Manejo conservador de retención de productos de la concepción con anticonceptivos orales combinados / Conservative Management of Retained Products of Conception with Combined Oral Contraceptives. Case Report

Objetivo: presentar el caso de una paciente con retención de productos de la concepción (RPC) después de aborto médico, tratada con anticonceptivos orales combinados (ACOC), y efectuar revisión de la literatura. Caso Clínico: paciente de 37 años, con sangrado genital escaso y leve dolor pélvico, quien tuvo aborto provocado con misoprostol cuatro días antes, acude sin signos de infección, con endometrio mixto de 18,5 mm. Durante seis semanas de seguimiento persiste sangrado y endometrio mixto engrosado, con disminución lenta de la gonadotrofina corionica humana (GCH); se sospecha RPC, se suministra ciclo de ACOC y al terminarlos expulsa completamente el tejido retenido. Metodología: búsqueda bibliográfica en bases de datos Google Scholar, Science Direct, RIMA, PubMed. Revisión de literatura: la RPC se presenta después de parto o aborto (más frecuente). Criterios diagnósticos: sangrado persistente, hallazgos ecográficos y medición de GCH. Diagnóstico diferencial: enfermedad trofoblastica gestacional y malformaciones arteriovenosas uterinas. Es factible el manejo conservador, con bajas tasas de infección o procedimientos quirúrgicos. Ante la evolución prolongada, presencia de signos de infección o hemorragia importante, se impone la evacuación quirúrgica, tradicionalmente con dilatación y legrado, y más recientemente resección histeroscópica. La bibliografía reciente sugiere el uso de ACOC como manejo médico. En nuestro caso, la paciente tomó un ciclo de ACOC y al terminarlos presentó expulsión de los restos retenidos. Conclusiones: el manejo conservador de la RPC con ACOC surge como una opción en casos seleccionados; son necesarios estudios controlados para definir su utilidad..Au

Objective: to report the case of a patient with retained products of conception (RPC) after a medical abortion, successfully treated with combined oral contraceptives (COCs), and to review the literature. Clinical case: a 37-year-old patient, with little genital bleeding and slight pelvic pain, who had had a misoprostol-induced abortion four days before consulting, she attended without signs of infection, with a thikened 18.5 mm mixed endometrium. After six weeks follow-up genital bleeding and thickened mixed endometrium persist, with a slow decrease in human chorionic gonadotropin (HCG), RPC is suspected, and a COC cycle is administered, when finished, she completely expelled the retained tissue. Methodology: Google Scholar, Science Direct, RIMA and PubMed databases were searched. Literature review: RPC occurs after delivery or abortion (more frequent), diagnostic criteria: persistent bleeding, ultrasound findings and HCG measurement; the differential diagnosis includes gestational trophoblastic disease and uterine arteriovenous malformations. Conservative management is feasible, with low rates of infection or surgical procedures, however, in case of prolonged evolution, evident signs of infection or significant bleeding, surgical evacuation is required, traditionally with dilation and curettage, and more recently hysteroscopic resection. Novel bibliography suggests the use of ACOC as medical management. In our case, the patient took a cycle of COC and at the end she expelled the retained remains. Conclusions: conservative management of RPC with COC arises as an option in selected cases, controlled trails are needed to define its usefulness..Au

Effect of electroacupuncture at / 中国针灸

OBJECTIVE@#To observe the clinical therapeutic effect of the combination of electroacupuncture (EA) at @*METHODS@#A total of 58 patients after uterine curettage of incomplete abortion were randomized into an EA group and a western medication group, 29 cases in each one. In the western medication group, mifepristone tablets were administered orally, 2 tablets each time, once daily. In the EA group, on the base of the treatment as the western medication group, EA was applied to @*RESULTS@#After treatment, the intrauterine residue area and CDFI blood flow signal positive rate were all reduced as compared with the values before treatment in patients of the two groups (@*CONCLUSION@#The combined treatment of electroacupuncture at

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.

Aspiración manual endouterina (AMEU): Revisión de la literatura y estudio de serie de casos / Manual vacuum aspiration (MVA): a literature review and a case series study

Introducción y objetivo El aborto es la pérdida del producto de la concepción antes de la viabilidad fetal y se considera la principal complicación del embarazo. El objetivo de nuestro trabajo es evaluar los resultados iniciales y en mediano plazo del manejo con Aspiración Manual Endouterina (AMEU) del aborto en el primer trimestre. Métodos Análisis estadístico de serie de casos de 53 pacientes sometidas a AMEU en el Hospital Carlos Van Buren, Valparaíso desde noviembre 2017 a junio 2018 por aborto del primer trimestre. El diagnóstico fue clínico y mediante ultrasonografía. Se efectuó un cuestionario de satisfacción posterior al procedimiento. Resultados Se analizaron 53 pacientes, cuya edad promedio es de 29 años, 19 nulíparas, 34 multíparas, con edad gestacional promedio de 8 semanas. Se analizaron 53 biopsias de contenido intrauterino que resultaron en 53 abortos, de éstos 39 retenidos y 14 incompletos. Se registró un 3% de complicaciones (1 caso de perforación uterina que sólo requirió manejo médico y 1 caso de evacuación incompleta). El cuestionario reveló en una mayoría, el alivio de los síntomas y satisfacción en relación al procedimiento. Conclusión La AMEU es una buena alternativa en el manejo del aborto debido a menores costos, baja tasa de complicaciones y alta eficacia. Los centros que disponen de diversas alternativas para el manejo del aborto deben asegurarse de que la mujer participe activamente en la elección en cuanto a su resolución.

ABSTRACT Introduction and objective Miscarriage is the loss of the product of conception before fetal viability and it is considered the main complication of pregnancy. The main objective of our study is to evaluate initial and midterm reports using Manual Vacuum Aspiration (MVA) as management of first trimester miscarriage. Methods Statistic analysis of a case series of 53 patients submitted to MVA at Hospital Carlos Van Buren, Valparaíso since November 2017 until June 2018 with first trimester miscarriage. The diagnosis was clinical and ultrasonographic. A post procedure satisfaction questionnaire was carried out. Results Fifty-three patients were analyzed, with mean age of 29 years, 19 were nulliparous, 34 multiparous, mean gestational age of 8 weeks. Fifty-three intrauterine biopsies were analyzed, of which 53 were miscarriage, 39 retained sacs and 14 incomplete. We had 3% of complications (1 case of uterine perforation requiring only medical treatment and 1 case incomplete vacuum). The questionnaire revealed in a majority, the relief of symptoms and satisfaction with the procedure. Conclusion MVA is a good alternative in the management of miscarriage due to less costs, low rate of complications and high efficacy. The centres with various alternatives for miscarriage management must ensure that the women actively participates in the election of the resolution.

Abordagem terapêutica no processo de esvaziamento uterino / Enfoque terapéutico en el proceso de vaciación uterino / Therapeutic approach in the uterine evacuation process

Objetivos identificar a terapêutica utilizada no processo de esvaziamento uterino e traçar o perfil obstétrico das mulheres assistidas nesse processo. Método pesquisa quantitativa, retrospectiva, de caráter exploratório-descritivo, constituída por 466 prontuários de mulheres internadas para esvaziamento uterino, no período de junho de 2015 a junho de 2016. Resultados a idade variou entre 14 e 43 anos, o principal diagnóstico foi o aborto incompleto, responsável por 44,85% das internações, a terapêutica inicial mais utilizada foi o misoprostol (57,71%) e o tempo de internação até o esvaziamento uterino variou entre 0,20 e 137 horas. Conclusão o perfil obstétrico da mulher que vivencia a perda gestacional não difere do encontrado nacionalmente; a curetagem foi a terapêutica final mais utilizada acrescida de alguns desfechos desfavoráveis, como maior tempo de internação e exposição excessiva a medicação.

Objetivos identificar la terapéutica utilizada en el proceso de vaciamiento uterino y trazar el perfil obstétrico de mujeres asistidas en ese proceso. Método investigación cuantitativa, retrospectiva, de carácter exploratorio-descriptivo, constituida por 466 prontuarios de mujeres internadas para vaciamiento uterino, de junio de 2015 a junio de 2016. Resultados edad entre 14 y 43 años, el principal diagnóstico fue el aborto incompleto, responsable por 44,85% de las internaciones, la terapéutica inicial más utilizada fue el misoprostol (57,71%) y el tiempo de internación hasta el vaciamiento uterino varió entre 0,20 y 137 horas. Conclusión el perfil obstétrico de la mujer que vive la pérdida gestacional no difiere de lo encontrado nacionalmente; el curetaje fue la terapia final más utilizada, sumada de algunos resultados desfavorables, como mayor tiempo de internación y exposición excesiva a la medicación.

Objectives identify the therapeutics used in the uterine evacuation process and outline the obstetric profile of the women attended in this process. Method quantitative, retrospective, exploratory and descriptive research, consisting of 466 records of women hospitalized for uterine evacuation between June 2015 and June 2016. Results ages ranged between 14 and 43 years. The main diagnosis was incomplete abortion, responsible for 44.85% of the hospitalizations. The most used initial therapy was misoprostol (57.71%) and the length of hospitalization before the uterine evacuation ranged between 0.20 and 137 hours. Conclusion the obstetric profile of women who experience gestational loss does not differ from the profile found in Brazil; curettage was the most used final therapy, in addition to some unfavorable outcomes, such as longer hospitalization and excessive exposure to medication.

Evolución clínica de las pacientes con manejo quirúrgico vía aspiración manual endouterina del aborto incompleto menor de doce semanas cero días de edad gestacional / Clinical evolution of patients with surgical management via manual vacuum aspiration of incomplete abortion less than twelve weeks zero days of gestational age

El aborto espontáneo es la complicación más frecuente al inicio del embarazo, llegando a ocurrir hasta en un 20% de los mismos; siendo que la mayoría de los casos ocurren antes de las 12 semanas de edad gestacional. Se han establecido tres tipos de manejo del aborto espontáneo: el manejo quirúrgico (el más frecuentemente empleado), el manejo médico y el manejo expectante. El presente estudio es un estudio descriptivo retrospectivo que trata sobre el manejo quirúrgico del aborto incompleto espontáneo menor de 12 semanas mediante el uso de la aspiración manual endouterina, conocida también como AMEU, procedimiento con el que se pretende la evacuación de restos ovulares. Se realizó la revisión de 90 expedientes clínicos de pacientes a quienes se les realizó legrado por AMEU en caso de aborto incompleto espontáneo en el período comprendido entre junio y diciembre de 2017. La muestra se calculó a partir de un universo de 326 pacientes a quienes se les realizó legrado por AMEU durante el año 2017. A los expedientes revisados se le aplicó un instrumento de elaboración propia de los investigadores basado en los objetivos del estudio y en las variables a estudiar. La información obtenida se tabuló mediante el uso de Microsoft Excel y se graficó mediante el uso de dicho software. Los resultados obtenidos arrojaron una tasa de éxito del AMEU, entendiéndose ésta como la remoción completa de restos ovulares, de un 96.6%. Este dato se encuentra dentro del rango de éxito del AMEU a nivel internacional. Entre las complicaciones que se evidenciaron posterior al procedimiento se encontró retención de restos ovulares en un 3.3%, que requirieron reintervención. Se evidenció un caso de infección posterior al procedimiento; con una tasa de infección de 1.1%; dentro de los rangos descritos en la literatura médica internacional

Effectiveness and safety of sublingual misoprostol in medical treatment of the 1st trimester miscarriage: experience of off-label use in Korea

OBJECTIVE: This study was conducted to determine the effectiveness and safety of medical treatment with sublingual misoprostol (MS) in the 1st trimester miscarriage under the approval by Health Insurance Review and Assessment Service (HIRA) for off-label usage by the single medical center in Korea. METHODS: A retrospective cohort study was performed in one institution between April 2013 and June 2016. Ninety-one patients diagnosed with miscarriage before 14 weeks of gestation and wanted to try medical treatment were included. A detailed ultrasound scan was performed to confirm the diagnosis. Patients took 600 microgram (mcg) of MS sublingually at initial dose, and repeated the same dose 4–6 hours apart. Successful medical abortion was defined as spontaneous expulsion of gestational products (including gestational sac, embryo, fetus, and placenta). If gestational products were not expelled, surgical evacuation was performed at least 24 hours later from the initial dose. Information about side effects was obtained by medical records. RESULTS: About two-thirds of patients had a successful outcome. The median interval time from pill to expulsion was 18 hours in the successful medical treatment group. There was no serious systemic side effect or massive vaginal bleeding. Presence or absence of vaginal spotting before diagnosis of miscarriage, uterine leiomyomas, subchorionic hematoma, or distorted shape of gestational sac on ultrasound scan were not statistically different between the two groups. CONCLUSION: Medical treatment with sublingual MS can be a proper option for the 1st trimester miscarriage, especially for the patient who want to avoid surgical procedure. We can reduce the unnecessary sedation or surgical intervention in the patients with the 1st trimester miscarriage.

Análisis de conocimiento, actitudes y prácticas sobre aborto incompleto en una muestra de proveedores de salud en obstetricia de Ecuador / Analysis of knowledge, attitudes and practices about incomplete abortion in a sample of obstetrics health providers in Ecuador

Objetivos: analizar el nivel de conocimientos, actitudes y prácticas que tiene una muestra voluntaria de proveedores de salud en obstetricia asistentes al XXI Congreso Nacional de Ginecología y Obstetricia del Ecuador sobre muerte materna, leyes nacionales y tratamientos relacionados al aborto incompleto. Material y Métodos: Se realizó una intervención investigativa transversal...

Objectives: To examine the level of knowledge, attitudes and practices which has voluntary sample of health care providers at obstetrician tending the 21st National Congress of Gynecology and Obstetrics of Ecuador on maternal death, national laws and treatment related to incomplete abortion. Material and Methods: a descriptive and analytical cross - sectional investigative intervention through suvery...

Remifentanilo como analgesia complementaria en bloqueo paracervical para aspiracion manual endouterina. Hospital Vicente Corral Moscoso. Cuenca, 2013 / Remifentanil as complementary analgesia in paracervical blocking for endouterine manual aspiration. Hospital Vicente Corral Moscoso. Cuenca, 2013

OBJETIVO:Disminuir el dolor producido por la Aspira-ción Manual Endouterina (AMEU) en pa-cientes que se intervienen bajo bloqueo paracervical. MATERIALES Y MÉTODOS:Con un diseño clínico controlado aleato-rizado ciego, se incluyó, 80 pacientes (en dos grupos de 40) seleccionadas para tra-tamiento de aborto incompleto mediante Aspiración Manual Endouterina, en el De-partamento de Gineco-Obstetricia del Hospital Vicente Corral Moscoso. El grupo "A" (n = 40), recibió adicional al bloqueo para-cervical 1 mcg/kg de peso de remifentanil endovenoso como dosis inicial seguida de bolos de 0,5 mcg/kg de peso cada 4 minu-tos y al grupo "B" (n = 40), se realizó el proce-dimiento bajo bloqueo paracervical única-mente; Se determinó la intensidad del dolor mediante la escala visual análoga de 10 puntos, cambios hemodinámicos y efectos secundarios.RESULTADOS:No hay diferencia significativa en los grupos de estudio tanto en edad (p = 0,118), peso (p = 0,522), talla (p = 0,114), IMC (p = 0,668), nivel de instrucción (p = 0,699). La adición de remifentanil, disminuyó el dolor según la EVA de 7,58 grupo "B" con respecto a 2,98 del grupo "A", (p = 0,000); no se tuvo cambios significativos en cuanto a tensión arte-rial media y frecuencia cardiaca (p > 0,05); el efecto secundario que se presentó con diferencia estadísticamente significativa (p = 0,001) es la náusea que es mayor en el gru-po "B".DISCUSIÓN:La adición de remifentanil al bloqueo para-cervical, disminuyó el dolor mediante EVA en un 46%, sin mayor cambio en la hemo-dinamia y con menos efectos secundarios que los que presenta el grupo control (náu-sea 92,3% con p de 0,001).

OBJECTIVE:To reduce the pain of manual vacuum aspi-ration (MVA) in patients involved under pa-racervical block. MATERIALS AND METHODS:In a clinical randomized controlled blind design, 80 patients were included (in two groups of 40) selected for an incomplete treatment of abortion with manual vacuum aspiration, in the Gynecology and Obstetrics Department of the Vicente Corral Moscoso Hospital. The group "A" (n = 40) received ad-ditional to the paracervical block 1 mcg / kg intravenous remifentanil as an initial dose fo-llowed by 0.5 mcg / kg every 4 minutes and the group "B" (n = 40), the procedure was performed only under paracervical. Pain in-tensity was determined by visual analog sca-le of 10 points, hemodynamic changes and side effects. RESULTS:There is no a significant difference in the study groups in both age (p = 0.118), weight (p = 0.522), height (p = 0.114), BMI (p = 0.668), educational level (p = 0.699). The addition of remifentanil, reduced pain according to the EVA of 7.58 group "B" with respect to 2.98 group "A", (p = 0.000); it had no significant changes in arterial pressure and heart rate (p> 0.05); the side effect was presented with statistically significant difference (p = 0.001) it is nausea which is higher in group "B". DISCUSSION:The addition of remifentanil to paracervical block, decreased the pain through EVA by 46%, without much change in hemodyna-mics and with fewer side effects than has the control group (92.3% nausea with p 0.001).

Placenta percreta resulting in incomplete spontaneous abortion in first trimester

Placenta percreta is a rare complication potentially fatal to fetus and the mother. We present here a 41-year-old female patient who underwent curettage for incomplete abortion at 6[th] week of pregnancy. She had persistent vaginal bleeding for 2 months after the curettage, for which she was treated with hysterectomy. Preoperative ultrasonography and magnetic resonance imaging [MRI] made the diagnosis of placenta percreta. Postoperative pathological examination confirmed this diagnosis

Efectividad del tratamiento médico con misoprostol en pacientes con aborto incompleto que acudieron al Hospital Nacional Dos de Mayo: enero-diciembre 2012 / Effectiveness of medical treatment with misoprostol in patients with incomplete abortion attended at the National Hospital Dos de Mayo: january-december 2012

El presente trabajo de investigación surge a raíz de la resistencia, temor y la falta de compromiso del personal médico del HNDM (Hospital Nacional Dos de Mayo) para incorporar el Misoprostol como primera alternativa en el tratamiento del aborto incompleto precoz, esto quizás por el miedo a las complicaciones y por ende a los problemas médico legales a pesar de que existen varias revisiones sistemáticas quienes demuestran fehacientemente la efectividad del Misoprostol en el tratamiento del aborto incompleto precoz. Este trabajo de investigación es mediante un estudio Descriptivo, Transversal y retrospectivo el cual nos permitirá demostrar una vez más la efectividad y beneficios del Misoprostol en pacientes que acudieron al HNDM y que fueron diagnosticados de aborto incompleto y recibieron tratamiento médico con Misoprostol en relación al Tx quirúrgico, esto permitirá motivar al personal de salud del HNDM a incorporar al Misoprostol como tratamiento de primera línea en el aborto incompleto precoz. El número total de abortos en general en el Hospital Nacional Dos de Mayo en el periodo de Enero a Diciembre del 2012 fue 496 de los cuales 322 (65 por ciento) fueron aborto incompleto que cumplían los criterios para el TX médico, y solo 111 (34 por ciento) recibieron tratamiento médico con misoprostol 600 mcg vía oral en dosis única y 153 (48 por ciento) termino en AMEU y 58 (18 por ciento) en EBA más LU. El servicio de Gineco Obstetricia del HNDM cuenta con 28 Gíneco Obstetras de los cuales solo 12 (43 por ciento) realiza tratamiento médico con misoprostol y 16 (57 por ciento) tratamiento quirúrgico (AMEU-LU) a pacientes con aborto incompleto que cumplen los criterios para TX médico, siendo las principales causas: resistencia al cambio 56 por ciento, temor a las complicaciones 31 por ciento y falta de capacitación 13 por ciento. De un total de 111 HCL con abortos incompletos que reciben tratamiento médico con misoprostol el 78 por ciento son menores de 30 años y el...

The present research stems from the resistance, fear and lack of commitment HNDM medical staff to incorporate Misoprostol as first aIternate in the earIy treatment of incompIete abortion, that perhaps the fear of compIications and hence medico-legal probIems even though there are several systematic reviews who clearly demonstrate the effectiveness of MisoprostoI in the treatment of earIy incomplete abortion. This research is a descriptive, transversal and retrospective which will allow us to further demonstrate the effectiveness of Misoprostol in patients attending the HNDM and who were diagnosed with incomplete abortion with Misoprostol received medical treatment, this will allow us to motivate the HNDM health staff to incorporate the Misoprostol as first line treatment of incomplete abortion in earIy. The total number of abortions in general in the National Hospital Dos de Mayo in the period from January to December 2012 was 496 of which 322 (65 per cent) were incomplete abortion that met the criteria for the TX doctor, and only 111 (34 per cent) received medical treatment with Misoprostol 600 mcg orally in a single dose and 153 (48 per cent) ended in MV A and 58 (18 per cent) in aduIt education more LV The Department of Obstetrics and Gynecology of the HNDM account with 28 Ob/gyns of which only 12 (43 per cent) performs medical treatment with Misoprostol and 16 (57 per cent) TX in surgical patients with incomplete abortion that meet the criteria for TX doctor, being the main causes: resistance to change 56 per cent, fear of complications 31 per cent and lack of training 13 per cent. A total of 111 HCL with incomplete abortions that receive medical treatment with Misoprostol 78 per cent are under 30 years of age and 39 per cent and 33 per cent come from the District of Lima and Victory respectively, 52 per cent have full high school education and 31 per cent complete primary school, on the other hand, the 41 per cent are housewife and 53 per cent merchant...

Effect of Taohong Siwu decoction on angiogenesis of medicine-induced incomplete-abortion in early pregnancy rats and expressions of Ang-1, Ang-2 and Tie-2 / 中国中药杂志

<p><b>OBJECTIVE</b>To observe the effect of Taohong Siwu decoction (THSWD) on micro-vascular density (MVD) in rat uterus, the content of angiopoietin-1 (Ang-1) and angiopoietin-2 (Ang-2) in serum, and the expression of tyrosine kinasa receptor (Tie-2) in uterus.</p><p><b>METHOD</b>Early pregnancy rats were intragastrically administrated with misoprostol (100 microg x kg(-1)) and mifepristong (8.3 mg x kg(-1)) to established the incomplete-abortion model. The incomplete-abortion rats were randomly divided into the model group (the same volume of distilled water), the positive control group (at the daily dose of 4.3 g x kg(-1) Motherwort Particles), and THSWD-treated groups (at the daily dose of 18.0, 9.0 and 4.5 g x kg(-1)). Pregnant rats were taken as the control group (the same volume of distilled water). After the successive oral administration for 7 days, blood was collected from aorta abdominalis, and rat uterine tissues were collected. The content of serum Ang-1 and Ang-2 were detected by ELISA; And the levels of Tie-2 and MVD in uterine tissues were detected by SP immunohistochemistry.</p><p><b>RESULT</b>THSWD remarkably increased the levels of MVD in uterus of medicine-induced abortion rats, the content of Ang-1 and Ang-2 in serum, and the expression of Tie-2 in uterine tissues.</p><p><b>CONCLUSION</b>THSWD has the effect in markedly promoting angiogenesis in incomplete-abortion rats. Its mechanism may be related to the regulation of concentrations of Ang-1 and Ang-2 in serum and Tie-2 in uterine tissues.</p>

Evaluation of Misoprostol in the Medical Management of Abortion.

The present study was carried out to compare the safety and efficacy of Misoprostol with Surgical Evacuation in the management of abortion. 100 women as specified by the inclusion and exclusion criteria were recruited for this prospective observational study. 50 subjects (Group A) were managed medically by Misoprostol and 50 subjects (Group B) underwent Surgical Evacuation. Clinical outcome, time taken for expulsion, number of doses required, mean duration of hospital stay, mean analgesic requirement, mean blood loss and side effects were compared between the two groups. It was concluded that vaginal administration of Misoprostol is a safe, effective and cheap alternative to surgical evacuation. No serious adverse effects were observed with Misoprostol.

Aspiração manual intrauterina no tratamento do abortamento incompleto até 12 semanas gestacionais: uma alternativa à curetagem uterina / Manual vacuum aspiration uterine treatment of incomplete abortion to 12 gestational weeks: an alternative to curettage

OBJETIVO: Analisar a eficácia e a ocorrência de complicações, além do tempo de permanência hospitalar e as perdas sanguíneas. MÉTODOS: Trinta pacientes foram selecionadas, alternada e consecutivamente, em um dos grupos (15 no Grupo Curetagem e 15 no Grupo de Aspiração manual intrauterina). As variáveis analisadas foram: eficácia do método, ocorrência de complicações, tempo pré-procedimento, tempo de execução do procedimento, tempo pós-procedimento e tempo total de permanência hospitalar, além de hematócrito e hemoglobina, medidas antes e após o procedimento. As pacientes foram avaliadas clinicamente 10 a 14 dias após o procedimento. Para a análise estatística, foram aplicados testes paramétricos e não-paramétricos e o nível de significância admitido foi de p>0,05. RESULTADOS: Ambos os métodos foram eficazes e não foi registrada nenhuma complicação. As perdas sanguíneas foram semelhantes e o tempo de permanência hospitalar foi significativamente menor no Grupo de Aspiração Manual Intrauterina (p=0,03). CONCLUSÃO: a aspiração manual intrauterina é tão eficaz e segura quanto à curetagem uterina, com a vantagem de necessitar menor tempo de permanência hospitalar, o que aumenta a resolutividade do método, melhorando a qualidade da assistência a essas pacientes.

PURPOSE: To analyze the effectiveness and occurrence of complications, in addition to hospitalization time and blood losses. METHODS: Thirty patients were assigned alternatively and consecutively to one of two groups (15 to the Curettage Group and 15 to the Manual Vacuum Aspiration Group). The following variables were analyzed: effectiveness of the method, occurrence of complications, time before the procedure, time of execution of the procedure, time after the procedure, and total time of hospital permanence, in addition to hematocrit and hemoglobin, which were measured before and after the procedure. Patients were evaluated clinically 10 to 14 days after the procedure. Parametric and nonparametric tests were used for statistical analysis, with the level of significance set at p>0.05. RESULTS: Both methods were efficient and no complications were recorded. Blood losses were similar in the two groups, but the hospitalization time was significantly shorter for the Manual Vacuum Aspiration Group (p=0.03). CONCLUSION: Manual vacuum aspiration is as efficient and safe as uterine curettage, with the advantage of requiring shorter hospitalization, which increases the resolution of the method, improving the quality of care for these patients.

O abortamento incompleto (provocado e espontâneo) em pacientes atendidas em maternidade do Sistema Único de Saúde / Incomplete abortion (spontaneous and induced) in patient's admitted to a Sistema Único de Saúde maternity

JUSTIFICATIVA E OBJETIVOS: A interrupção da gestação, no Brasil, é praticada amplamente pelas mulheres, em contexto clandestino. O Ministério da Saúde (MS) defende que é uma questão de saúde pública. O objetivo deste estudo foi conhecer aspectos do abortamento incompleto em 1000 mulheres submetidas à curetagem uterina, atendidas em hospital do Sistema Únicode Saúde (SUS).MÉTODO: Aplicou-se um método descritivo por meio de questionário estruturado.RESULTADOS: Obtiveram-se 36,4% de abortamentos espontâneos e 63,6% provocados; dados obtidos através da classificação da Organização Mundial da Saúde (OMS). Destes, 18,2% são certamente provocados, 2%, provavelmente provocados; 43,4% são possivelmente provocados. Entre os abortamentos certamente provocados, 89% reportaram ao uso do misoprostol.CONCLUSÃO: O perfil das mulheres com risco de provocarem o abortamento é jovem com parceiro estável; são mulatas; não usuárias de anticoncepcional ou preservativo nas relações sexuais;tiveram início precoce da atividade sexual; não planejaram a gestação; secundigestas; primíparas; idade gestacional menor que 10 semanas; raras complicações relacionadas ao abortamento.(AU)

BACKGROUND AND OBJECTIVES: Illegal abortion is a common practice among Brazilian women. Ministry of Health considers it as a matter of public health. The aim of this research is to know the aspects involved in incomplete abortion among 1000 women submitted to uterine curettage attending a public hospital of Sistema Único de Saúde (SUS).METHOD: A descriptive method carried out through interviews by means of a questionnaire was applied and it was duly structured for the data gathering.RESULTS: Through the use of structured questionnaire, 36,4% were spontaneous abortions and 63.3% were induced abortions. Accordingto the classification of World Health Organization (WHO),among the induced abortions, 18.2% were certainly induced, 2% probably induced and 43.4% were possibly induced. Among certainly induced abortions 89% reported the use of misoprostol.CONCLUSION: The profile of women in risk of practicing abortion:young, stable partner, multiethnic, not using a contraceptive method or condom for intercourses, early search, non desired pregnancy, second pregnancy, primipara, gestational age under ten weeks, rare complications related to the abortion.(AU)

Perda gestacional retida: tratamento baseado em evidência / Missed miscarriage: treatment based on evidence

A perda gestacional é a complicação mais comum da gestação, a qual acarreta sérias repercussões sociais, psicológicas e clínicas para as pacientes. Perda gestacional retida é definida como a visualização do saco gestacional vazio até a décima segunda semana de gestação, gestação intrauterina no primeiro trimestre com perda da atividade cardíaca ou a estabilização da medida comprimento crânio-nádega (CCN) em avaliações ecográficas sucessivas. Historicamente, a conduta cirúrgica tem sido o tratamento de escolha para esse quadro clínico. No entanto, há novas tendências baseadas em estudos recentes que sugerem alternativas terapêuticas válidas como a conduta expectante ou a conduta farmacológica. Esta revisão apresentou a evidência científica atual das diferentes possibilidades de tratamento da perda gestacional, sua eficácia e a relação com possíveis complicações.

Miscarriage is the most common complication of pregnancy which causes serious social, psychological and clinical consequences for patients. Missed miscarriage is defined as the visualization of a gestational sac empty until 12th week of pregnancy, 1st trimester intrauterine pregnancy with loss of heart activity or stabilization of the cranial-rump length measurement (CRL) in successive sonographic evaluations. Historically the surgical approach has been the treatment of choice for this clinical event. However, the new trends based on recent studies suggest that alternative therapies are valid as expectant treatment or pharmacological treatment. This review presented the current scientific evidence of the different possibilities for the treatment of pregnancy loss, its efectiveness and relation to possible complications.

Nuliparidad como factor asociado al dolor operatorio severo, durante el tratamiento del aborto incompleto mediante aspiración manual endouterina: Hospital Nacional Dos de Mayo 2008 / Parity as factor associated to the severe pain postoperative, during the treatment of the incomplete abortion by manual aspiration endouterine: National Hospital Two of May 2008

Objetivo: Determinar si la nuliparidad está asociada al dolor pélvico intraoperatorio severo, durante la aspiración manual endouterina por aborto incompleto. Metodología: Estudio observacional de corte transversal y prospectivo, incluyendo pacientes con aborto incompleto operadas mediante la aspiración manual endouterina (AMEU). El dolor pélvico fue cuantificado utilizando la Escala Visual Numérica. Para el análisis de los datos, se usó la prueba Chi cuadrado, OR y análisis multivariado. Resultados: De 272 pacientes con aborto incompleto operadas mediante la AMEU, entre julio 2008 y marzo 2009, 191 (70.2 por ciento) fueron incluidas y 81 (29.8 por ciento) excluidas. El 67.5 por ciento de las pacientes incluidas tuvieron entre 20 y 34 años, 40.8 por ciento procedían de los distritos La Victoria y El Cercado, 72.2 por ciento eran casadas o convivientes, y el 82.7 por ciento pertenecían al nivel socioeconómico C, D y E. Las nulíparas representaron el 50.8 por ciento y las no nulíparas el 49.2 por ciento. El 66.0 por ciento de las nulíparas y el 56.4 por ciento de las no nulíparas tuvieron dolor pélvico intraoperatorio severo, siendo la diferencia no significativa (p=0.168; OR=1.656, lC: 0.809-3.389). El promedio del dolor pélvico intraoperatorio (6.82±2.20 puntos) fue significativamente mayor que el dolor preoperatorio (2.81±1.87), (p=0.00). Conclusión: La nuliparidad no estuvo asociada significativamente al dolor pélvico intraoperatorio severo, durante la AMEU por aborto incompleto.

Outcome of conservative and surgical methods in the management of early incomplete abortions

Abortions are the most common complications of pregnancy. This study was conducted to figure out primary outcomes of surgical and conservative management of incomplete abortions in early pregnancy. This study was carried out in Mousavi and Vali Asr hospitals of Zanjan in 2008-2009. 48 women with incomplete abortions were divided into two groups based on their own preferences: conservative management [n=25] and surgical management [n=23]. In the conservative group, the patients were granted with a two-week interval for spontaneous resolution and then a sonoghraphy was performed. In the surgical group curettage was done and after two weeks patients were visited. In both groups, we compared satisfaction, time taken to do normal activities, bleeding days, pelvic pain and the need for follow up care after two weeks. In the conservative group, spontaneous resolution occurred in 19 patients [76%] after two weeks. In this group satisfaction was higher and time taken to return to the normal activities was shorter than the surgical group, but bleeding days was longer in the conservative group and more patients needed follow up care after 2 weeks. There was no significant difference in pelvic pain between two groups. Conservative management is a superior alternative method in the management of incomplete abortions in early pregnancy. However, further researches are necessary in order to attribute these results to all patients

Can ultrasound predict the presence of retained products of conception following first-trimester spontaneous abortion?

The incidence of retained products of conception [RPOC] has been reported as 1-3% and ultrasound has an important role in their diagnosis and selection of patients for surgical management. The aim of this study is to identify that ultrasound is a predictor of the presence of retained product of conception [RPOC] within the uterine cavity in women with the clinical diagnosis of incomplete first trimester abortion. hundred patients with a diagnosis of incomplete abortion and RPOC based on clinical and sonographic findings were enrolled. The gold standard test was pathologic reports of samples obtained during dilatation and curettage. Endometrial thickness and homogenesity of the endometer were determined by sonography. The sensitivity and specificity of the measurements for detecting RPOC were assessed. Histopathological reports confirmed the diagnosis of RPOC in 71 patients [71%]. Mean endometrial thickness with RPOC was 16.3 mm versus 12.1 mm without RPOC. Heterogenic endometrium was seen in 56 out of 71 patients [78%]. The sensitivity and specificity of the endometrial thickness greater than 11.25mm for detecting RPOC were 81% and 45%, respectively. Regarding the endometrial thickness and heterogenic endometer, 13.5 mm had the best performance criteria with 60% and 63% sensitivity and specificity, respectively. An endometrial thickness of 11.25 mm or more detected by sonography had the best diagnostic efficacy, considering the heterogenecity with the thickness of the endometrium, 13.5 mm had the best performance criteria for detection of RPOC following first trimester spontaneous abortion

Severe vaginal bleeding secondary to cesarean scar dehiscence following incomplete abortion management

Severe uterine bleeding is not a common presentation of cesarean section scar dehiscence in the first trimester. We present a 41-year-old lady with uterine scar dehiscence that was probably secondary to uterotonic medication used for the management of first trimester incomplete abortion. The use of uterotonic medications [Methergine] may be a contributing factor in this case. It should be used with caution in patients with previous uterine scar