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Gynaecology: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
ERPC – best option if persistent bleeding, infection, unstable, molar pregnancy or patient’s choice.Consider cervical priming.Vacuum aspiration under general anaesthetic. Oxytocin.Complications of ERPC.Tissue for histology.
Pregnancy – wanted and unwanted
Published in Suzanne Everett, Handbook of Contraception and Sexual Health, 2020
The main methods of abortion are: Surgical abortion, which can be carried out by: Vacuum aspiration.Dilatation and curettage (D&C).Dilatation and evacuation (D&E).Medical abortion.
Abortion In Context
Published in Jane M. Ussher, Joan C. Chrisler, Janette Perz, Routledge International Handbook of Women’s Sexual and Reproductive Health, 2019
Carried out properly, abortion is one of the safest procedures in Western biomedicine. Indeed, abortion is many times safer than childbirth. Abortions done early in a pregnancy (i.e., within the first 12 weeks after the woman’s last menstrual period) are carried out either by medication or by a procedure called vacuum aspiration or suction aspiration. Vacuum aspiration, which takes 5–10 minutes, was invented in the early 1960s, and it came into widespread use soon thereafter (Joffe & Reich, 2015). Medication abortion (popularly termed a “pill abortion”) involves taking medicines that induce an abortion. Medication abortions were first introduced in 2000 and involved mifepristone (then called RU-486). Currently, the protocol for a medication abortion involves either two different medications (mifepristone and misoprostol) or multiple doses of misoprostol. The pills are taken in sequence over the course of several days. This sets in motion a physical process akin to a miscarriage. According to current World Health Organization (WHO) standards, medication abortions can be provided up to 12 weeks after the first day of the women’s last menstrual period (WHO, 2014). After 12 weeks, termination of a pregnancy requires a surgical procedure. The most common procedure, called dilation and extraction (D&E), is an outpatient procedure that requires clinic visits on two successive days.
“I suppose we’ve all been on a bit of a journey”: a qualitative study on providers’ lived experiences with liberalised abortion care in the Republic of Ireland
Published in Sexual and Reproductive Health Matters, 2023
Brendan Dempsey, Michael Connolly, Mary F. Higgins
As procedures completed in Irish maternity hospitals are provided as an in-patient service, the hospital providers are tasked with handling and disposing of the fetal remains. Some referred to handling the fetal remains as the most difficult part of abortion care, especially when required to do so multiple times a week. One midwife talked about seeing the human features of the fetus, such as “little fingernails”, and said that fetuses can be “so well formed … coming up to that twelve-week mark”. The hospital providers also discussed the challenge of providing abortion care via surgical methods, saying that vacuum aspiration “is not a pleasant procedure”, even though it is no more technically difficult “than any of the other surgical evacuations of the uterus”. In Ireland, surgery is mostly offered under 12 weeks and most procedures after that are managed medically. Contact with the fetal remains made some providers think that abortion results in the loss of potential life. Recalling an experience where a patient returned to the hospital with their baby after deciding not to proceed with abortion, a midwife said that they thought “of all the other little babies that weren’t going to be alive and so that kind of made me think about what I was doing, you know?”
Severe, protracted anaphylaxis with hypovolemic shock after sublingual misoprostol administration
Published in Journal of Obstetrics and Gynaecology, 2022
Tvrtko Tupek, Analena Gregorić, Dino Pavoković, Anis Cerovac, Dubravko Habek
When her vital functions came back to normal, retention of the placental tissue in the cervical canal and increased vaginal bleeding were observed. The vacuum aspiration and curettage were performed and during the procedure, the placental residual tissue and 600–700 mL of blood were obtained. After the procedure, vaginal bleeding decreased significantly and patient was transfered to gynecological intensive care unit for recovery. During that day she recived a first dose of concentrated erythrocyte, 1000 mL of colloid solution and 4000 mL of crystalloid solution whereupon she became consistently hemodinamically stable with blood pressure 110/60−130/70 mmHg. Next morning, patient's haemoglobin was 69 g/L and second dose of concentrated erythrocytes was administered. The diuresis was normal. Her vital functions were normal during next two days and patient was discharged home.
Effect evaluation on use of bedside fiber bronchoscope in treating stroke-associated pneumonia
Published in Topics in Stroke Rehabilitation, 2018
Qiu Han, Chun Chen, Hai-qin Hu, Jun Shen, Guang Yang, Bin Chen, Lei Xia
Patients in the two groups were treated with routine phlegm-resolving (ambroxol by intravenous injection) and anti-infective therapy. The conventional suction catheter was used for sputum suction for patients in the control group, while bedside fiber bronchoscope was used for sputum suction and alveolar lavage in the experimental group. Before the operation, the patients were provided sufficient oxygen and were monitored with electrocardiogram and pulse oxygen in the process of operation. For the experimental group, the patient was anesthetized through oral cavity or surface of nasal cavity and placed in a supine position. The bedside fiber bronchoscope was inserted through mouth or nose to eliminate the secretions of the upper airways, and then got into the glottis. After the lumen of weasand observed, the bedside fiber bronchoscope was inserted into the left or right principal bronchus according to the principle that the health side be prior to the stricken side. Then it kept going into bronchus at different levels step by step and kept sucking until the tracheal cavity was unobstructed. In the lung lobes with phlegm that was difficult to remove, room temperature sterile saline was infused rapidly and vacuum aspiration was operated immediately to ensure the tracheal cavity to be unobstructed. The operation must be paused when the pulse oxygen was lower than 85%, and it can be resumed with pulse oxygen corrected to be normal and stable.