Gynaecology: Answers
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf in Get Through MRCOG Part 2: Short Answer Questions, 2020
The procedure is known as evacuation of retained products of conception (ERPC) (1). It is the treatment of choice if there is excessive and persistent bleeding, if the woman is haemodynamically unstable in the presence of infected retained tissue or suspected gestational trophoblastic disease, or (as in this case) if the woman chooses to have surgery (1). Cervical priming may be considered with prostaglandins, as there is evidence that prior to surgical termination of pregnancy prostaglandins reduce the force of dilatation required, haemorrhage, and uterine and cervical trauma (1). The operation is usually performed under general anaesthetic by suction curettage. Vacuum aspiration is preferable to sharp curettage, as it is associated with less pain and blood loss and a shorter operating time (1). Use of routine oxytocin is associated with statistically but not clinically significant reduction in blood loss (1). Complications of ERPC include uterine perforation, cervical tears, intraabdominal trauma, haemorrhage and intrauterine adhesions (1).
Contraception and termination of pregnancy
David M. Luesley, Mark D. Kilby in Obstetrics & Gynaecology, 2016
Vacuum aspiration should be avoided at gestations below 7 weeks as the failure rate is higher. Conventional vacuum aspiration is an appropriate method at gestations of 7–15 weeks and can be carried out either under local or general anaesthesia [B]. For first-trimester suction termination, either electric or manual aspiration devices may be used, as both are effective and acceptable to women and clinicians. For gestations above 14 weeks, surgical abortion by D&E, preceded by cervical preparation, is safe and effective and should be undertaken by specialist practitioners who have a reasonable caseload to maintain their skills. Cervical preparation should be considered in all cases. The various regimens are: Up to 14 weeks: misoprostol 400 mg vaginally or sublingually 3 hours before surgery;14–18 weeks: osmotic dilators.
Contraception and abortion
Helen Bickerstaff, Louise C Kenny in Gynaecology, 2017
Vacuum aspiration is the method that should be used to conduct a surgical termination of pregnancy up to 14 weeks. The procedure involves gently dilating the cervix with graduated dilators (usually to the size in mm that the uterus is in weeks’ gestation) and then evacuating the cavity with gentle suction. This usually takes less than 10 minutes to perform. Sharp curettage should never be performed (increased risk of perforation and intrauterine adhesions). Vacuum aspiration can be performed either using a manual handheld aspirator (manual vacuum aspiration, MVA) or using electrical vacuum aspiration (EVA). There is little to choose between MVA and EVA. The MVA may be more practical and portable for use in the outpatient setting. The EVA gives a more constant suction.
“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.
Comparison of manual vacuum aspiration to traditional methods of managing early pregnancy miscarriage
Published in Cogent Medicine, 2018
Oscar MacCormac, Alexandra Edwards, Murray Forsyth, Fanny Ti, Shilpa Deb
MVA is carried out in an out-patient setting and thus does not require hospital admission or a theatre team for management. The procedure is straightforward and can be carried out by doctors and appropriately trained EPAU advanced nurse practitioners. The procedure is performed under local anaesthesia using a self-locking syringe that creates a defined amount of vacuum in order to evacuate the products of conception (Goldberg, Dean, Kang, Youssof, & Darney, 2004; Milingos et al., 2009). Some studies have assessed the outcomes of MVA vs surgical management of miscarriage (SMM) but none have assessed these outcomes alongside patient comfort. The objective of this study was therefore to determine how manual vacuum aspiration compares to surgical and medical management in terms of outcomes and patient comfort within our EPAU.
Related Knowledge Centers
- Cervical Dilation
- Dilation & Curettage
- Dilation & Evacuation
- Endometrial Biopsy
- Molar Pregnancy
- Miscarriage
- Cervix
- Gestational Age
- Abortion
- Dilation & Evacuation
- Dilation & Curettage
- Karman Cannula