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Minerva Ginecologica 2017 February;69(1):23-8

DOI: 10.23736/S0026-4784.16.03935-6

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

Lower complication rates with office-based D&C under ultrasound guidance for missed abortion

Michael CHAIKOF 1, 2, Tal LAZER 1, 2, Itai GAT 1, 2, 3, Kevin QUACH 2, Basheer ALKUDMANI 1, 2, Khaled ZOHNI 1, 2, 3, Ari BARATZ 1, 2, 4, 5, Karen GLASS 1, 2, 5, Prati SHARMA 1, 2, 5, Clifford LIBRACH 1, 2, 5

1 Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada; 2 CReATe Fertility Centre, Toronto, Canada; 3 Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel; 4 Department of Reproductive Health and Family Planning, National Research Centre, Cairo, Egypt; 5 Department of Gynecology, Women’s College Hospital, Toronto, Canada


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BACKGROUND: Missed abortion (MA) can be managed expectantly, medically or surgically. Surgical management has been performed safely in the office setting by suction dilation and curettage (D&C). Prior studies suggest that intraoperative ultrasound guidance (USG) may reduce complications for first-trimester therapeutic abortion. The aim of this study was to evaluate the safety of office D&C for MA using real-time USG.
METHODS: This retrospective cohort study included 255 patients who underwent office D&C under USG for first trimester MA at a single university-affiliated fertility clinic during January 2011-December 2013. Transabdominal USG was utilized during the procedure and was immediately followed by a transvaginal ultrasound examination to confirm full evacuation. Intra- and postoperative complication rates were compared to previously published data.
RESULTS: There were no intraoperative complications, including excessive blood loss or uterine perforation. Two of the 255 patients (0.87%) were diagnosed with RPOCs requiring uterine re-evacuation. This rate of RPOCs was superior to rates previously reported for D&Cs without USG (2.6-4.9%, P=0.046). There were no other post procedure complications identified.
CONCLUSIONS: We observed very low complications rate in Office-based D&C under USG, lower than those reported in the literature with unguided D&C.


KEY WORDS: Abortion, missed - Dilatation and curettage - Ultrasonography

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