ABSTRACT
Study Objective To describe the feasibility of hysteroscopy assisted suction curettage for early pregnancy loss and to investigate whether it reduces the rates of retained products of conception (RPOC) and intrauterine adhesions (IUA). Design Prospective single-arm cohort study. Setting University-affiliated department of Obstetrics and Gynecology. Patients or Participants Women admitted for surgical evacuation in cases of early pregnancy loss. Interventions Vaginal misoprostol was administered for cervical ripening preoperatively. Under general anesthesia, hysteroscopy was performed to identify the pregnancy's implantation wall, followed by ultrasound-guided suction and curettage directed to the implantation wall, and hysteroscopy to verify uterine cavity emptying. Postoperative IUA were evaluated by follow-up hysteroscopy. Measurements and Main Results Identification of the pregnancy's implantation wall on hysteroscopy, and intra- and postoperative complications associated with the procedure. The evaluation of postoperative IUA was limited due to the COVID-19 pandemic restrictions. Main Results: 40 patients, with early pregnancy loss were studied. In 33 out of 40 cases (82.5%), the implantation wall was clearly visualized on hysteroscopy. In 4 cases, suspected RPOC were diagnosed intraoperatively by hysteroscopy and removed. The histology examination confirmed the presence of RPOC in 3 out of 4 cases. Follow-up office hysteroscopy was performed in 9 women, diagnosing mild IUA in one out of 9 cases. In 15 cases, a new pregnancy was reported at time of follow-up. Conclusion Hysteroscopy assisted suction curettage for early pregnancy loss is safe procedure, which allows the identification of the pregnancy's implantation wall in most cases and may reduce the rates of RPOC and IUA. By identification of uterine anomalies, the procedure may offer a potential benefit in terms of reproductive outcomes for hypo-fertile patients.
ABSTRACT
Background: Advanced Care Planning (ACP) is a complicated process that allows patients to make decisions about their future medical care that are consistent with their values. Documentation of patient's values should be done routinely and revised with change in the medical condition, this allows for their voice to be heard when they are no longer able to choose. We recently instituted addressing elements known as 4Ms (What matters, medication, mentation, and mobility) into our daily clinic flow as part of our certification to become an Age Friendly Health System1. This clinic-based QI project aims to assess the effect of the 4Ms process on ACP completion. Methods: We used a retrospective chart review and an electronic health record (EHR) generated report that compared patients seen in our office in 2 six-month periods;before (Jan-Jun, 2020) and after (Jul -Dec, 2020) instituting 4M care into our practice to assess its effects on our ACP completion rate. This QI project was conducted at our Geriatric Care Clinic, an outpatient clinic with a multidisciplinary team including physicians, pharmacists, nurses, and medical assistants. Our clinic used a checklist form as part of the rooming process that included all elements of the 4Ms. This project looked at the effect of addressing what matters most on ACP completion and documentation rates. We reviewed ACP documentation in the EHR that includes: Living Will, Advance Directive, Power of Attorney, Five Wishes, to populate a completion rate. Results: We anticipate an increase in our ACP completion rate. Conclusions: We anticipate that there should be an improvement in our ACP completion rates after instituting 4M screening procedures. We recognize that our results may be complicated by changes in ACP discussion practices as they relate to differences in care during the COVID-19 pandemic. instituting 4M screening practices may be a useful process to improve ACP discussion and documentation.