Reflexões da pandemia de COVID-19: a tomada de decisão médica na abordagem terapêutica pós-aborto em dois hospitais públicos do Distrito Federal / Reflections of the COVID-19 pandemic: medical decision-making in the post-abortion therapeutic approach in two public hospitals in the Federal District, Brazil / Reflexiones de la pandemia de COVID-19: toma de decisiones médicas en el abordaje terapéutico postaborto en dos hospitales públicos del Distrito Federal, Brasil

Objetivo: identificar possíveis alterações da tomada de decisão médica para esvaziamento uterino pós-aborto de primeiro trimestre no cenário da COVID-19em dois hospitais públicos do Distrito Federal. Metodologia: abordagem qualitativa, que usou dois procedimentos metodológicos­documental e entrevistas­,cuja coleta de dados ocorreu entre maio e junho de 2022. No hospital A, coletou-se, em 25 registros consecutivos do livro do centro cirúrgico, a técnica de esvaziamento uterino pós-aborto prevalecente em 2020. No hospital B, coletou-se o mesmo dado em 48 prontuários clínicos, 23 de 2019 e 25 de 2020. As entrevistas semiestruturadas foram realizadas com onze profissionais de saúde: três médicos, quatro enfermeiros e quatro técnicos de enfermagem, lotados na obstetrícia/centro cirúrgico de cada hospital. Resultados: ambos os hospitais, no recorte temporal do estudo de 2019 a 2020, dispuseram de insumos para a eleição por quaisquer das técnicas de esvaziamento uterino. No hospital A, em 2020, a tomada de decisão médica foi 100% pela aspiração manual intrauterina. Em2019, no hospital B, a eleição foi 100% pela dilatação e curetagem; em 2020, período da COVID-19, apesar da dilatação e curetagem manter-se prioritária em 78% dos casos, notabilizou redução em relação a 2019. Evidenciou-se, ainda, no hospital B um maior quantitativo de atendimentos e internações de mulheres em processo de pós-aborto, se comparado como período anterior à COVID-19. Conclusão: o fator determinante para a tomada de decisão médica em ambos os hospitais é a aptidão técnica do médico para a abordagem eleita.

Objective: to discern potential shifts in medical decision-making regarding the selection of uterine evacuation techniques post-abortion in the first trimester within the context of the COVID-19 scenario at two public hospitals in the Federal District. Methods: employing a qualitative approach, the study utilized two methodological procedures - documents and interviews. Data collection occurred between May and June of 2022. At Hospital A, prevalent post-abortion uterine evacuation techniques in 2020 were obtained from 25 consecutive records sourced from the surgical center book. At Hospital B, similar data was collected from 48 clinical records, encompassing 23 from 2019 and 25 from 2020. Semi-structured interviews were conducted with eleven health professionals, including three doctors, four nurses, and four nursing technicians, working in the obstetrics/surgical center of each hospital. Results: during the study period (2019 and 2020), both hospitals maintained supplies for adopting various uterine evacuation techniques. In Hospital A in 2020, medical decision-making predominantly favored manual intrauterine aspiration. Conversely, in 2019 at Hospital B, dilation and curettage were the preferred technique in 100% of cases, and despite remaining a priority in 78% of cases in 2020 during the COVID-19 period, there was a noticeable reduction compared to 2019. Hospital B also witnessed a heightened number of consultations and hospitalizations of women in the post-abortion process during the COVID-19 period compared to the pre-pandemic period. Conclusion: the pivotal factor influencing medical decision-making in both hospitals is the technical proficiency required for executing the chosen uterine evacuation technique.

Objetivo: identificar posibles cambios en la toma de decisiones médicas al elegir la técnica de evacuación endouterina después de un aborto en el primer trimestre en el escenario COVID-19en dos hospitales públicos del Distrito Federal. Metodología:enfoque cualitativo, que utilizó dos procedimientos metodológicos, documentos y entrevistas, cuya recolección de datos se realizó entre mayo y juniode 2022. En el hospital A se recogió la técnica de evacuación endouterina postaborto prevalente en el año 2020 en 25 registros consecutivos del libro del centro quirúrgico, en el hospital B se recogieron los mismos datos en 48 historias clínicas, 23 del 2019 y, 25 del año 2020. Se realizaron entrevistas semiestructuradas a once profesionales de la salud: tres médicos, cuatro enfermeras y cuatro técnicos de enfermería, trabajando en el centro obstetricia/quirúrgico de cada hospital. Resultados:ambos hospitales en el período de estudio, 2019 y 2020, contaron con insumos disponibles para elegir cualquiera de las técnicas de evacuación endouterina. En el hospital A, en 2020, la toma de decisiones médicas se basó en la aspiración intrauterina manual. En 2019, en el hospital B, la elección fue del 100% para dilatación y legrado; En 2020, durante el período COVID-19, a pesar de que la dilatación y el legrado siguieron siendo una prioridad en el 78% de los casos, hubo una reducción notable en relación a 2019. En el hospital B, también hubo un mayor número de consultas y hospitalizaciones de mujeres en proceso postaborto, en comparación con el período anterior al COVID-19. Conclusión: el factor determinante para la toma de decisiones médicas en ambos hospitales es la capacidad técnica para realizar la técnica elegida.

Histopathological changes in the uterus in women with abnormal uterine bleeding – A 2-year hospital-based retrospective study in a tertiary care center in Assam, India

Background: Abnormal uterine bleeding (AUB) or menstrual bleeding of abnormal amount, duration, or schedule is a common gynecological condition occurring in up to 50% of women of all age groups. Chronic, heavy, prolonged, or irregular uterine bleeding can lead to anemia, and raise a concern about severe underlying malignancy. Therefore, histopathological examination of the endometrium is critical in evaluating the cause of AUB. Aims and Objectives: The aims of this study were to study the various histomorphological patterns in endometrial biopsies in cases of AUB. Materials and Methods: This is a retrospective study done on 212 endometrial tissues in women presenting with AUB. The study is aimed at analyzing the histopathological changes occurring in the endometrium by identifying the cause of bleeding and recording the incidence of various histopathological findings in different age groups. Results: Proliferative endometrium, the most common histopathological finding, accounted for 51.9% of cases, followed by secretory endometrium (24.5%). Eight cases of disordered proliferative endometrium were found in the present study. Eight cases, accounting for 3.8% of endometrial hyperplasia, were associated with AUB, out of which two cases were found to be complex hyperplasia with atypia. Endometrial carcinoma was seen in two cases associated with AUB. Pregnancy-related changes were found in 7 (3.3%) cases, retained product of conception was the leading cause of bleeding (3 cases). Conclusion: Histopathological evaluation of endometrium in women presenting with AUB is of paramount importance not only to diagnose various benign conditions but also to detect some highly malignant lesions and precancerous conditions so that early interventions can be started.

Abnormal uterine bleeding in perimenopausal women: sonographic and histopathological correlation and evaluation of uterine endometrium

Background: The objectives of the study was to establish the role of histopathological diagnosis of uterine endometrial lesions in patients of AUB at perimenopausal age and to correlate the transvaginal sonographic (TVS) finding with histopathological examination.Methods: This prospective observational study was carried out over 1 and 1/2 years in the two apex level teaching hospitals in eastern India. A total of 197 women in the age group of 40-49 years and ≥50 years (up to 55 years) who presented with abnormal uterine bleeding were included in the study. After selecting the patient with eligibility criteria in the OPD, detailed clinical history, systemic and gynecological examinations and investigations were done as per proforma. TVS study of endometrial pattern and thickness was measured followed by dilatation and curettage (D and C) and HPE of the endometrial curetting was done.Results: Menorrhagia (44.67%) was the most common clinical finding. Mean endometrial thickness measured by TVS was 7.04±2.11 mm in proliferative phase and 10.25±1.27 mm in the secretory phase. Proliferative endometrium (37.06%) was the most frequent finding in HPE followed by secretory endometrium (20.3%). Hyperplasia of endometrium was noted in 27 cases (100%) at 12-15 mm of endometrial thickness on TVS whereas endometrial hyperplasia with and without atypia and endometrial carcinoma was noted in 25 cases (92.59%) at the same thickness of 12-15 mm of uterine endometrium on HPE. Endometrial hyperplasia and polyp both had sensitivity of 84.21% and 71.43% respectively on TVS as compared with histopathology.Conclusions: Increased endometrial thickness and echo pattern by TVS correlated well with abnormal endometrial tissue histopathology in perimenopausal women with AUB.

Co-relation of endometrial thickness by transvaginal sonogram with histopathology pattern in abnormal uterine bleeding: a study from South India

Background: Under normal circumstances, a woman's uterus sheds a limited amount of blood during each menstrual period (around 80 ml). Bleeding that occurs erratically or excessive menstrual bleeding is called abnormal uterine bleeding (AUB). The causes of AUB are many and varied. Initial investigations include transvaginal ultrasound and histopathologic assessment of the endometrium. Objective of this study was to evaluation of endometrial thickness with trans-vaginal ultrasound and its correlation with histopathology by dilatation and curettage in abnormal uterine bleeding. To determine the efficacy of transvaginal ultrasound in evaluating the endometrial thickness. To correlate the endometrial thickness by transvaginal ultrasound with endometrial histopathology in women with AUB.Methods: It is a retrospective observational study. All reproductive and perimenopausal age group women who underwent dilatation and curettage for abnormal uterine bleeding during the period June 2014-June 2016 was taken and analyzed and correlated with their endometrial thickness measured with Transvaginal ultrasound.Results: Around 478 patients who underwent endometrial sampling over a period of two years were analyzed. Maximum number of patients were in the fourth decade and the overweight category 36.6%. Proliferative endometrium was the most common histopathologic picture (44.76%). Detection of precancerous lesions were-5.87% and endometrial cancer was 1.05%.Conclusions: An ET of 8 mm and above gave 100% sensitivity and negative predictive value for precancerous and cancerous lesions.

Patient satisfaction and experience with various modes of Xylocaine administration for cervical dilatation and endometrial curettage: a randomized interventional study

Background: Patient satisfaction after a surgical procedure is an important outcome of hospital care. Many of the gynaecological menstrual problems such as abnormal uterine bleeding, postmenopausal bleeding requires endometrial evaluation which is done traditionally by dilatation and curettage. But this procedure is painful and requires appropriate pain management protocol. The aim is to evaluate the post-operative patient satisfaction following dilatation and curettage procedure.Methods: This study was conducted in a tertiary care hospital belonging to a medical college. A total of 236 patients were recruited for the study who subsequently underwent dilatation and curettage with different mode of Xylocaine anesthesia for pain relief. Of them 16 patients were excluded due to valid reasons and the remaining 220 were interviewed face to face following the procedure. The level of anxiety was assessed using Beck’s Anxiety inventory and also perception of satisfaction was documented along with complication related to the anesthesia.Results: The overall level of satisfaction was higher in the group receiving both paracervical block and intrauterine instillation of lidocaine during the procedure of dilatation and curettage. A further analysis showed that increase in level of satisfaction was due to improvement in pain scores due to combined mode of paracervical and endometrial anesthesia.Conclusions: A multimodal pain management protocol which involves pre-procedural sedation, combined cervical and endometrial anesthesia improves overall outcome with respect to reduction in anxiety scores and postoperative satisfaction levels.

Intrauterine bony fragments - An unexpected finding in the hysterectomy specimen

Intrauterine bony fragments (IUBF) are an unusual finding in hysterectomy specimen received in a histopathology laboratory. Females harboring IUBF may present non-specific symptoms like vaginal bleeding, leukorrhea, chronic pelvic pain, and secondary infertility. Herein we report the case of a 35-year-old female who presented vaginal discharge and bleeding for two years, since when she had an abortion. Later, hysterectomy specimen revealed bone pieces in the uterine cavity.

Evaluation of endometrial thickness with transvaginal ultrasonography in perimenopausal women presenting with abnormal uterine bleeding and correlation with its histopathological findings

Background: Abnormal uterine bleeding is the most common presenting menstrual complaint in women of perimenopausal age group. Most frequently used diagnostics tests to investigate the causes of abnormal bleeding are Transvaginal ultrasonography (TVS) and endometrial biopsy. Uterine curettage is an invasive procedure and is performed with anaesthesia. TVS is a non-invasive method that has been used to evaluate the endometrium and uterine cavity. The objectives of this study were to measure and evaluate the role and accuracy of endometrial thickness by transvaginal ultrasonography study to detect endometrial pathology in perimenopausal women presenting with Abnormal Uterine Bleeding. To correlate the transvaginal sonographic results with the Histopathological findings to discriminate normal from pathological endometrium.Methods: Prospective study including 150 perimenopausal women with abnormal uterine bleeding. Endometrial thickness was measured by TVS and then D and C was performed for all the patients.Results: Out of 150 women, 128 (85.3%) had normal and 22 (15%) had an abnormal endometrium. 43.3% were of 41-45 years and 65.3% patients presented with complaint of heavy menstrual bleeding. Majority of the patients in the study group were para 2 or more. Fibroid uterus (24%) was the commonest uterine pathology detected on TVS. 53.3% of patients had endometrial thickness in the range 10-14.9 mm. Most common finding on HPE was secretory endometrium (44.6%). Endometrial carcinoma was found in 3%. Endometrial thickness <14mm was associated with least abnormal endometrial pathology.Conclusions: Endometrial thickness of less than 14 mm need not be indicated for D and C in perimenopausal abnormal uterine bleeding. In perimenopausal women with AUB, TVS should be the investigation of choice due to its convenience, accuracy and non- invasiveness.

Evaluation of Acceptability, Safety, and Efficacy of Intrauterine Device Insertion during the Postpartum Period: A Prospective Analysis

Background: Abnormal uterine bleeding (AUB) is the most common complaint in gynecology and an important source ofmorbidity. It may be evaluated by hysteroscopy or by dilatation and curettage.Materials and Methods: Between January 2015 and August 2016, 50 patients with AUB who got admitted at MNR MedicalCollege in the Department of Obstetrics and Gynaecology were subjected to panoramic hysteroscopy and subsequent dilatationand curettage. Data were collected and analyzed.Results: AUB was more common in 30–39 years. The most common presenting complaint was menorrhagia. Negativehysteroscopic view was seen in 54% of cases. Abnormalities seen were endometrial hyperplasia, polyps, submucous myoma, andendometrial atrophy. Both hysteroscopy and curettage were accurate when an abnormality was diagnosed, giving a specificity of96.15% and positive predictive value of 96.65%. However, the ability to diagnose a lesion (sensitivity) was more with hysteroscopyin comparison to curettage (91.66 vs. 79.16). Forty-one patients (82%) had the same tissue diagnosis in both hysteroscopy andcurettage. Hysteroscopy revealed more information than curettage in 12% and curettage had more information in 6% of cases.Conclusion: This study confirms the conclusion of many others that hysteroscopy is superior to dilatation and curettage inevaluating patients with AUB.

A study on correlation of placenta praevia with previous caesarean section and other risk factors

Background: Obstetric haemorrhage is the leading cause of preventable maternal mortality worldwide. One of the major contributors to obstetric haemorrhage is antepartum haemorrhage which is mainly caused by placenta praevia and abruptio placenta. The study aims to quantify the risk of placenta praevia based on the presence and number of caesarean sections and to assess other risk factors.Methods: This study was a prospective case control study conducted in the department of obstetrics and gynecology, Lalla Ded hospital, Srinagar, Jammu and Kashmir, India from August 2009 to October 2010. As per the inclusion and exclusion criteria of study 100 cases and 200 controls were selected and the association of placenta praevia with proposed risk factors was analysed statistically.Results: Present study showed that the risk of developing placenta praevia in future pregnancy increased steadily as the number of previous caesarean sections increased, risk being 2.1, 2.8 and 4 times with previous one, two and three caesarean deliveries respectively. Similarly, the risk of developing placenta praevia was more in women with history of previous abortion (risk being 2.8 and 6.5 times more in women with one and two abortions in the past). Previous dilatation and curettage and age more than 30 years also proved to be independent risk factors.Conclusions: To conclude advanced maternal age, previous abortion, dilatation and curettage and a history of previous caesarean section appear to increase the occurrence of placenta praevia. The study strongly emphasises the need to decrease the primary caesarean section rate.

Selective estrogen receptor modulator: efficacy in abnormal uterine bleeding in perimenopausal women

Background: Abnormal uterine bleeding affects 50% women of perimenopausal age group. The use of ormeloxifene (SERMS) in management of AUB is well known. The objective of the present study was aimed to see the effects of ormeloxifene on different types of endometrium.in the medical management of Abnormal Uterine Bleeding (AUB).Methods: It was Prospective, interventional study. A total of 90 women who attended Outpatient Gynaecology Department, Guwahati with complain of AUB in perimenopausal age group (37-48) were prescribed 60mg ormeloxifene twice weekly for 3 months followed by once weekly for next 3 months after preliminary D and C.Results: Ormeloxifene was found to be more effective in reducing PBAC score and ET in patients with proliferative and secretory endometrium The reduction in mean PBAC score with ormeloxifene (175.3 to 20.93)(p value 0.0001) and ET (9.6 to 2.9 mm) (p value 0.0001) in proliferative endometrium, (179.2 to 14.8 (p value 0.0001) ) and ET 11.1 to 1.9 mm (p value 0.0003)in secretory endometrium was observed after 6 months. However, it was found not to be effective in reducing PBAC score and ET in patients with atrophic endometrium. Change in PBAC SCORE from 176.4 to 150.8 (p value 0.08) and in ET from 2.8 to 2.1mm( p value 0.3) was observed. No major side effects were reported.Conclusions: Ormeloxifene is effective in AUB with proliferative and secretory endometrium.

Assessment of Diagnostic Efficiency of Pipelle Endometrial Sampling in Patients with Abnormal Uterine Bleeding

Abnormal uterine bleeding is among the most prevalent uterine disorders among the females of pre and perimenopausal age. Endometrial sampling pipelle method is emerging as convenient and popular method for endometrial sampling in recent scenario. Accuracy of pipelle method in comparison of dilatation & curettage is still not clear. Therefore the present study was designed to assess the efficacy of pipelle method in comparison of dilatation & curettage method for endometrial sampling in patients with abnormal uterine bleeding. Methods: The present study included 200 patients suffering with abnormal uterine bleeding. On the other hand, patients having abnormal uterine bleeding of 16 to 70 years age having normal haematological findings were included in the study. Pippele method of sampling was performed before the D & C method was completed in all the patients. Results: Histological findings of the endometrial obtained by pipellle method showed endometrial hyperplasia (44%) was most common followed by proliferative phase (16%), secretary phase (12%) and proliferative endometrial phase (12%). While, endometrial carcinoma and choriocarcinoma were recorded in 2.5% and 1% cases. On the other hand, proliferative phase, secretary phase, endometrial phase and proliferative endometrial phase were observed in 17.5%, 13%, 39.5% and 15% correspondingly. Endometrial carcinoma and choriocarcinoma detected in 4% and 1.5% patients. Conclusion: Results of the present study showed that pipelle method of endometrial sampling is equally effective to its contemporary method D & C. Moreover, this technique is more convenient as it can be performed outdoor during routine examination. In addition there is no need of anaesthesia for pipelle method like D & C. We strongly recommend pippele method instead of D & C for the diagnosis of abnormal uterine bleeding as it has a high specificity rate and accuracy rate, without post sampling bleeding and pain.

Diagnostic role of hysteroscopy in abnormal uterine bleeding: a comparative study of hysteroscopy findings with histopathology from Mysore, South India

Background: Dilatation and curettage has long been the diagnostic gold standard for abnormal uterine bleeding. However, even a trained gynecological curettes at best 70-80% of the endometrium. Hysteroscopy is gaining acceptability over other diagnostic technique like dilatation and curettage, hysterosalpingogram and ultrasound. The objective of this study is to find out the role of hysteroscopy in abnormal uterine bleeding and to compare hysteroscopy findings with histopathology.Methods: Fifty patients in perimenopausal age group with abnormal uterine bleeding attending JSS Medical College and Hospital Mysore, during the period 1999-2001 were studied by diagnostic hysteroscopy followed by dilatation and curettage.Results: Mean age of the study group was 44.3% years (±2.5 SD). Menorrhagia was the commonest symptom and was found in 68% of the patients. Diagnostic hysteroscopy identified 23 cases as Normal endometrium, 16 cases as endometrial hyperplasia, 3 cases as atrophic endometrium, 4 cases as endometrial polyp, 4 cases as fibroids. Compared with histopathological findings as definitive diagnosis, hysteroscopy correctly picked up 19 cases of (86.9%), normal endometrium, 12 cases of hyperplasia (75%), 3 cases of atrophic endometrium (100%), 4 cases of polyps (100%), and 4 cases of fibroid (100%).Conclusions: Hysteroscopy should be considered as a basic and essential diagnostic procedure in the diagnostic work up of abnormal uterine bleeding.

Role of Misoprostol in Cervical Ripening for Dilatation and Curettage

Background: Difficulty in cervical dilatation is a hard situation during the procedure of diagnostic dilatation and curettage in some cases. Aim: Aim of the present study was to evaluate the use of Misoprostol for cervical dilatation before D&C in Gynecological cases. Dilatation of cervix is performed as a preliminary step to curette the uterine cavity. Endometrial sampling is often performed either by D&C or by hysteroscopy as an office procedure. Materials and methods: The study was performed at Department of Obstetrics and Gynecology, Victoria Hospital, Visakhapatanam, Andhra Pradesh from June 2018 to May 2019. The study comprised of 150 patients recruited from Gynecology Department with different indications for D&C. Selected cases had a full history of menstrual, Gynec, Obstetric, Personal and Family. A per abdomen and per speculum examination were done to note the Vaginal and Cervical condition. A bimanual pelvic examination was done to estimate size, position and mobility of uterus. In this study, the patients were allocated to receive either oral or vaginal misoprostol or no drug. All the subjects allocated to receive either oral or vaginal Misoprostol were instructed to take the medication at home, the night before the operative procedure. They were given 200 micro grams Misoprostol orally or vaginally 12 hours prior to the procedure. Results: In present study, majority of cases (57.33%) fall in age group of 30-39 years and 34% cases fall in age group of 40-49 years. 83% in Misoprostol group and 90% cases in control group had previous vaginal deliveries. 19% cases in Misoprostol and 20% cases in control group had a prior uterine surgery. Indication for D&C, in majority of cases 66 cases (44%) Heavy menstural bleeding was an indication, followed by Irregular bleeding 53 cases (35.33%), Intermenstural bleeding 29 cases R. Padmaja, P. Rajasekhar. Role of Misoprostol in Cervical Ripening for Dilatation and Curettage. IAIM, 2019; 6(11): 118- 123. Page 119 (19.33%). Cervical dilatation effectively achieved in 62.5% in Nulliparous 69.2% in Primiparous, 94.93% in Multiparous. Conclusion: Both Oral and Vaginal Misoprostol are equally effective in inducing Cervical priming prior to Dilatation and Curettage.

Necessity of prophylactic uterine artery embolization before curettage in treatment of cesarean scar pregnancy / 中国介入影像与治疗学

Objective To evaluate the necessity of prophylactic uterine artery embolization (UAE) before curettage in treatment of cesarean scar pregnancy (CSP).Methods A total of 142 patients with CSP were enrolled and divided into 3 groups according to Adler grading standard,including little vascularity (grade 0-Ⅰ,n=40),moderate vascularity (grade Ⅱ,n=41) and rich vascularity groups (grade Ⅲ,n=61).All patients were treated with curettage or prophylactic UAE before curettage.The differences of age,times of cesarean section,time to last cesarean section,intraoperative blood loss and success rate of therapy were compared between different treatment methods in each group.Results There was no statistical difference of age,times of cesarean section,time to last cesarean section,intraoperative blood loss and success rate of therapy between curettage and prophylactic UAE before curettage in little vascularity group and moderate vascularity group (all P＞0.05).Compared with curettage,the success rate of prophylactic UAE before curettage was higher and the intraoperative blood loss was lower in rich vascularity group (both P＜0.05).There was no statistical difference of age,times of cesarean section nor time to last cesarean section in rich vascularity group (all P＞0.05).Conclusion It is necessary to perform prophylactic UAE before curettage for cesarean scar pregnancy patient with rich vascularity,which is helpful to reduction of intraoperative blood loss.

Clinical effect of methotrexate combined with dilatation and curettage treatment on the treatment of cesarean section scar pregnancy and the effect on HCG / 中国生化药物杂志

Objective To investigate the clinical effect of methotrexate combined with dilatation and curettage on the treatment of cesarean section scar pregnancy and the effect on HCG (chorionic gonadotropin). Methods 130 cases with cesarean section scar pregnancy admitted in Taizhou hospital from January 2016 to March 2017 were randomly divided into two groups. The control group wasreceived dilatation and curettage. The study group was given methotrexate combined with dilatation and curettage.The effect and the influence to HCG in the two groups were compared. Results The effective rate in the study group was significantly higher than that in the control group (P<0.05). There was no significant difference in HCG level between the two groups before treatment. The levels of HCG in the study group were significantly lower than that in the control group (P<0.05). Conclusion Methotrexate combined with curettage on the treatment of cesarean scar pregnancy, can improve the therapeutic effect, reduce postoperative bleeding and hospitalization time, reduce the level of HCG.

Dilatation and curettage is more accurate than endometrial aspiration biopsy in early-stage endometrial cancer patients treated with high dose oral progestin and levonorgestrel intrauterine system / 부인종양

OBJECTIVE: To determine whether less invasive endometrial (EM) aspiration biopsy is adequately accurate for evaluating treatment outcomes compared to the dilatation and curettage (D&C) biopsy in early-stage endometrial cancer (EC) patients treated with high dose oral progestin and levonorgestrel intrauterine system (LNG-IUS). METHODS: We conducted a prospective observational study with patients younger than 40 years who were diagnosed with clinical stage IA, The International Federation of Gynecology and Obstetrics grade 1 or 2 endometrioid adenocarcinoma and sought to maintain their fertility. The patients were treated with medroxyprogesterone acetate 500 mg/day and LNG-IUS. Treatment responses were evaluated every 3 months. EM aspiration biopsy was conducted after LNG-IUS removal followed D&C. The tissue samples were histologically compared. The diagnostic concordance rate of the two tests was examined with κ statistics. RESULTS: Twenty-eight pairs of EM samples were obtained from five patients. The diagnostic concordance rate of D&C and EM aspiration biopsy was 39.3% (κ value=0.26). Of the seven samples diagnosed as normal with D&C, three (42.8%) were diagnosed as normal by using EM aspiration biopsy. Of the eight samples diagnosed with endometrioid adenocarcinoma by using D&C, three (37.5%) were diagnosed with endometrioid adenocarcinoma by using EM aspiration biopsy. Of the 13 complex EM hyperplasia samples diagnosed with the D&C, five (38.5%) were diagnosed with EM hyperplasia by using EM aspiration biopsy. Of the samples obtained through EM aspiration, 46.4% were insufficient for histological evaluation. CONCLUSION: To evaluate the treatment responses of patients with early-stage EC treated with high dose oral progestin and LNG-IUS, D&C should be conducted after LNG-IUS removal.

Persistent low-level elevation of serum human chorionic gonadotropin after termination of pregnancy: a rare case of peritoneal trophoblastic implant

Peritoneal trophoblastic implant can occur after treatment of ectopic pregnancy. Similarly, after termination of intrauterine pregnancy, trophoblastic implants are rare but can be a complication of perforation during dilatation and curettage. We report an extremely rare case of trophoblastic implant on the myometrium, ovarian surface, and peritoneal wall 4 months after uncomplicated dilatation and curettage. To the best of our knowledge, this is the first case of peritoneal trophoblastic implant following dilatation and curettage without uterine perforation. Knowledge of this case is useful for the management of patients with persistent low-level elevation of serum human chorionic gonadotropin after termination of pregnancy.

Effects of retained placenta and membrane patients who complete curettage of uterine cavity with the hysteroscopy when injecting oxytocin in the cervix before operation and shorting the time of single expanding uterus / 中国医师杂志

Objective To investigate the effects on retained placenta and membrane patients who complete curettage of uterine cavity with the hysteroscopy when injecting oxytocin in the cervix before operation and shorting the time of single expanding uterus.Methods Totally 147 patients at the Maternal and Child Health Hospital of Hunan Province were divided into the intervention group (72 cases) and control group (75cases).The intervention group was injected 10u oxytocin in the cervix before hysteroscopy and curettage of uterine cavity,all at once,controlling the time of single expanding uterus (no more than 5 minutes).The control group was not injected oxytocin before hysteroscopy and curettage of uterine cavity,and not limited the time of single expanding uterus (5 minutes to 10 minutes).A series of parameters were compared among two groups,including total expansion uterine time,mean single expansion uterine time,operation time,frequency of hysteroscopy,the amount of bleeding,hemoglobin decline,hemostatic measures use rate,postoperative infection rate,the rate of the second time curettage,and incidence of intrauterine adhesions.Results Compared to the control group,total expansion uterine time,mean single expansion uterine time,and operation time were significantly shorter in the intervention group;at the same time,the amount of bleeding,other hemostatic measure use rate,and incidence of intrauterine adhesions were significantly less in the intervention group (P ＜ 0.05).On the other hand,frequency of hysteroscopy,postoperative infection rate,the rate of second time curettage were not more (P ＞ 0.05).Conclusions Not only the time of operation and the amount of bleeding are decreased but also postoperative infection rate and incidence of intrauterine adhesions are decreased when injecting oxytocin before hysteroscopy and shorting the time of single Expanding uterus.In other words,this method can keep clear vision of operation under direct vision,avoid repeated curettage,tissue trauma,decrease incidence of intrauterine adhesions,increase operative successful rate,and keep healthy and reproductive capacity of patients.Therefore,it is worth promoting.

Diagnosis and treatment of cesarean scar pregnancy / 实用医学杂志

Objective To determine the clinical value of hysteroscopy technology in high risk planned abortion. Methods A retrospective study of clinical manifestation, medical tests, treatment methods and effects of 97 cases (hospitalized from June, 2013 to October 2014) was made in the research. Of the 97 cases, 53 underwent UAE, and 44 did not undergo UAE. The risk factors and treatment features were concluded. Results The hemorrhage risk relates to menopause period. The longer menopause period, the higher the hemorrhage risk will be. The hemorrhage risk has nothing to do with HCG. For those whose menopause is less than 56 days, hemorrhage risk showed no difference between groups with or without UAE. For those whose menopause is less than 56 days, hemorrhage risk decreases in group with UAE. Hemorrhage risk and hysterectomy possibility are higher if menopause has happened for more than 11 weeks. Conclusion Cesarean scar pregnancy needs to be detected and treated early, in this way, the possibility for complications can be lowered. For cases whose menopause has been more than e weeks, hemorrhage risk should be cautioned.

Cervical pregnancy treated by uterine artery chemoembolization combined with dilatation and curettage / 实用放射学杂志

Objective To evaluate the efficacy and safety of uterine artery chemoembolization(UACE)in conjunction with dilata-tion and curettage in the treatment of cervical pregnancy.Methods UACE was performed in 7 patients with cervical pregnancy,after bilateral uterine artery perfusion of methotrexate,using gelatin sponge for embolization.Dilatation and curettage was carried out within 1 week after the procedure.Results The symptom of vaginal bleeding was effectively controlled after UACE,then dilatation and curettage performed in 6 within 1 week,the blood loss during curettage procedure was 10-30 mL(mean 21 mL).The serumβ-HCG decreased to normal range within 1 week in 1 and 3 weeks in 6 after intervention,average 1 6.4 ± 6.9 days.No serious com-plications occurred and follow up did not show symptoms of premature ovarian failure.Conclusion UACE combined with dilatation and curettage significantly improve the efficacy and safety of the treatment of cervical pregnancy,and avoid serious incident,such as massive hemorrhage and unnecessary resection,the clinical application is safe and effective.