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Peer Reviewed

Title: Oral compared with intravenous sedation for first-trimester surgical abortion: a randomized controlled trial.
Author: Allen RH; Fitzmaurice G; Lifford KL; Lasic M; Goldberg AB
Source: Obstetrics and Gynecology. 2009 Feb;113(2 Pt 1):276-83.
Abstract: OBJECTIVE: To test the equivalency of oral sedation and intravenous sedation for pain control in first-trimester surgical abortion. METHODS: Women undergoing suction curettage at less than 13 weeks of gestation were randomly assigned to oral sedation, 10 mg of oxycodone and 1 mg of lorazepam, or intravenous sedation, 100 micrograms fentanyl and 2 mg midazolam. All patients received 800 mg of preoperative ibuprofen and a 20-mL paracervical block with 1% lidocaine. The primary outcome was intraoperative pain as measured on a 21-point verbal rating scale that had a range from 0 to 100 (0=no pain and 100=worst pain ever) with an equivalence margin for the treatment group comparison of +/-10. RESULTS: Of 130 women, 65 were randomly assigned to oral sedation and 65 to intravenous sedation. The groups differed at baseline by age and preoperative ratings of depression, stress, and anxiety; however, when adjusted for these differences, the primary results were unaffected. Mean intraoperative pain scores, controlling for age and preoperative depression, stress, and anxiety, were 61.2 for oral sedation and 36.3 for intravenous sedation (mean difference 24.9, 95% confidence interval 15.9-33.9). Other findings included no difference in postoperative adverse effects and less satisfaction with pain control with oral sedation compared with intravenous sedation. CONCLUSION: Oral sedation, as studied, is not equivalent to intravenous sedation for pain control during first-trimester surgical abortion. CLINICAL TRIAL REGISTRATION:: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00337792 LEVEL OF EVIDENCE: I.
Language: English
Keywords:
MASSACHUSETTS | RESEARCH REPORT | CLINICAL TRIALS | COMPARATIVE STUDIES | EVALUATION INDEXES | KAP SURVEYS | PREGNANT WOMEN | ANESTHESIA | ABORTION | PREGNANCY, FIRST TRIMESTER | CURETTAGE | ADMINISTRATION AND DOSAGE | PAIN | SIDE EFFECTS | SATISFACTION | Developed Countries | United States of America | North America | Americas | Clinical Research | Research Methodology | Studies | Quantitative Evaluation | Evaluation | Surveys | Sampling Studies | Population Characteristics | Demographic Factors | Population | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Obstetrical Surgery | Surgery | Drugs | Signs and Symptoms | Diseases | Psychological Factors | Behavior
Document Number: 330360 Notification

Peer Reviewed

Title: The management of failed second-trimester termination of pregnancy.
Author: Basu JK; Basu D
Source: Contraception. 2009 Aug;80(2):170-3.
Abstract: BACKGROUND: Management of failed medical second-trimester termination of pregnancy (TOP) is a challenge with best therapy not determined. STUDY DESIGN: This was a cross-sectional study using retrospective record review of all women requesting medical TOP in the second trimester from January to June 2005. A comparative analysis was done to determine differences in demography, surgical methods and complications between two groups: (a) women who successfully aborted (first-admission group) and (b) women who failed to abort during their first admission (repeat-admission group). RESULTS: Study sample included 567 subjects [523 (92%) in the first-admission group and 44 (8%) in the repeat-admission group]. There were no significant differences in gestational age (p=.99), parity (p=.24) and previous history of cesarean section (p=.38) between the two groups. All of them successfully aborted, but the women in the repeat-admission Group 4 (9%) had more surgical interventions than those in the first-admission Group 6 (2%) (p<.0001). CONCLUSION: Failure to abort pregnancies in the second trimester with misoprostol is not uncommon. Our hospital protocol of adequate counseling and early repeat admission with good clinical selection criteria might be an alternative in a resource-constraint environment where resources and skills to perform surgical dilatation and evacuation are not available.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | COMPARATIVE STUDIES | ABORTION | MISOPROSTOL | PREGNANCY, SECOND TRIMESTER | CERVICAL DILATATION | CURETTAGE | HYSTEROTOMY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Pregnancy | Reproduction | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Surgery | Gynecologic Surgery | Urogenital Surgery
Document Number: 342391 Notification

3.
Title: [Appendix protrusion from perforation of uterus--the rare complication during abortion] Protruzia apendixu cez perforacny otvor v cervixe maternice ako zriedkava
Author: Lakyova L; Dankovcik R; Kudlac M; Mikulova J; Radonak J
Source: Ceska Gynekologie. 2009 Feb;74(1):67-9.
Abstract: AIM: Point to an extremly rare complication of a curettage during abortion and follow up surgical treatment of this complicated state. CASE: In the case of 32 years old woman, multipara, was perforated cervix uteri during the abortion curettage and fat tissue of mesentery was aspirated into canulla. Apendix vermiformis was aspirated into cannula with its protrusion through the neck of the womb during repeated revision. Surgeon made appendectomy lege artis after abdomen revision and looking after haemoperitoneum. Because of serious devastation of right fallopian tube, salpingektomy was performed. Perforation of cervix in the lenght of three cm was sutured. Extensive incomplete rupture continuing from perforation gap was sutured from ligamentum sacrouterinum I.dx to fundus uteri. Intact foetus of 5,5 week of gestation was leaved in toto because of the high risk of the womb wall disruption during repeatedly attempted abortion. CONCLUSION: In case of the suspection of the uterus injury a revision and interdisciplinary approach to the solution of complications is necessary.
Language: Slovene
Keywords:
DEVELOPING COUNTRIES | RESEARCH REPORT | ABORTION | CURETTAGE | UTERINE EFFECTS | UTERINE PERFORATION | MULTIPARITY | SURGERY | TREATMENT | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Perforations | Diseases | Parity | Fertility Measurements | Fertility | Population Dynamics | Demographic Factors | Population
Document Number: 341331

Peer Reviewed

Title: Exploring the costs and economic consequences of unsafe abortion in Mexico City before legalisation.
Author: Levin C; Grossman D; Berdichevsky K; Diaz C; Aracena B; Garcia SG
Source: Reproductive Health Matters. 2009 May;17(33):120-132.
Abstract: An assessment of abortion outcomes and costs to the health care system in Mexico City was conducted in 2005 at a mix of public and private facilities prior to the legalisation of abortion. Data were obtained from hospital staff, administrative records and patients. Direct cost estimates included personnel, drugs, disposable supplies, and medical equipment for inducing abortion or treating incomplete abortions and other complications. Indirect patient costs for travel, childcare and lost wages were also estimated. The average cost per abortion with dilatation and curettage was US $143. For manual vacuum aspiration it was US $111 in three public hospitals and US $53 at a private clinic. The average cost of medical abortion with misoprostol alone was US $79. The average cost of treating severe abortion complications at the public hospitals ranged from US $601 to over US $2,100. Increasing access to manual vacuum aspiration and early abortion with misoprostol could reduce government costs by 62%, with potential savings of up to US $1.6 million per year. Reducing complications by improving access to safe services in outpatient settings would further reduce the costs of abortion care, with significant benefits both to Mexico's health care system and women seeking abortion. Additional research is needed to explore whether cost savings have been realised post-legalisation.
Spanish Abstract: En 2005, antes de la legalizaci�n del aborto en el Distrito Federal de M�xico, se realiz� una evaluaci�n del impacto y los costos del aborto en el sistema de salud del D.F., en diversos establecimientos p�blicos y privados. Se obtuvieron datos de personal hospitalario, registros administrativos y pacientes. Los c�lculos de costos directos inclu�an personal, medicamentos, suministros desechables, y equipo m�dico para inducir el aborto o tratar abortos incompletos y otras complicaciones. Tambi�n se calcularon los costos indirectos de las pacientes en viajes, cuido de ni�os y sueldos perdidos. El costo promedio por cada aborto con dilataci�n y curetaje fue de US $143. Para la aspiraci�n manual endouterina (AMEU), fue de US $111 en tres hospitales p�blicos y US $53 en una cl�nica privada. El costo promedio del aborto inducido con misoprostol solo fue de US $79. El costo promedio de tratar las complicaciones graves del aborto en los hospitales p�blicos vari� de US $601 a m�s de US $2,100. Al ampliar el acceso a la AMEU y al aborto precoz con misoprostol, se podr�an disminuir los costos gubernamentales en un 62%, un posible ahorro de hasta US $1.6 millones al a�o. Al disminuir las complicaciones tras mejorar el acceso a los servicios seguros en �mbitos ambulatorios, disminuir�an tambi�n los costos de la atenci�n del aborto, lo cual ser�a un gran beneficio tanto para el sistema de salud de M�xico como para las mujeres que buscan servicios de aborto. A�n se necesitan m�s investigaciones para explorar si se han logrado ahorros en costos post-legalizaci�n.
French Abstract: En 2005, avant la l�galisation de l'avortement, on a �valu� les r�sultats et le co�t de l'avortement sur le syst�me sanitaire � Mexico, dans des �tablissements publics et priv�s. Les donn�es ont �t� obtenues aupr�s du personnel hospitalier et des patientes, et dans les dossiers administratifs. Les estimations directes des co�ts incluaient le personnel, les m�dicaments, les consommables et l'�quipement m�dical pour provoquer l'avortement ou traiter les avortements incomplets et d'autres complications. Les frais indirects de d�placement, de garde d'enfants et de perte de gain des patientes ont aussi �t� calcul�s. Le co�t moyen par avortement avec dilatation et curetage �tait de $US143. Par aspiration manuelle, il �tait de $US 111 dans trois h�pitaux publics et $US 53 dans une clinique priv�e. Le co�t moyen de l'avortement m�dicamenteux avec du misoprostol seul �tait de $US 79. En moyenne, le traitement des complications graves de l'avortement dans les h�pitaux publics allait de $US 601 � plus de $US 2100. Un acc�s �largi � l'aspiration manuelle et � l'avortement pr�coce au misoprostol permettrait de r�duire de 62% les co�ts gouvernementaux, avec des �conomies potentielles se chiffrant � $US 1,6 million par an. En r�duisant les complications par l'am�lioration de l'acc�s � des services ambulatoires s�rs, on diminuerait encore le co�t des soins de l'avortement, avec de nets avantages pour le syst�me de sant� mexicain et les femmes souhaitant avorter. Il faut mener des recherches suppl�mentaires pour d�terminer si des �conomies ont �t� r�alis�es apr�s l'adoption de la l�galisation.
Language: English
Keywords:
MEXICO | URBAN AREAS | RESEARCH REPORT | CLIENTS | ABORTION | ABORTION LAW | EXPENDITURES | FEES | CERVICAL DILATATION | CURETTAGE | PROGRAM ACCESSIBILITY | COST BENEFIT ANALYSIS | North America | Americas | Developing Countries | Geographic Factors | Population | Program Activities | Programs | Organization and Administration | Fertility Control, Postconception | Family Planning | Financial Activities | Economic Factors | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Surgery | Program Evaluation | Quantitative Evaluation | Evaluation
Document Number: 342021 Notification

Title: First trimester procedural abortion in family medicine.
Author: Lyus RJ; Gianutsos P; Gold M
Source: Journal of the American Board of Family Medicine. 2009 Mar-Apr;22(2):169-74.
Abstract: Unintended pregnancy is common, and in the United States almost half of all women will have at least one abortion during their lifetime. The majority of abortions are performed in the first trimester. Although advances have been made in the provision of medical abortion in the family medicine setting, procedural methods remain the cornerstone of abortion care. We present a step-wise review of first trimester procedural abortion using the manual vacuum aspirator to demonstrate the feasibility of incorporating this service into a primary care setting.
Language: English
Keywords:
UNITED STATES OF AMERICA | RECOMMENDATIONS | PREGNANCY, FIRST TRIMESTER | ABORTION | MEDICAL PROCEDURES | COUNSELING | CERVICAL DILATATION | CURETTAGE | ANALGESIA | ANESTHESIA | FETAL MEMBRANES | PRIMARY HEALTH CARE | Developed Countries | North America | Americas | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Medicine | Health Services | Delivery of Health Care | Health | Clinic Activities | Program Activities | Programs | Organization and Administration | Treatment | Obstetrical Surgery | Surgery | Fetus
Document Number: 342001 Notification

Peer Reviewed

Title: Paracervical compared with intracervical lidocaine for suction curettage: a randomized controlled trial.
Author: Mankowski JL; Kingston J; Moran T; Nager CW; Lukacz ES
Source: Obstetrics and Gynecology. 2009 May;113(5):1052-7.
Abstract: OBJECTIVE: To estimate the efficacy of paracervical compared with intracervical administration of local anesthesia during first-trimester suction curettage. METHODS: A double-blind, randomized controlled trial comparing paracervical with intracervical lidocaine was performed in women undergoing elective first-trimester suction curettage with conscious sedation. Pain was assessed at baseline, with dilation, and with curettage using a 10-cm visual analog scale (VAS). Assuming a minimal clinically important difference in pain score of 1.6 cm and a mean pain score (+/-standard deviation [SD]) of 4.7 (+/-2.9) cm for paracervical block, 120 patients would provide 80% power with an alpha of .05. RESULTS: For the 132 women randomly assigned, no significant differences in VAS scores (mean+/-SD) were observed between paracervical and intracervical blocks during dilation (2.6+/-2.3 compared with 2.8+/-2.2, P=.72) or curettage (3.9+/-2.9 compared with 3.3+/-2.5, P=.16). CONCLUSION: For women undergoing first-trimester suction curettage with conscious sedation, there was no clinically meaningful difference in pain relief between paracervical and intracervical lidocaine. Providers should feel confident that both techniques provide equally effective and acceptable analgesia.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | COMPARATIVE STUDIES | PREGNANCY, FIRST TRIMESTER | CURETTAGE | ABORTION | OBSTETRICAL SURGERY | CONTRACEPTIVE USE-EFFECTIVENESS | PAIN | Developed Countries | North America | Americas | Studies | Research Methodology | Pregnancy | Reproduction | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Contraceptive Effectiveness | Contraception | Signs and Symptoms | Diseases
Document Number: 341343

7.
Title: Sonographic appearances of the endometrium after termination of pregnancy in asymptomatic versus symptomatic women.
Author: McEwing RL; Anderson NG; Meates JB; Allen RB; Phillipson GT; Wells JE
Source: Journal of Ultrasound In Medicine. 2009 May;28(5):579-86.
Abstract: OBJECTIVE: The purpose of this study was to describe normal sonographic appearances of the endometrium in asymptomatic women after elective termination of pregnancy (TOP) and to determine whether sonographic findings are discriminatory in symptomatic women after TOP. METHODS: Sonographic parameters were compared in prospectively recruited women after elective TOP. The first 38 were asymptomatic. In a later group, 105 had symptoms suggestive of retained products of conception (RPOC). Endometrial thickness, cavity irregularity, echogenicity of cavity contents, color Doppler flow, and resistive indices (RIs) were assessed. In the symptomatic group, sonographic findings were correlated with symptoms and histologic results. RESULTS: There was a marked overlap in sonographic appearances between the groups. The endometrial cavity is commonly irregular and thickened and may show prominent color Doppler flow in women with an uneventful course as well as in women with histologically proven RPOC. Differences between asymptomatic and symptomatic women were only seen for: endometrial thickness (10.8 mm [range, 1-29 mm] versus 15.3 mm [range, 1.8-34 mm]; P = .0005), and cavity irregularity was greater in symptomatic women (P = .001). Color Doppler flow mean RIs were similar. Symptoms were similar in women proceeding to curettage versus no curettage; no significant relationship was found between individual symptoms and sonographic parameters. Chorionic villi were seen in 47 of 56 women (84%) with positive histologic results. CONCLUSIONS: Sonographic appearances and symptoms correlate poorly with each other and with histologic results. Sonography has limited benefits in triaging women with suspected RPOC after TOP in the first trimester. Our findings support a more conservative approach to suspected RPOC after TOP.
Language: English
Keywords:
NEW ZEALAND | RESEARCH REPORT | COMPARATIVE STUDIES | CLIENTS | PREGNANCY, FIRST TRIMESTER | ABORTION | CURETTAGE | PRODUCTS OF CONCEPTION, RETENTION | SIGNS AND SYMPTOMS | ENDOMETRIAL EFFECTS | ULTRASONICS | HISTOLOGY | Oceania | Developed Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Pregnancy Complications | Diseases | Endometrium | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology
Document Number: 341998 Notification

Peer Reviewed

Title: First-trimester surgical abortion practices: a survey of National Abortion Federation members.
Author: O'Connell K; Jones HE; Simon M; Saporta V; Paul M; Lichtenberg ES
Author: National Abortion Federation Members
Source: Contraception. 2009 May;79(5):385-92.
Abstract: BACKGROUND: Designated providers in specialized clinics perform the majority of approximately 1.1 million first-trimester abortions carried out in the United States each year. Our objective was to assess the first-trimester surgical abortion practices of National Abortion Federation (NAF) members. STUDY DESIGN: We mailed questionnaires to NAF administrators and providers at their 364 active-member facilities in 2002. RESULTS: Two hundred eighty-nine (79%) facilities responded; we received administrative questionnaires from 273 facilities and 293 individual clinicians. NAF facilities provided at least 325,000 first-trimester surgical abortions in the United States in 2001. The majority of providers are obstetrician-gynecologists (63%), male (62%) and at least 50 years old (64%). Half of clinicians (49%) selectively utilize manual vacuum aspiration. Almost half (47%) routinely use a metal curette to verify procedure completion; these providers are more likely to be over 50 years of age or to have 20 years or more of abortion experience. Other practices are more uniform, including routine tissue examination (93%), postoperative antibiotics (88%) and contraceptive provision (oral contraceptives, 99%; depot medroxyprogesterone acetate, 79%). CONCLUSIONS: Most perioperative practices for first-trimester abortions are similar among these respondents, in accord with evidence-based guidelines. The aging of skilled practitioners raises concerns about the future availability of surgical abortion.
Language: English
Keywords:
CANADA | UNITED STATES OF AMERICA | RESEARCH REPORT | ABORTION | PREGNANCY, FIRST TRIMESTER | CURETTAGE | CERVICAL DILATATION | SURGERY | Developed Countries | North America, Northern | Americas | North America | Fertility Control, Postconception | Family Planning | Pregnancy | Reproduction | Obstetrical Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342084 Notification

9.
Title: Artificial abortions performed at the University Clinical Centre of Kosovo from January 2005 to December 2007.
Author: Pacarada M; Kongjeli N; Kongjeli G; Obertinca B
Source: Medicinski Arhiv. 2009;63(2):87-9.
Abstract: The objective of this study was to determine the number of abortions performed at the Clinic of Gynecology and Obstetrics at the University Clinical Centre of Kosovo (UCCK) in Prishtina, Kosovo, from January 2005 to December 2007. We performed a retrospective epidemiological study of 1079 artificial abortions based on patient records. In total, 39% of the patients were from Prishtina. In terms of age, 51.5% of the women who received abortions were 20-35 years old. In terms of gravidity, 43% of the patients had more than four previous deliveries, whereas 7.7% of the patients were pregnant for the first time. The majority of abortions were performed at 7-9 gestational weeks via dilation followed by suction curettage (vacuum aspiration) or curettage with sharp instruments. The number of abortions per annum decreased from 486 in 2005 to 293 in 2007.
Language: English
Keywords:
EUROPE, SOUTHEASTERN | RESEARCH REPORT | EPIDEMIOLOGY | RETROSPECTIVE STUDIES | YOUTH | WOMEN | AGE FACTORS | ABORTION | ABORTION RATE | CURETTAGE | Europe | Developing Countries | Public Health | Health | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care
Document Number: 342403 Notification

11.

Peer Reviewed

Title: Second-trimester pregnancy termination with 600-microg vs. 400-microg vaginal misoprostol and systematic curettage postexpulsion: a randomized trial.
Author: Carbonell JL; Torres MA; Reyes R; Ortega L; Garcia-Gallego; Sanchez C
Source: Contraception. 2008 Jan;77(1):50-55.
Abstract: This study was conducted to compare efficacy and safety of 600 mcg of misoprostol vaginally every 6 h up to four doses vs. 400 mcg of misoprostol vaginally every 4 h up to five doses, followed by systematic curettage of the uterine cavity, for pregnancy termination between 12 and 20 weeks' gestation. We used a randomized clinical trial conducted at Hospital Gineco-Obstetrico "Eusebio Hernandez", Havana, Cuba. Subjects were women requesting voluntary termination of pregnancies between 12 and 20 weeks' gestation. Two hundred ten women were randomly assigned to receive 600 mcg of vaginal misoprostol every 6 h up to four doses (Group I) vs. 400 mcg of vaginal misoprostol every 4 h up to five doses (Group II), followed by curettage 1 h after expulsion. The main outcomes measured were successful abortion rate and mean expulsion time. Successful abortion occurred in 103/105 women (98.1%) in Group I and in 99/105 (94.3%) in Group II [p=.279, relative risk (RR)=3.121 and 95% confidence interval for RR=0.615 to 15.833]. Fetus mean expulsion time was 10.7+or-1.3 (SD) h in Group I and 11.5+or-5.0 (SD) h in Group II (p=.209). Six hundred micrograms of misoprostol administered vaginally every 6 h was as effective as 400 mcg of misoprostol every 4 h for second-trimester pregnancy termination. (author's)
Language: English
Keywords:
SPAIN | CUBA | RESEARCH REPORT | CLINICAL TRIALS | PREGNANT WOMEN | PREGNANCY, SECOND TRIMESTER | MISOPROSTOL | CURETTAGE | ADMINISTRATION AND DOSAGE | Europe, Southwestern | Europe | Developed Countries | Developing Countries | Caribbean | Americas | Clinical Research | Research Methodology | Population Characteristics | Demographic Factors | Population | Pregnancy | Reproduction | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs
Document Number: 323059

12.

Peer Reviewed

Title: Validity of pipelle endometrial sampling in patients with abnormal uterine bleeding.
Author: Fakhar S; Saeed G; Khan AH; Alam AY
Source: Annals of Saudi Medicine. 2008 May-Jun;28(3):188-191.
Abstract: The authors compared endometrial sampling by pipelle endometrial curette with conventional dilatation and curettage (D&C) in patients with abnormal uterine bleeding. Endometrial sampling with pipelle curette was performed on 100 patients followed by formal D&C. Samples were labeled as A and B, respectively, and sent to a histopathologist who was blinded as to the method of sampling. The histopathology reports of both samples were compared, taking D&C as the gold standard. An adequate sample was obtained in 98% of cases by pipelle and in 100% of cases by D&C. Pipelle had a sensitivity, specificity, positive predictive value and negative predictive value of 100% for diagnosing endometrial carcinoma, hyperplasia and secretory endometrium. Pipelle also had high diagnostic sensitivity, specificity and negative predictive value (100%, 98% and 100%, respectively) for hyperplasia with atypia, and low sensitivity (57%) and positive predictive value (57%), but high specificity (97%) and negative predictive value (97%) for endometritis. Similarly, for proliferative endometrium, the pipelle technique had values of 94% and 93% for sensitivity and specificity, respectively. Both samples labeled as inadequate for histology by pipelle were polyps on the D&C report. Difficult endotracheal intubation was encountered in two cases of D&C. No other complications of the procedure were observed. The pipelle is a safe device for getting an adequate endometrial sample for histology, with a high sensitivity and specificity for detection of hyperplasia and malignancy.
Language: English
Keywords:
PAKISTAN | RESEARCH REPORT | METHODOLOGICAL STUDIES | CLINICAL RESEARCH | COMPARATIVE STUDIES | WOMEN IN DEVELOPMENT | ENDOMETRIAL EFFECTS | BLEEDING | CURETTAGE | VALIDITY | PHYSICAL EXAMINATIONS AND DIAGNOSES | ENDOMETRIAL CANCER | UTERUS | Developing Countries | Asia, Southern | Asia | Research Methodology | Studies | Economic Development | Economic Factors | Endometrium | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Signs and Symptoms | Diseases | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Measurement | Examinations and Diagnoses | Cancer | Neoplasms
Document Number: 327457

13.

Title: Previous history of surgically induced abortion and complications of the third stage of labour in subsequent normal vaginal deliveries.
Author: Haldre K; Rahu K; Karro H; Rahu M
Source: Journal of Maternal-Fetal and Neonatal Medicine. 2008 Dec;21(12):884-8.
Abstract: OBJECTIVE: To estimate the risk of complications of the third stage of labour needing manual revision of uterine cavity or curettage in deliveries following one or multiple induced abortions in nulliparous women who had singleton live births in Estonia in 1994-2002. METHODS: Registry study using the data from the Estonian medical birth registry: 32,652 women had not had any abortions, 7,333 women had had one and 2,383 women had had two or more surgically induced abortions before their first delivery. Multiple logistic regression analysis was performed to estimate crude odds ratios (OR), adjusted ORs and their 95% confidence intervals, with women having had no abortions as the reference group. Adjustment was made for maternal age, sex and weight of infant, labour induction/augmentation. RESULTS: In the single abortion group, the crude OR was 1.25 (95% confidence intervals (CI) 1.12-1.40), the adjusted OR was 1.23 (95% CI 1.10-1.38); in the multiple abortion group the crude OR was 1.28 (95% CI 1.06-1.53), the adjusted OR was 1.24 (95% CI 1.03-1.49). CONCLUSIONS: Our findings suggest a positive association between one or more first trimester abortion(s) and the risk of complications in the third stage of labour in subsequent singleton delivery.
Language: English
Keywords:
ESTONIA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | MULTIVARIATE ANALYSIS | CASE CONTROL STUDIES | PREGNANT WOMEN | PREVALENCE | CHILDBIRTH | ABORTION | PREGNANCY COMPLICATIONS | CURETTAGE | BLEEDING | POSTPARTUM | Europe, Eastern | Europe | Developing Countries | Research Methodology | Data Analysis | Studies | Population Characteristics | Demographic Factors | Population | Measurement | Pregnancy Outcomes | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Diseases | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Signs and Symptoms | Puerperium
Document Number: 330725 Notification

14.

15.

Peer Reviewed

Title: Microchimerism after induced or spontaneous abortion.
Author: Sato T; Fujimori K; Sato A; Ohto H
Source: Obstetrics and Gynecology. 2008 Sep;112(3):593-7.
Abstract: OBJECTIVE: To investigate fetomaternal microchimerism in women with induced abortion or spontaneous pregnancy loss. METHODS: Peripheral blood samples were obtained from 76 healthy women who underwent dilation and curettage in the first trimester but had never had an abortion or male delivery before. Samples were collected at three time points: just before, 7 days after, and 30 days after abortion. Y chromosome-specific, nested polymerase chain reaction targeting the sex-determining region of Y (SRY) was used to test DNA extracted from buffy coat cells. DNA was also extracted from the chorion to determine sex. The sensitivity of our assay allowed detection of approximately one male cell in 100,000 female cells. RESULTS: Thirty-six male and 40 female chorions were obtained. Male DNA was found in 52.8% of women who had a male chorion before abortion, decreasing to 5.6% at 7 days after abortion. At 30 days after abortion, no male DNA was detected. Male DNA was never detected at any point from women with a female chorion. CONCLUSION: Fetal cells in the maternal circulation are undetectable 30 days after induced abortion or spontaneous pregnancy loss. Fetal cells may be harbored in maternal organs.
Language: English
Keywords:
JAPAN | RESEARCH REPORT | CLINICAL RESEARCH | GENETIC TECHNIQUES | WOMEN | FETUS | ABORTION | ABORTION, SPONTANEOUS | CURETTAGE | POSTABORTION | SEX FACTORS | GONADOTROPINS, CHORIONIC | GENETICS | CYTOLOGY | Asia, Eastern | Asia | Developed Countries | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Demographic Factors | Population | Pregnancy | Reproduction | Fertility Control, Postconception | Family Planning | Pregnancy Complications | Diseases | Obstetrical Surgery | Surgery | Treatment | Population Characteristics | Gonadotropins | Hormones | Endocrine System | Physiology | Biology
Document Number: 329052 Notification

16.

Peer Reviewed

Title: Multivalvular bacterial endocarditis after suction curettage abortion [letter]
Author: Tocce K; Teal SB
Source: Obstetrics and Gynecology. 2008 Nov;112(5):1179; author reply 1180-1.
Abstract: Dr. Jeppson et al recently reported a young, apparently healthy woman who developed endometritis after an elective abortion at 16 weeks of gestation. She later developed bacterial endocarditis and subsequently died. The patient's prophylaxis against endometritis was a postoperative prescription for doxycycline twice daily for 3 days. The authors conclude that this case highlights the importance of administering the "correct antibiotic prophylaxis for surgical site-related infections no more than 1 hour before or at the time of surgery." They reason that if the patient's risk of endometritis was decreased, it may have decreased the risk of endocarditis. The American Heart Association (AHA) does not recommend antibiotic prophylaxis for infective endocarditis prevention for genitourinary procedures because "no studies exist that demonstrate that the administration of antimicrobial prophylaxis prevents [infective endocarditis] in association with procedures performed on the [gastrointestinal] or [genitourinary] tract." Likewise, the National Institute for Health and Clinical Excellence (United Kingdom) no longer recommends antibiotic prophylaxis to prevent infective endocarditis during gynecologic procedures. Unfortunately, no definitive "correct antibiotic prophylaxis" exists to prevent postabortal endometritis. The study cited to support the authors' recommended timing of antibiotics analyzed major orthopedic, colon, and vascular surgeries in a Veteran's Administration setting. The cited meta-analysis examined 12 studies using 10 different antibiotic regimens. The American College of Obstetricians and Gynecologists Practice Bulletin Number 74 suggests two regimens for antimicrobial prophylaxis during induced abortion/dilation and curettage: oral doxycycline 100 mg 1 hour preoperatively and 200 mg postoperatively or metronidazole 500 mg twice daily for 5 days (postoperative therapy only). Case reports that propose wide-ranging conclusions based on a single, rare, unfortunate outcome are unhelpful. Contrary to the authors' statements, there is no consensus that postabortal endometritis prophylaxis must be administered pre-procedure, and expert consensus from the AHA that abortion does not warrant endocarditis prophylaxis. We will stick to AHA guidelines for prevention of endocarditis and await further controlled research on regimens to prevent postabortal endometritis. (full-text)
Language: English
Keywords:
UNITED STATES OF AMERICA | CRITIQUE | WOMEN | ENDOMETRIOSIS | ABORTION | ANTIBIOTICS | CURETTAGE | POSTABORTION CARE | Developed Countries | North America | Americas | Demographic Factors | Population | Diseases | Fertility Control, Postconception | Family Planning | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Surgery
Document Number: 329437 Notification

17.

Peer Reviewed

Title: Diagnosis of uteroperitoneal fistula through color Doppler hysterosonography.
Author: Guimaraes Filho HA; da Costa LL; Araujo Junior E; Zanforlin Filho SM; Pires CR
Source: Archives of Gynecology and Obstetrics. 2007 Jul;276(1):85-86.
Abstract: Uterine fistulas are infrequent pathologic entities characterized by abnormal communication of the uterus with any other organ or structure through a perforation formed due to traumatic and infectious conditions among others. The use of hysterosonography as method of diagnosis for that pathologic entity has few descriptions in medical literature. MEDLINE search resulted in only two cases reporting the use of HS in the diagnosis of uterine fistula. Our objective is to report a case of uteroperitoneal fistula caused by uterine trauma during curettage, diagnosed by color Doppler hysterosonogrphy. The importance of our report lies on HS as a simple, safe and low cost method, which can be used for the diagnosis of fistulous processes involving the uterus. (author's)
Language: English
Keywords:
BRAZIL | RESEARCH REPORT | PREGNANT WOMEN | CURETTAGE | ABORTION | MENSTRUATION DISORDERS | ULTRASONICS | EXAMINATIONS AND DIAGNOSES | UTERUS | PERITONEAL DISEASES | FISTULA | South America, Eastern | South America | Latin America | Americas | Developing Countries | Population Characteristics | Demographic Factors | Population | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Fertility Control, Postconception | Family Planning | Diseases | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology
Document Number: 317652 Notification

18.

Peer Reviewed

Title: Spontaneous uterine rupture during pregnancy: Case report and review of literature.
Author: Nkwabong E; Kouam L; Takang W
Source: African Journal of Reproductive Health. 2007 Aug;11(2):98-103.
Abstract: Rupture of a gravid uterus is a surgical emergency. Predisposing factors include a scarred uterus. Spontaneous rupture of an unscarred uterus during pregnancy is a rare occurrence. We hereby present the case of a spontaneous complete uterine rupture at a gestational age of 34 weeks in a 35 year old patient. The case was managed at the University Teaching Hospital of Yaounde (Cameroon). She had past history of two uterine curettages. She presented with abdominal pain of sudden onset. After ultrasound scan, uterine rupture was diagnosed and an emergency laparotomy done. The entire amniotic sac was found in the peritoneal cavity with a rupture of the uterine fundus. Spontaneous uterine rupture occurs when there is an upper segment uterine scar. This case report shows that past history of curettage is a risk factor for the presence of uterine scar. (author's)
Language: English
Keywords:
CAMEROON | LITERATURE REVIEW | RESEARCH REPORT | CASE STUDIES | PREGNANT WOMEN | UTERINE EFFECTS | UTERINE PERFORATION | PREGNANCY COMPLICATIONS | CURETTAGE | RISK FACTORS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Uterus | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Perforations | Diseases | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 323807

19.
Peer Reviewed

Title: Abortion: An open secret? Abortion and social network involvement in Burkina Faso.
Author: Rossier C
Source: Reproductive Health Matters. 2007 Sep;15(30):230-238.
Abstract: Abortion in Burkina Faso is a subject that neither abortion providers nor women want to talk about. Abortion providers fear criminal prosecution; women's silence is dictated more by the wish to avoid the stigma of a "shameful" pregnancy. Qualitative investigations in Burkina Faso among 13 key informants in a rural village in 2000 and 30 women and men aware of experience of abortion in the capital Ouagadougou in 2001, explored two paradoxes: what prompts women and providers to reveal something they want to be kept totally secret, and how do women keep their abortion secret while nevertheless talking to others about it? The study found that young women in Burkina Faso are impelled to talk to their boyfriends, friends and in fewer cases women relatives about their unplanned pregnancy, first to decide to have an abortion and then to get help in finding a clandestine provider. Abortion is also kept secret because it is a subject on which there is no social consensus, alongside extra-marital sexual activity, contraceptive use by young people and out-of-wedlock pregnancies. The key to keeping a secret lies in the choice of those with whom to share it; good confidants are those who are bound by secrecy through the bonds of intimacy or shared transgression. (author's)
Language: English
Keywords:
BURKINA FASO | RESEARCH REPORT | QUALITATIVE RESEARCH | ABORTION | ABORTION LAW | CURETTAGE | PREGNANCY, UNPLANNED | SOCIAL NETWORKS | BELIEFS | CULTURE | RUMORS | TABOO | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Reproductive Behavior | Fertility | Population Dynamics | Demographic Factors | Population | Friends and Relatives | Family and Household | Sociocultural Factors | Communication
Document Number: 321387

20.

Peer Reviewed

Title: Plastic suction curette as uterine manipulator at combined laparoscopicsterilization: A prospective study of 531 cases.
Author: Banerjee AK; Emembolu JO
Source: European Journal of Contraception and Reproductive Health Care. 2006 Dec;11(4):310-313.
Abstract: The objective was to determine the efficacy and safety of a plastic suction curette (PSC) as uterine manipulator during combined surgical abortion and laparoscopic sterilization. This prospective observational study was conducted between January 1996 and December 2003 in a university teaching hospital and a district hospital. All cases of combined first trimester surgical abortion and laparoscopic sterilization were performed under general anaesthesia in the day surgery unit. A straight or curved PSC with a diameter of 7-12 mm was used for surgical abortion and, afterwards, to manipulate the uterus at laparoscopic sterilization. The negative pressure of 600 mmHg or -80 kPa was maintained during manipulation. Any intra-operative trauma or difficulties in identifying the tubes and blood loss during sterilization were noted. A total of 531 cases of combined abortion and laparoscopic sterilization were performed. There was no failure to identify the tubes nor any uterine perforation; blood loss was minimal. No patient required hospital admission because of direct surgical complications. The plastic suction curette is a safe and efficient uterine manipulator at combined laparoscopic sterilization procedure. (author's)
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | PROSPECTIVE STUDIES | PREGNANT WOMEN | LAPAROSCOPY | FEMALE STERILIZATION | CURETTAGE | UTERUS | UTERINE PERFORATION | SAFETY | ABORTION | Europe, Western | Europe | Developed Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Endoscopy | Physical Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Sterilization, Sexual | Family Planning | Obstetrical Surgery | Surgery | Treatment | Genitalia, Female | Genitalia | Urogenital System | Physiology | Biology | Perforations | Diseases | Public Health | Fertility Control, Postconception
Document Number: 314575 Notification

21.
Title: Women's preferences for misoprostol in case of early pregnancy failure.
Author: Graziosi GC; Bruinse HW; Reuwer PJ; Mol BW
Source: European Journal of Obstetrics, Gynecology and Reproductive Biology. 2006 Feb 1;124(2):184-186.
Abstract: The aim of this study was to assess the preference of women with early pregnancy failure for treatment with misoprostol as compared to curettage. Women with early pregnancy failure were interviewed and asked whether they were motivated to trade a non-invasive but potentially less effective treatment with misoprostol at the virtually 100% guarantee of complete evacuation after curettage. All women had a structured interview, in which they were informed about both treatment options. The women were asked for a treatment preference in case the complete evacuation rate after misoprostol was set at 100%. In case the women preferred misoprostol, the complete evacuation rate was subsequently decreased to 10% using steps of 5%. The study group consisted of 64 women with early pregnancy failure. Seven women (11%) did not opt for misoprostol at all, because of fear of pain or bleeding using misoprostol. Fifty percent of the women would prefer misoprostol if its complete evacuation rate exceeds 65%. A majority of women would prefer misoprostol over curettage if its complete evacuation rate exceeds 65%. (author's)
Language: English
Keywords:
NETHERLANDS | RESEARCH REPORT | INTERVIEWS | WOMEN | ABORTION, SPONTANEOUS | TREATMENT | MISOPROSTOL | CURETTAGE | Europe, Western | Europe | Developed Countries | Data Collection | Research Methodology | Demographic Factors | Population | Pregnancy Complications | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Obstetrical Surgery | Surgery
Document Number: 296806

22.
Peer Reviewed

Title: A lost intrauterine device. Guess where we found it and how it happened?
Author: M�layim B; M�layim S; Celik NY
Source: European Journal of Contraception and Reproductive Health Care. 2006 Mar;11(1):47-49.
Abstract: Perforation of the uterus by an intrauterine device (IUD) is a serious complication occurring at or following 1/350 to 1/2500 insertions. It is more common among women with 'lost' IUDs. If a woman presents with pelvic pain and a history of a 'lost' IUD, X-rays of the abdomen and of the pelvis should be ordered. We report on a 'lost' IUD that had been inserted 12 years previously. It was found in the lower anterior abdominal wall. Most probably uterine perforation had happened during a dilatation and curettage (D & C) attempted for removal of the device. Thereafter the IUD must have migrated to the abdominal wall. This case illustrates that unless it can be recovered by simple traction on the threads, a trained medical professional should be called upon for removal of the IUD. (author's)
Language: English
Keywords:
TURKEY | RESEARCH REPORT | CLINICAL RESEARCH | CASE STUDIES | WOMEN | IUD MIGRATION | COMPLICATIONS | UTERINE PERFORATION | CURETTAGE | Europe, Southeastern | Europe | Developing Countries | Research Methodology | Studies | Demographic Factors | Population | IUD | Contraceptive Methods | Contraception | Family Planning | Diseases | Perforations | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 295020

23.

Title: [Comparative study of manual vacuum aspiration and uterine curettage for treatment of abortion] Tratamento do abortamento incompleto por aspiracao manual ou curetagem.
Author: Pereira PP; de Oliveira AL; Cabar FR; Armelin AR; Maganha CA
Source: Revista da Associacao Medica Brasileira. 2006 Sep-Oct;52(5):304-307.
Abstract: The objectives were to compare manual vacuum aspiration (MVA) and uterine curettage (D&C) for first trimester abortions, in terms of the efficiency of eliminating ovular remnants, frequency of complications, duration of the procedure, and duration of patients' hospitalization. In a prospective study, 50 patients in the MVA group and 50 in the D&C group were randomly included. Inclusion criteria were: spontaneous abortion, gestational age less than 13 weeks, patent cervix, endometrial thickness >15 mm, afebrile state, and hemoglobin >10 g/dl. Blood samples were collected before and after surgical procedures for control of hemoglobin levels. Anesthesia was performed in all cases. The time required for each surgical procedure was recorded. Groups were similar regarding gestational age (9.93 � 2.40 vs 9.73 � 2.58 weeks; p = 0.71) and endometrial thickness before surgery (22.14 � 4.80 vs 22.68 � 5.68 mm; p = 0.65). There were no surgical or anesthetic complications in either group. Durations of the procedure and of hospitalization were significantly shorter in the MVA group (3.71 vs 10.18 min, p < 0.001, and 14.18 vs 23.06 h, p = 0.03, respectively). Decrease of hemoglobin levels was greater after the surgical procedure in the D&C group (p = 0.02). MVA caused less blood loss, was less time consuming, and resulted in shorter hospitalization. However, both surgical procedures were found to be efficient for treatment of incomplete abortions during the first trimester of pregnancy, with no complications after both treatments. (author's)
Language: Portuguese
Keywords:
RESEARCH REPORT | COMPARATIVE STUDIES | WOMEN | ABORTION | CURETTAGE | PREGNANCY, FIRST TRIMESTER | HEMOGLOBIN LEVEL | Studies | Research Methodology | Demographic Factors | Population | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Pregnancy | Reproduction | Hemic System | Physiology | Biology
Document Number: 316295 Notification

24.

Title: Bolivia and Mexico: System-wide planning is needed for decentralized postabortion care. [Bolivia y M�xico: para descentralizar la atenci�n postaborto se requiere una planificaci�n que contemple todo el sistema]
Author: Population Council. Frontiers in Reproductive Health
Source: Washington, D.C., Population Council, Frontiers in Reproductive Health, 2005 Feb. 3 p. (OR Summary No. 49)
Abstract: Sharp curettage and manual vacuum aspiration, the most common treatments for incomplete abortion in developing countries, are equally safe and effective and can be provided on an outpatient basis. Integrating clinical treatment with family planning counseling and services increased clients� knowledge and contraceptive use. However, integrated postabortion care requires a strategic approach that examines system-wide requirements for care. (author's)
Spanish Abstract: El legrado y la vacuoextracci�n manual, los tratamientos del aborto incompleto m�s difundidos en los pa�ses en v�as de desarrollo, son igualmente seguros y efectivos y pueden practicarse en forma ambulatoria. La integraci�n del tratamiento cl�nico con el asesoramiento y los servicios de planificaci�n familiar mejoraron el conocimiento y aumentaron el uso de anticonceptivos entre los clientes. Sin embargo, la atenci�n postaborto integrada requiere un m�todo estrat�gico que analice los requerimientos de atenci�n en la totalidad del sistema. (del autor)
Language: English
Keywords:
BOLIVIA | MEXICO | RESEARCH REPORT | CROSS-CULTURAL COMPARISONS | WOMEN IN DEVELOPMENT | DECENTRALIZATION | ABORTION | CURETTAGE | POSTABORTION CARE | INTEGRATED PROGRAMS | FAMILY PLANNING POLICY | HEALTH POLICY | PAIN | Developing Countries | South America, Central | South America | Latin America | Americas | North America | Comparative Studies | Studies | Research Methodology | Economic Development | Economic Factors | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Health Services | Delivery of Health Care | Health | Programs | Organization and Administration | Population Policy | Social Policy | Policy | Signs and Symptoms | Diseases
Document Number: 291032 Notification

26.
Peer Reviewed

Title: Misoprostol versus curettage in women with early pregnancy failure: impact on women's health-related quality of life. A randomized controlled trial.
Author: Graziosi GC; Bruinse HW; Reuwer PJ; van Kessel PH; Westerweel PE
Source: Human Reproduction. 2005;20(8):2340-2347.
Abstract: We aimed to compare patients� health-related quality of life after a misoprostol strategy to a curettage in women with early pregnancy failure after failed expectant management. A multicentre randomized clinical trial was performed in The Netherlands. In all, 154 women with early pregnancy failure con- firmed at ultrasonography who had been managed expectantly unsuccessfully for $1 week were randomly assigned to undergo either treatment with misoprostol (n 5 79) or curettage (n 5 75). The main outcome measures were health-related quality of life and satisfaction with treatment. In the misoprostol strategy 47% of the women needed additional curettage, as compared to 4% after curettage. In both groups, health-related quality of life was impaired most severely 2 days after treatment. In the misoprostol group, health-related quality of life was more severely impaired; after 2 days this was due to more pain and after 2 and 6 weeks this was due to a worse general health perception. Health-related quality of life was temporarily significantly more impaired in women in whom misoprostol failed as compared to women in whom misoprostol treatment was successful. In both treatment groups, an equal percentage of women (58%) would choose the same treatment in the future. In women treated with misoprostol, however, this choice depended on the initial success of misoprostol: in cases where misoprostol had caused complete evacuation, 76% of the women would opt for the same treatment, whereas only 38% of women who needed curettage after unsuccessful misoprostol would do so (P < 0.01). Our study shows that, although both the misoprostol strategy and the curettage strategy resulted in complete evacuation in the end, women are willing to accept some disadvantages of misoprostol to avoid curettage. A treatment inconvenience using misoprostol is accepted as long as initial evacuation rate is high. This finding should be an integral part of counselling women when deciding upon management of early pregnancy failure. (author's)
Language: English
Keywords:
NETHERLANDS | RESEARCH REPORT | CLINICAL TRIALS | PREGNANT WOMEN | PREGNANCY, FIRST TRIMESTER | FETAL DEATH | MISOPROSTOL | CURETTAGE | ABORTION | MATERNAL HEALTH | SATISFACTION | QUALITY OF LIFE | Europe, Western | Europe | Developed Countries | Clinical Research | Research Methodology | Population Characteristics | Demographic Factors | Population | Pregnancy | Reproduction | Mortality | Population Dynamics | Prostaglandins, Synthetic | Prostaglandins | Endocrine System | Physiology | Biology | Obstetrical Surgery | Surgery | Treatment | Fertility Control, Postconception | Family Planning | Health | Psychological Factors | Behavior | Social Welfare | Economic Factors
Document Number: 288756 Notification

27.
Peer Reviewed

Title: Adenosine deaminase activity in serum and placenta of patients with anembryonic pregnancies and missed abortions.
Author: Kutlar I; Aksoy F; Koyluoglu O; Ugur MG; Balat O
Source: Archives of Gynecology and Obstetrics. 2005 Aug;272(2):124-126.
Abstract: The aim of this study is to assess adenosine deaminase (ADA) activity in the serum and placenta of patients with missed abortions, anembryonic pregnancies, and voluntary abortions. Nine cases of anembryonic pregnancies and 21 cases of missed abortions (group I, n = 30), and voluntary dilatation and curettage cases (group II, n = 30) were included in this prospective study. Adenosine deaminase activity in serum and placental tissue was measured according to the Giusti method. The t-test was applied for statistical evaluation with the help of SPSS 9.0. The mean serum ADA level in the abortion cases (group I) was 9.13 � 1.59 U/l, while it was 17.06 � 6.5 U/l in the control group (group II; p < 0.05). Also, the mean placental ADA levels in abortion cases and in the control group were 11.8 � 4.7 nmol/mg protein/min and 25.8 � 6.6 nmol/mg protein/min respectively (p < 0.05). These results suggest that ADA may have a modulatory role in the implantation and duration of pregnancy. Low levels of ADA in early pregnancy may lead to an accumulation of products toxic to DNA and to the subsequent loss of the pregnancy. (author's)
Language: English
Keywords:
TURKEY | RESEARCH REPORT | CLINICAL RESEARCH | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | PREGNANCY COMPLICATIONS | ABORTION | CURETTAGE | GENETICS | Europe, Southeastern | Europe | Developing Countries | Research Methodology | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Diseases | Fertility Control, Postconception | Family Planning | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Biology
Document Number: 298232 Notification

28.
Peer Reviewed

Title: Attitudes and practices of private medical providers towards family planning and abortion services in Nigeria.
Author: Okonofua FE; Shittu SO; Oronsaye F; Ogunsakin D; Ogbomwan S
Source: Acta Obstetrica et Gynecologica Scandinavica. 2005;84:270-280.
Abstract: The study was designed to investigate the attitudes and practices of private medical practitioners towards abortion, postabortion care and postabortion family planning in Nigeria. Three hundred and twenty-three private practitioners who were proprietors of private clinics in three states of the country were interviewed with a structured questionnaire that elicited information on their knowledge and experiences of abortion and postabortion care in the cities. Twenty-four percent of the doctors reported that they routinely terminate unwanted pregnancies when requested to do so by women, while 82% reported that they frequently treat women who experience complications of unsafe abortion. Over 45% reported that they use manual vacuum aspiration (MVA) for the management of abortion in the first trimester, while 25% use dilatation and curettage (D&C). Nearly 28% reported the use of MVA followed by D&C in the first trimester. Fifty-seven percent reported their lack of expertise in managing second-trimester abortions, while those admitting that they manage second-trimester abortions reported nonstandard methods and procedures. In addition, there was evidence of inadequate counseling of women, lack of institutional protocols and poor use of postabortion family planning by the doctors. These results suggest the need for a program of retraining of private practitioners on the principles and practices of safe abortion, postabortion care and family planning in Nigeria and the integration of these topics into medical training curricula in the country. (author's)
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | KAP SURVEYS | PHYSICIANS | FAMILY PLANNING | ABORTION | REPRODUCTIVE HEALTH | POSTABORTION CARE | PRIVATE SECTOR | CURETTAGE | SEXUALLY TRANSMITTED DISEASE PREVENTION | Africa, Western | Africa, Sub Saharan | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Fertility Control, Postconception | Health Services | Macroeconomic Factors | Economic Factors | Obstetrical Surgery | Surgery | Treatment | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases
Document Number: 282052 Notification

29.
Peer Reviewed

Title: Prospective randomized, double-blinded, placebo-controlled trial of preoperative rofecoxib for pain relief in uterine curettage.
Author: Poomtavorn Y; Phupong V
Source: Archives of Gynecology and Obstetrics. 2005 Dec;273(2):115-118.
Abstract: The objective was to evaluate the analgesic efficacy of preoperative rofecoxib in patients who underwent uterine curettage. This double-blinded, randomized, placebo-controlled trial included 80 women who underwent uterine curettage. Forty women were randomly assigned to rofecoxib 50 mg and 40 women to the placebo. The main outcome measure was the intensity of pain measured by the visual analog scale and categorical pain scores during and after the procedure. Chi-squared, Fisher exact, Student t test, and Mann-Whitney U tests were used for statistical analysis. The intensity of pain was not found to be different between groups over the course of procedure (P > 0.05). There were no serious adverse effects in this study. The preoperative administration of rofecoxib was not effective in reducing pain in uterine curettage. (author's)
Language: English
Keywords:
THAILAND | RESEARCH REPORT | CLINICAL TRIALS | DOUBLE-BLIND STUDIES | PREGNANT WOMEN | WOMEN IN DEVELOPMENT | ANALGESIA | CURETTAGE | PREOPERATIVE PROCEDURES | PAIN | Developing Countries | Asia, Southeastern | Asia | Clinical Research | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Economic Development | Economic Factors | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Obstetrical Surgery | Surgery | Signs and Symptoms | Diseases
Document Number: 298257

30.
Peer Reviewed

Title: Comparison of D&C and hysterectomy pathologic findings in endometrial cancer patients.
Author: Wang X; Huang Z; Di W; Lin Q
Source: Archives of Gynecology and Obstetrics. 2005 Jul;272(2):136-141.
Abstract: Objective: The objective of this study is to compare the accuracy of tumor grade in endometrial cancer between fractional dilatation and curettage (D&C) and postoperative hysterectomy specimen findings. Methods: From January 2000 to November 2002, 52 women with abnormal vaginal bleeding and diagnosed for suspected endometrial cancer were treated in the Department of Obstetrics and Gynecology, Renji Hospital, Shanghai Second Medical University. The comparison of tumor grades was performed on both D&C and hysterectomy specimens, the relationship between the concordance rate of grade, and the depth of tumor invasion into the myometrium. The expression of estrogen receptor (ER), progesterone receptor (PR), p53, Bc12, and proliferation cell nuclear antigen (PCNA) in tumor samples were analyzed. Results: The concordance rates were 20% in grade 1, 61.5% in grade 2, and 77.8% in grade 3. The concordance rates for grade 2 and grade 3 were higher than grade 1 significantly (grade 2 ~ grade 1, P = 0.010; grade 3 ~ grade 1, P = 0.005). Fourteen out of 52 (26.9%) patients diagnosed with atypical endometrial hyperplasia by D&C had their diagnosis changed to endometrial cancer after being ascertained by hysterectomy specimen. The accuracy of tumor grade diagnosis by D&C was 50%, and 48% of patients were downgraded after comparison of post-operative specimens. The concordance rate of tumor invasion into the outer half of myometrium was higher than in tumors localized in the endometrium (P = 0.030). No association between high concordance rate and the expression of ER, PR, p53, Bc1-2 and PCNA was found. Conclusion: We concluded that D&C had a high accuracy in the diagnosis of endometrial cancer in grade 3 tumors (77.8%) and tumor invasion into the outer half of the myometrium (75%). Overall, 48% of endometrial cancer patients' tumor grades seemed to be decreased by D&C evaluation; thus, the diagnosis of endometrial disorders by D&C should not be overlooked. (author's)
Language: English
Keywords:
CHINA | RESEARCH REPORT |