single and unemployed were found more likely to interfere with their pregnancies and thus induce abortion. RESULTS: There was no statistical difference between those who induced abortion and those who had spontaneous abortion, in terms of gestational age at which the abortion occurred. More of those who had interfered with their pregnancies were admitted for septic incomplete abortion, whereas those with no evidence of intervention were admitted to inevitable and spontaneous abortion (p < 0.001). Of those who had induced abortion 98.5pc stated that they did not want their pregnancies, compared with 39.3pc of those who did not interfere with their pregnancies (p < 0.001). CONCLUSION: The study highlights the importance and relevance of the abortion issue particularly in RSA where abortion is about to be legalized. Whether the legalization will decrease morbidity and mortality associated with criminally induced abortions remains to be established. The study also shows that those who induce abortion are worse off in terms of morbidity and other sequelae as well as cost to the health care system. Strategies for reducing the rate of abortion have been discussed.
Abortion, Incomplete↗
Pelvic MR imaging findings in gestational trophoblastic disease, incomplete abortion, and ectopic pregnancy: are they specific?
Thirty-nine patients with abnormally elevated levels of serum beta subunit of human chorionic gonadotropin (beta-hCG) were studied to determine whether findings at magnetic resonance (MR) imaging are specific for primary molar disease, persistent gestational trophoblastic disease (GTD), incomplete abortion, and ectopic pregnancy. Among the latter three groups, the only significant differences were a higher prevalence of endometrial distention in the group with incomplete abortion (P < .0035) and the absence of junctional zone disruption in the group with ectopic pregnancy (P < .05). In the group with primary molar disease, total intrauterine volume was significantly increased (P < .001), and endometrial distention and presence of an endometrial mass had a significantly higher prevalence than that in the persistent GTD groups with (P < .04) or without (P < .001) metastases. Myometrial or extrauterine disease was identified in 65% of the patients with persistent disease and a beta-hCG level greater than 500 mIU/mL (500 IU/L). Thus, although MR imaging findings in persistent GTD, incomplete abortion, and ectopic pregnancy are relatively nonspecific, MR imaging can depict invasive disease that may alter therapeutic management in patients with documented GTD.
Abortion, Incomplete↗
Assessment of the manual vacuum aspiration (MVA) equipment in the management of incomplete abortion.
In a study to assess the efficacy of and safety of vacuum aspiration syringe in the management of incomplete abortion 300 patients with non septic abortion were evacuated by the method in the ward. A control group 285 patients was evacuated in theatre by sharp currettage. All patients were followed up for 21 days. 54.7% of the study patients were evacuated without any need for analgesia while all the control patients were given intravenous pethidine and valium. 2.3% of vacuum aspiration and 3.5% of control patients needed revacuation (p greater than 0.05). 70.3% of vacuum aspiration cases were dry by day 7 compared to 64.6% of the control group (p greater than 0.05). Immediate complications of nausea and vomiting were seen in 5.3% study patients (p less than 0.001). There was one uterine perforation in the control group. 5.4% of study and 6.0 of control patients developed mild to severe sepsis (p greater than 0.05). Vacuum aspiration is a safe, simple and quick method of treating incomplete abortion. Its wider use in developing countries is highly recommended.
Abortion, Incomplete↗
The diagnosis of incomplete abortion.
A prospective study of 203 patients referred with a diagnosis of incomplete abortion is reported and the final histological diagnosis is discussed. Eighty-six patients (42 percent) were not pregnant, and 14 (7 percent) had other abnormalities of pregnancy. Clinical features of value in confirming the diagnosis were cervical dilation (misleading in 6 percent), uterine enlargement (misleading in 31 percent) and pain (misleading in 34 percent). Amenorrhoea was significantly shorter in patients with dysfunctional bleeding and bleeding prolonged in the other groups, but a wide range was noted. Age did not differ significantly between the two groups. A histological diagnosis was made in all but five patients. No clinical feature was completely reliable and curettage was often necessary to reach a final diagnosis.
Abortion, Incomplete↗
A randomized trial of misoprostol compared with manual vacuum aspiration for incomplete abortion.
OBJECTIVE: To compare the safety, efficacy, and acceptability of misoprostol and manual vacuum aspiration for the treatment of incomplete abortion in a hospital setting in Kampala, Uganda. METHODS: Three hundred seventeen women with clinically diagnosed incomplete first-trimester abortions were randomized to treatment with either manual vacuum aspiration or 600 mug misoprostol orally to complete their abortions. All women received antibiotics posttreatment and were followed up 1-2 weeks later. RESULTS: Regardless of treatment allocation, nearly all women in this study successfully completed their abortions with either oral misoprostol or manual vacuum aspiration (96.3% versus 91.5%, relative risk 1.05, 95% confidence interval 0.98-1.14). Complications were less frequent in those receiving misoprostol than those having manual vacuum aspiration (0.9% versus 9.8%, relative risk 0.1, 95% confidence interval 0.01-0.78). In the 6 hours after treatment, women using misoprostol reported heavier bleeding but lower levels of pain than those treated with manual vacuum aspiration. Rates of acceptability were similarly high among women in the 2 treatment groups, with 94.2% and 94.7% of women reporting that their treatment was satisfactory or very satisfactory in the misoprostol and manual vacuum aspiration groups, respectively. CONCLUSION: For treatment of first-trimester uncomplicated incomplete abortion, both manual vacuum aspiration and 600 microg oral misoprostol are safe, effective, and acceptable treatments. Based on availability of each method and the wishes of individual women, either option may be presented to women for the treatment of incomplete abortion. LEVEL OF EVIDENCE: I.
Abortifacient Agents, Nonsteroidal↗
Ovarian abscess associated with incomplete abortion and intrauterine contraceptive device.
A 28-yera-old woman with an intrauterine device (IUD) was admitted to hospital with signs of incomplete abortion. The IUD was removed and curettage revealed necrotic infected decidua with no trophoblastic cells or chorionic villi. The patient subsequently developed multiple abscesses in the right ovary. The mechanism of development of ovarian abscesses in patients with IUD or with infected incomplete abortion is discussed.
Abortion, Incomplete↗
Prevalence of Asherman's syndrome after secondary removal of placental remnants or a repeat curettage for incomplete abortion.
This prospective study assesses the prevalence of intrauterine adhesions among women undergoing secondary removal of placental remnants after delivery, or a repeat curettage for incomplete abortions, and evaluates risk factors associated with the presence of intrauterine adhesions. In 50 women, undergoing either a secondary removal of placental remnants more than 24 h after delivery, or a repeat curettage for incomplete abortions, ambulatory hysteroscopy was performed 3 months after the intervention. Intrauterine adhesions were found in 20 of the women (40%): five patients had Asherman's syndrome grade I, six had grade II, six had grade III and three had grade IV. In women with menstrual disorders a statistically significant 12-fold increased risk for Asherman's syndrome grade II-IV was found. Previous abortion as well as infection during surgery were associated with a mildly but non-significant increased risk. Based on our findings, hysteroscopy is recommended only in those patients who develop menstrual disorders, either after secondary intervention for placental remnants after delivery or after a repeat curettage.
Abortion, Incomplete↗
Incomplete abortion at the teaching hospital, Blantyre, Malawi.
A total of 444 women treated for incomplete abortion using the manual vacuum aspiration technique, at the Queen Elizabeth Central Teaching Hospital, Blantyre, between 10th January and 9th April, 1994, were interviewed by means of partially structured questionnaire, to determine among other things, their socio-demographic profiles, contraceptive behaviour, as well as associated complications. These formed 56.0% of all abortion cases seen in the department during the study period. All abortion formed 68.0% of all the gynaecological admissions, and an abortion delivery ratio of 1:4. The ages of the patients ranged from 15 to 44 years with a mean of 24.4 years. Adolescents formed 21.2% of the total, while those aged 35 years and above formed 8.4%. Only 15.8% of the total were single. Their parities ranged from 0 to 12 with a mean of 2, while number of living children ranged from 0 to 9 with a mean of 1.7. 16.9% of them had had previous abortions, with the highest number of abortion being 6 and a mean of 1.6. 79.9% of the total group were housewives, and 10.6% students. Of their male partners (i.e. people responsible for the index pregnancy), only 4.2% were students and 25.0% of the school girls were involved with fellow school boys. Majority of the rest (56.3%) were involved with more mature self-sustaining males. The gestational ages ranged from 6 weeks to 20 weeks with a mean of 15 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)
Abortion, Incomplete↗
Suction v. conventional curettage in incomplete abortion. A randomised controlled trial.
This randomised controlled trial of 357 patients who had had an incomplete abortion compared suction curettage with conventional curettage for evacuation of the uterus. The 179 patients undergoing suction curettage had a significantly lower intra-operative blood loss (P < 0.0001) and a significantly higher mean haemoglobin level at follow-up compared with the 178 patients who had conventional curettage. Suction curettage was a faster procedure and less painful. No difference was found between the two groups with regard to the incidence of post-abortal sepsis, or the re-evacuation rate. No problems were encountered with the use of suction curettage in the presence of uterine sepsis. In an era where blood transfusions should be kept to an absolute minimum, suction curettage will help to save blood in several ways.
Abortion, Incomplete↗
Management of incomplete abortion with manual vacuum aspiration in comparison to sharp metallic curette in an Ethiopian setting.
This institution based case control study emanated from the fact that manual vacuum aspiration (MVA) has been recently introduced in Ethiopia and Gandhi Memorial hospital is currently serving as the pioneering centre. Abortion is an important everyday medicolegal, social, political and public health issue. The objectives of the study were to focus on abortion issues, to show that MVA is alternative instrument applicable in our setting and to highlight some of the determinants that can influence the choice of instruments in the management of incomplete abortions of less than 12 weeks of gestation. A total of 1896 patients who fulfilled the inclusion criteria underwent evacuation and curettage with MVA and SMC during the study period. The main considered variables included socio-demographic characteristics, service-providers, complications in relation to operators and method of surgery, duration of the surgery, patient pain evaluation and uterine factors. MVA is found to be equally safe, effective, simple and fast set of instruments which can be employed in the management of incomplete abortions. Integration of MVA in the medical training is recommended as it is a measure which can greatly contribute towards the reduction of maternal morbidity and mortality especially in a developing country like ours where resources are scare and alternatives are quite limited.
Abortion, Incomplete↗
Treating incomplete abortion in El Salvador: cost savings with manual vacuum aspiration.
When manual vacuum aspiration (MVA) was introduced to treat incomplete abortion at a regional training hospital in El Salvador, this study evaluated the impact of replacing sharp curettage with MVA. Hospital cost, length of hospital stay, complication rates and postabortion contraceptive acceptance were compared in a prospective, nonrandomized, controlled study of 154 women assigned to either traditional sharp curettage services or MVA services plus contraceptive counseling. Assignment depended on availability of trained providers. Compared to sharp curettage, use of MVA and associated changes in protocol led to a significant cost savings of 13% and shorter hospital stay of 28%. Dedicated family-planning counseling resulted in a threefold higher rate of contraceptive acceptance. Although the difference in cost was significant, much higher savings could be realized if minimal postoperative stays were implemented for both procedures. Barriers to early discharge include patient expectations, physician attitudes and training and hospital systems administration.
Abortion, Incomplete↗
Is ward evacuation for uncomplicated incomplete abortion under systemic analgesia safe and effective? A randomised clinical trial.
OBJECTIVE: To compare evacuation under systemic analgesia (fentanyl and midazolam) in a treatment room (ward group) with evacuation under general anaesthesia in theatre. DESIGN: A prospective randomised clinical trial. SETTING: A tertiary medical centre serving a black urban population. SUBJECTS: One hundred and forty-two patients with uncomplicated incomplete abortions. INTERVENTION: Randomisation into two groups, those for evacuation under systemic analgesia and those for evacuation under general anaesthesia. MAIN OUTCOME MEASURES: Both groups were compared in terms of safety, efficacy, acceptability, blood consumption and time delay between admission and evacuation. RESULTS: Significantly less blood was used in the ward group (37 units for 13 patients) than in the theatre group (65 units for 24 patients) (P < 0.03). Significantly less time was taken between admission and evacuation in the ward group (median 7 hours 15 minutes) than in the theatre group (median 12 hours 38 minutes) (P < 0.0003). Evacuation under fentanyl and midazolam was safe, effective and acceptable for the majority of patients compared with evacuation under general anaesthesia. CONCLUSION: Patients with uncomplicated incomplete abortions (uterine size equivalent to a pregnancy of 14 weeks' duration or less) can undergo evacuation safely and effectively under fentanyl and midazolam and have a significantly smaller chance of requiring a blood transfusion.
Abortion, Incomplete↗
Consultant report: Incomplete abortions treated at Jahanshah Saleh Hospital in Tehran, Iran from May 14, 1973 to April 30, 1974.
In the period from May, 1973 to April, 1974, one hundred patients were treated for incomplete abortion at the Jahanshah Saleh Hospital in Tehran, Iran. Patients admitted to the hospital were from 4 to 28 weeks' gestation and were routinely administered analgestics before the abortion was completed by D & C. The D & C took about 10 minutes and the patient was usually able to go home that same day. Twenty-four women (24.0%) experienced complication(s) including blood loss, fever requiring antibiotic treatment, and pelvic infection.
Abortion, Incomplete↗
[Manual intrauterine aspiration in the treatment of incomplete abortion].
Manual vacuum aspiration (MVA) is a method proposed for uterine evacuation in cases of incomplete abortion, using a syringe of plastic material to produce negative pressure. With this technique, we treated 122 cases of different types of abortion at The Instituto Nacional de Perinatología, and results obtained were compared with those of 126 women treated with standard dilation and curettage (D&C). The sociodemographic characteristics of the two groups were similar. Molar pregnancy and blind ova were more frequent in cases treated with MVA. Types of anesthesia used were similar in both groups with the exception of 10 cases of MVA, that received paracervical block. Four surgical complications occurred, one of hemorrhage in each group and two cases of incomplete evacuation in the MVA group. Histopathological examinations using morphometric techniques showed similar proportions, of fetal parts, villi, decidua, myometrial cells and blood clots for both groups. It was concluded that MVA is as effective and safe as D&C, it is easy to perform, and is not associated with important complications. It can be used as an advantageous option for the evacuation of molar pregnancy.
Abortion, Incomplete↗
Incomplete abortion and hydrometrosis in a squirrel monkey (Saimiri sciureus).
A 6-year-old, primiparous female squirrel monkey, diagnosed as being at approximately 100 days of gestation, developed clinical signs of pregnancy toxemia. An ovariohysterectomy was performed and complete recovery followed supportive treatment. Based on histopathology, a diagnosis of incomplete abortion and hydrometrosis was made.
Abortion, Incomplete↗
Easing the pain: pain management in the treatment of incomplete abortion.
Although there have been significant improvements in post-abortion care programmes around the world, improving pain management has remained a significant challenge. The introduction of manual vacuum aspiration (MVA) has led to many positive changes in programmes, but the guidelines for pain control have generally been vague. Women are often treated with no pain control or in some cases receive too much pain medication. There are many factors contributing to this situation, including: the belief that women who have induced an abortion should be punished, the idea that pain control is unnecessary, the lack of availability of drugs and inadequate training and/or skills of providers. This paper argues for a greater focus on this important element of quality of care and for clearer guidelines on pain management during treatment of incomplete abortion with MVA. This includes the provision of analgesics immediately before the procedure, counselling and reassurance during the procedure and local anaesthesia when necessary.
Abortion, Incomplete↗