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Products of Conception
Published in Carlos Simón, Carmen Rubio, Handbook of Genetic Diagnostic Technologies in Reproductive Medicine, 2022
Nasser Al-Asmar, Marcia Riboldi
Once pregnancy loss has occurred, a sample of fetal tissue can be recovered by surgical methods, such as dilation and curettage (D&C) or uterine aspiration. These methods carry risk of maternal cell contamination (MCC) due to maternal and fetal tissue mixing during the procedure. Hysteroembryoscopy (which allows for direct and selective embryo and chorion biopsy) performed before curettage diminishes the likelihood of MCC and avoids the risk of misdiagnosis (30). However, hysteroembryoscopy requires a specialist in the technology and is not common practice in the obstetric field. An alternative to detect the presence of MCC in POC recovered by D&C or aspiration paired with molecular diagnosis of aneuploidies is presented below.
Assessment of fetal genetic disorders
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Teresa Martino, J. Pratt Rossiter, Karin J. Blakemore
One of the main disadvantages of multiple-marker screening was its timing in the second trimester. An abnormal screen, typically obtained at 16–18 weeks of gestation, sets into motion a series of events including repeat screening in some cases (if AFP is high, not for increased risk of aneuploidy), ultrasonography to confirm dating, genetic counseling, and the offer to have amniocentesis for chromosomal analysis and amniotic fluid AFP measurement. At the completion of this evaluation, most patients are beyond 18 weeks and many are beyond 20 weeks of gestation. By this time, many pregnant women have begun to feel fetal movement and are readily recognized as pregnant by casual observers. In addition, the options for termination are induction methods (prostaglandin and/or urea instillation, prostaglandin suppositories) or dilatation and evacuation at an advanced gestational age. Either method is associated with significantly greater morbidity than first-trimester dilatation and curettage, as well as increased medical costs. For these reasons, the ability to perform screening in the first trimester provides a significant benefit over second-trimester screening.
Gestational Trophoblastic Neoplasia
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
This term is applied when a CHM or rarely, a PHM invades into the myometrium. Invasive mole is common and is clinically identified by the combination of an abnormal uterine ultrasound and a persistent or rising hCG level following uterine evacuation. Except under unusual circumstances when a curettage specimen contains myometrium with invasive molar villi, the diagnosis of an invasive mole can only be made on a hysterectomy specimen. The pathological confirmation of this condition is, however, rarely required. Moreover, repeat dilatation and curettage (D&C) is often contraindicated because of the risks of uterine perforation, infection, life-threatening hemorrhage, and subsequent hysterectomy. In occasional cases where histology is available, invasive mole can be distinguished from choriocarcinoma by the presence of chorionic villi.
Choice of anesthetic technique for dilation and curettage for indication of pregnancy loss
Published in Baylor University Medical Center Proceedings, 2022
Alexandra Carlson, Jessica C. Ehrig, Kendall Hammonds, Michael P. Hofkamp
Miscarriage is the loss of pregnancy before viability, and it is estimated that 23 million miscarriages occur each year throughout the world.1 The management of loss of pregnancy is broadly divided between expectant, medical, and surgical treatment options, and dilation and curettage is one surgical treatment option for pregnancy loss.2 The choice of anesthetic technique for dilation and curettage depends on operative indication, patient comorbidities, and the preferences of the patient, anesthesia provider, and obstetrician. Patients at our hospital who have dilation and curettage for miscarriage have either general anesthesia or deep sedation. Our primary aim was to determine the difference in estimated blood loss between dilation and curettage performed under general anesthesia and deep sedation, and our secondary aim was to identify which patients at our hospital received general anesthesia for dilation and curettage. We hypothesized that patients at our hospital who received general anesthesia as the initial anesthetic technique for dilation and curettage for loss of pregnancy during the first or second trimesters would have a higher estimated blood loss, a higher body mass index, and a later gestational age compared to patients who received sedation for the same procedure.
Postpartum HELLP syndrome complicated with large subcapsular liver hematoma
Published in Baylor University Medical Center Proceedings, 2022
Syed Naqvi, Syed Hassnain, Amman Yousaf, Shoaib Muhammad, Diego Cabrera
Following the dilatation and curettage, her pain improved and vital signs returned to normal. However, her laboratory investigations showed thrombocytopenia and a gradual elevation of liver transaminases and lactate dehydrogenase. She was transferred to the intensive care unit for close monitoring, with a suspicion of HELLP and preeclampsia with severe features. However, laboratory results were extraordinarily, unlike the typical HELLP presentation. Her aspartate aminotransferase steadily increased, initially measured at 560 U/L and trending up to 7960 U/L (normal up to 48 U/L) (Figure 1a). The alanine aminotransaminase followed a similar pattern, rising from 297 to 3269 U/L (normal up to 55 U/L). In addition, her lactate dehydrogenase rose from 2148 to 12,110 U/L. Similarly, the platelets decreased from 134 k/μL on admission to 29 k/μL in <45 hours (Figure 1b). A hepatitis laboratory panel and ADAMSTS13 were unremarkable. Furthermore, the patient had a negative Coombs test, and a peripheral smear showed microspherocytes, as usually seen in HELLP, for which she was placed on intravenous steroids.
Success rate of methotrexate treatment for recurrent vs. primary ectopic pregnancy: a case-control study
Published in Journal of Obstetrics and Gynaecology, 2020
Gabriel Levin, Uri P. Dior, Asher Shushan, Ronit Gilad, Avi Benshushan, Amihai Rottenstreich
For the purpose of this study, we abstracted maternal hospital admission records, gynaecological ward follow-up charts, laboratory and ultrasound scan reports, operation reports and discharge letters from the electronic medical record databases of the gynaecological unit in our medical centre. Records were reviewed by a single reviewer (G. L.). The following data were extracted: patient characteristics (age, ethnicity, parity, obstetric history, body mass index, history of pelvic inflammatory disease, current usage of intrauterine device (IUD) and previous pelvic and uterine surgeries), current gestation characteristics (mode of conception, gestational age at admission, mean adnexal size, location of gestation, presence of yolk sac and foetal pole and endometrial thickness) and laboratory data (human chorionic gonadotropin [hCG] levels during hospitalisation and follow-up). Uterine surgery was defined as previous dilatation and curettage or hysteroscopy. Pelvic surgery was defined as a laparoscopic or open procedure performed for gynaecological or surgical conditions. The day of intramuscular MTX injection was defined as day 1 and the day prior to the first injection was defined as day 0. Initial 24 h hCG increment was calculated as the percent of change in hCG levels from day 0 to 1.