The Reproductive System and Its Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
Abortion applies to both intentional and unintentional termination of an existing pregnancy by expelling the products of conception from the uterus. A spontaneous abortion occurs naturally and may result from either fetal or maternal abnormalities, infection, or other diseases. Induced abortion (also called artificial abortion) may be induced by the administration of an abortifacient drug or surgically by dilating the cervix and scraping the uterine lining, a procedure known as dilation and curettage (D&C). A D&C is also used to remove excess endometrium in several bleeding and endometrial disorders. If the abortion is performed to medically benefit the mother, it is usually termed a therapeutic abortion.
Abnormal uterine bleeding
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
Endometrial biopsy does not detect polyps or fibroids9,10 and if these are suspected on the basis of history or clinical examination then current guidance is that transvaginal ultrasound scanning (TVS) should be performed [A].1,11 Abdominal ultrasound is required if the uterus is palpable abdominally. Hysteroscopy provides accurate visualisation of the uterine cavity and greater accuracy than TVS in distinguishing between polyps and submucosal fibroids9,10,11 although it is more invasive and potentially more costly.9 In centres where provision for outpatient hysteroscopy is limited, the ultrasound based technique of saline infusion sonography11 is useful in delineating the uterine cavity, but this method is not regarded as a first line investigation [A]. Dilatation and curettage has been relaced by the clinic-based techniques described above for routine investigation and should not be used alone as a diagnostic tool [B].1 Current guidelines1,12 recommend that TVS should be used, together with endometrial biopsy if indicated, for the initial investigation of AUB, with hysteroscopy as a back up technique [A]. However a recent economic evaluation 10 has suggested that initial investigation by hysteroscopy may be more cost effective in secondary care if contemporary ‘one-stop’ testing and treatment modalities are available during a single visit..
Alternative Modes of Tissue Coagulation and Removal
Sujoy K. Guba in Bioengineering in Reproductive Medicine, 2020
Simple erosion can be treated by hot wire electrocautery as an outpatient procedure with no anesthesia and only a tranquilizer for apprehensive patients. Extensive erosion requires general anesthesia because the treatment then is painful. For diathermy general anesthesia is preferred. Cervical dilation and curettage may be performed before beginning the electro-surgery if necessary. Steadying the cervix with a volsellum, linear strokes of the red hot cautery or diathermy are applied beginning from the margin of the internal os radially to the erosion-bearing portio vaginalis. Cystic glands are punctured by the cautery tip. Finally a small cervical dilator is passed into the cervical canal to prevent stenosis. Following treatment slough separates at the tenth to twelfth day and healing by epithelialisation occurs in about two months. Vaginal discharge may be excessive during this period.
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.
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.
Diagnosing and treating postpartum uterine artery pseudoaneurysm
Published in Baylor University Medical Center Proceedings, 2018
Kathlyn Parr, Anisha Hadimohd, Adrianne Browning, Jason Moss
The diagnostic modality of choice is transvaginal ultrasound with color Doppler. UAPs typically present as a hypoechoic mass with a “yin-yang” pattern on Doppler, reflecting turbulent blood flow into the pseudoaneurysm during systole and blood flow out of the cavity during diastole.1 UAPs can also be seen on magnetic resonance imaging and computed tomography with contrast.7,8 For hemodynamically stable patients, the treatment of choice is interventional radiology (IR) embolization of the uterine artery, which can be performed using various agents and is 93% to 96% successful.9 IR embolization is the preferred method because it is well tolerated by the patient, less invasive, allows for shorter hospitalization, and preserves fertility, in contrast to hysterectomy.3,10 For hemodynamically unstable patients, intraoperative ligation of the uterine vessels and hysterectomy are the options.5 Dilation and curettage should be avoided in these patients because it can disrupt the pseudoaneurysm, leading to heavier bleeding.7 This is important to prevent because delayed postpartum hemorrhage is often attributed to retained products of conception. Prior to proceeding with this procedure, the presence of a UAP should be ruled out. After IR embolization has been performed, patients should have a follow-up ultrasound in a few months to confirm resolution of the pseudoaneurysm.1
Related Knowledge Centers
- Cervical Dilation
- Curettage
- Curette
- Misoprostol
- Vacuum Aspiration
- Miscarriage
- Cervix
- Uterus
- Gynaecology
- Abortion