"We have to what?": lessons learned about engaging support staff in an interprofessional intervention to implement MVA for management of spontaneous abortion.
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The impact of ultrasonographic lesion size and initial human chorionic gonadotropin values on treatment success in cases with complete hydatidiform mole.
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The cervix-ripening effect of 15-methyl-prostaglandin F2 alpha methyl ester before vacuum aspiration for termination of early pregnancy in primigravidae.
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A double blind clinical trial on prostaglandin for cervix ripening prior to vacuum aspiration for termination of early pregnancy in primigravidae was carried out in 68 patients with 6-11 week's gestation. The patients were randomly treated with either 1.0 mg of 15-methyl-prostaglandin F2 alpha methyl ester vaginal suppository or a placebo suppository. A mean cervical dilation to 6.6 mm was achieved with minimal side effects in the prostaglandin group as against 4.3 mm in the placebo group. The 15-methyl-prostaglandin F2 alpha methyl ester suppository technique seems to be effective, safe and simple in ripening the cervix for termination of early pregnancy in primigravidae. (+info)
Diagnostic and therapeutic hysteroscopy for traumatic intrauterine adhesion. Clinical analysis of 70 patients.
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This paper presents the results of diagnostic and therapeutic hysteroscopy in 70 patients with traumatic intrauterine adhesions. In all the patients, the diagnoses and types of intrauterine adhesions were confirmed by hysteroscopy. In 68 out of the 70 patients (97.14%) intrauterine adhesions were released successfully after 1-3 times of surgery. Of the 64 patients with amenorrhea or hypomenorrhea before treatment, 54 (84.38%) had regular menstruation. In 35 patients who desired to have a child and were followed up more than 6 months after the withdrawal of contraception, 30 (85.71%) had intrauterine pregnancies. Among the 30 patients, 17 had full-term pregnancies, 12 were in progress and 1 had early spontaneous abortion. The postpartum course was uneventful in the 17 patients with term delivery. We conclude that hysteroscopy is of value in the diagnosis and treatment of traumatic intrauterine adhesions. (+info)
Methotrexate and misoprostol to terminate early pregnancy.
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BACKGROUND: Although medical termination of pregnancy is available in Europe and China as an alternative to surgical termination, political and social factors have blocked medical approaches to pregnancy termination in the United States. Methotrexate, which is toxic to trophoblastic tissue, has been used safely to treat unruptured ectopic pregnancies. This report describes the use of a single low dose of methotrexate followed by intravaginal misoprostol for the medical termination of early pregnancy. METHODS: Women seeking termination of pregnancy were selected for this study on the basis of their good general health, emotional stability, and a pregnancy of 63 days or less in duration. Each woman received an intramuscular dose of methotrexate (50 mg per square meter of body-surface area). Five to seven days later, 800 micrograms of misoprostol was administered intravaginally. If abortion did not occur after seven days, the women was offered a second dose of misoprostol or vacuum aspiration. Successful abortion was defined as a complete termination of pregnancy within seven days after the first or second administration of misoprostol. RESULTS: A total of 171 of the 178 women enrolled in the study (96 percent) had successful medical abortions. Twenty-five women (14 percent) did not have an abortion after the first dose of misoprostol and received a second dose. Eighteen subsequently had complete abortions, but seven required suction curettage. In all seven women who required suction curettage, there was histologic evidence of disruption in the conceptus. No important side effects or complications were noted. CONCLUSIONS: The combination of methotrexate and misoprostol represents a safe and effective alternative to invasive methods for the termination of early pregnancy. (+info)
Comparison of medical abortion with surgical vacuum aspiration: women's preferences and acceptability of treatment.
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OBJECTIVES: To assess women's preferences for, and the acceptability of, medical abortion and vacuum aspiration in the early first trimester. DESIGN: Patient centred, partially randomised trial. Medical abortion was performed with mifepristone 600 mg followed 48 hours later by gemeprost 1 mg vaginal pessary. Vacuum aspiration was performed under general anaesthesia. SETTING: Teaching hospital in Scotland. PATIENTS: 363 women undergoing legal induced abortion at less than nine weeks' gestation. MAIN OUTCOME MEASURES: Women's preferences for method of abortion before abortion; acceptability judged two weeks after abortion by recording the method women would opt to undergo in future and by semantic differential rating technique. RESULTS: 73 (20%) women preferred to undergo medical abortion, and 95 (26%) vacuum aspiration; 195 (54%) were willing to undergo either method, and were allocated at random. Both procedures were highly acceptable to women with preferences. Gestation had a definite effect on acceptability in randomised women; at less than 50 days there were no differences, but between 50 and 63 days vacuum aspiration was significantly more acceptable. CONCLUSIONS: Women who wish to use a particular method should be allowed their choice, regardless of gestation. Women of 50-63 days' gestation without preferences for a particular method are likely to find vacuum aspiration more acceptable. A patient centred, partially randomised trial design may be a useful tool in pragmatic research. (+info)
Karman's cannula and vacuum aspirator in gynecological practice.
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The charts of 340 patients who underwent an endometrial suction procedure using Karman's cannula and syringe were reviewed. The therapeutic uses of this instrument were for the treatment of chronic endometritis (18.6%), the evacuation of incomplete or missed abortion (14.6%) and hydatidiform mole (0.8%), and the retrieval of the missing tail of an intrauterine contraceptive device (1.2%). Its diagnostic indications include: the investigation of infertility (55.3%), dysfunctional uterine bleeding (8.7%), and postcoital bleeding (0.8%). The diagnostic yield of the instrument was 96.6%. Transient postoperative abdominal pain occurred in 65.9% of the cases while cervical dilatation preceded aspiration in 12.9% of the cases with cervical stenosis. The advantages of the instrument are discussed and its usefulness in everyday gynecological practice highlighted. (+info)