Ultrasound-guided surgical suction evacuation (US-SSE) for missed miscarriage

Abstract

Introduction: Surgical evacuation of the uterine contents in first trimester missed miscarriage is a blind procedure, carrying a risk of complications. This study was designed to evaluate the outcome of the implemented protocol of ultrasound-guided surgical suction evacuation (US-SSE) for first trimester missed miscarriage. Material and methods: Two hundred and twenty women diagnosed with missed miscarriage in the first trimester of pregnancy were included in this study and classified in two groups: 124 women in the US-SSE group, and 94 women in the blind surgical suction evacuation (B-SSE) group. Outcome measures: operative time, hemoglobin loss, hospital stay, cervical trauma, uterine perforation, retained products of conception (RPOC) requiring repeat evacuation, and post-operative infection. Results: The hemoglobin loss was significantly lower in the US-SSE group compared to B-SSE (0.9 ±1.1 vs. 1.2 ±0.8 gms% ; respectively, p = 0.0006), and the hospital stay was significantly shorter in the US-SSE group compared to B-SSE (1.1 ±1.3 vs. 1.5 ±0.9 days; respectively, p = 0.0001). Cervical trauma was significantly less frequent in the US-SSE group compared to B-SSE (0 (0%) vs. 2 (2.08%); respectively, p = 0.05), and uterine perforation was significantly less frequent in the US-SSE group compared to B-SSE (0 (0%) vs. 2 (2.08%); respectively, p = 0.05). Post-operative endometritis was significantly less frequent in the US-SSE group compared to B-SSE (0 (0%) vs. 3 (3.13%); respectively, p = 0.02), and RPOC requiring repeat evacuation was significantly less frequent in the US-SSE group compared to B-SSE (0 (0%) vs. 4 (4.16%); respectively, p = 0.007). Conclusions: US-SSE for first trimester missed miscarriage is safer than the B-SSE method, and is associated with significant reduction of intra-operative and post-operative complications.

Dehydroepiandrosterone can restore the function of the ovaries – a series of 5 cases and a review of the literature

“…Similarly, some patients qualified for the IVF procedure using the donor's egg cells were given pregnancies before the procedure of in vitro fertilization began. It has been found that the administration of DHEA in patients with premature ovarian failure prolongs the chances of pregnancy, reduces the risk of miscarriage and increases the chance of success when using IVF methods [14,15,16,[54][55][56][57].…”

Sonographic Detection of Uterine Perforation in Surgical Abortions: Case Report From a Developing Country.

“…In a randomized control trial by Acharya et al (11), complications of abortion were significantly reduced under ultrasound-guidance (<4%) in comparison to without ultrasound guidance (>15%). Another related randomized control trial showed that the incidence of uterine perforation was 0% with ultrasound guidance and approximately 3% without ultrasound guidance (12). While some may argue that routine ultrasound-guidance for surgical abortions may not be practicable from the economic standpoint in developing countries, it is worth noting that the annual cost of treating major complications of abortion in developing countries is over 500 million US dollars (13), including 200 million dollars on post-abortion care (14).…”