Prophylactic antibiotics for curettage abortion

Opinion is divided as to the advisability of routine use of prophylactic antibiotics for curettage abortion. Six studies, including three randomized clinical trials, suggest that prophylaxis reduces infectious morbidity associated with curettage abortions by about one half. Three other studies, two involving prophylaxis for instillation abortions and one involving a vaginal antiseptic for curettage abortion, support the hypothesis that antimicrobial prophylaxis reduces morbidity. Tetracyclines are commonly used for this purpose. The cost of routine prophylaxis even with an expensive tetracycline would appear to be offset by the savings in direct and indirect costs. Prophylaxis may help prevent both short-term morbidity and potential late sequelae, such as ectopic pregnancy and infertility.     

Non-invasive screening and rapid QF-PCR assay can greatly reduce the need for conventional cytogenetic analyses in prenatal diagnosis

In 2004, the UK National Screening Committee suggested that rapid screening tests, such as fluorescence in-situ hybridization (FISH) and/or quantitative fluorescence PCR (QF-PCR), should replace prenatal diagnosis of Down syndrome performed by conventional karyotyping. However, doubts have been expressed that replacement of conventional cytogenetic investigations would result in a substantial number of infants affected by preventable handicaps. Based on a brief analysis of 28,000 prenatal tests performed in genetic units, this paper discusses the advantages of using QF-PCR. All normal fetuses were correctly diagnosed without false positive results and approximately 93% major chromosome disorders were detected by the molecular approach. The need for cytogenetic tests was thus greatly reduced, since pregnancy can be terminated, if necessary, without the need to confirm the results. A careful combination of accurately performed non-invasive ultrasound and maternal blood tests, eventually followed by QF-PCR, should reduce the need for conventional chromosome analyses.     

结合彩色多普勒血流显像探讨药物流产后清宫时机的选择

目的结合彩色多普勒血流显像及临床观察指标探讨药物流产后清宫的时机。方法选择药物流产后,阴道超声检查宫腔内残留物厚度≥1.0cm的患者153例,接受清宫术的94例作为研究组,其余59例作为对照组,观察两组的临床结局。结果彩色多普勒血流显像诊断不全流产准确率95.7%,研究组阴道出血时间、出血量、尿HCG转阴率、月经复潮时间明显高于对照组（P〈0.05）。结论彩色多普勒血流显像对药物流产后宫内残留有重要的诊断价值,药物流产后宫内残留组织厚度≥1cm、有丰富血流信号者应尽早清宫,以减少药物流产的并发症。     

Prophylactic antibiotics for suction curettage in incomplete abortion

Objective: The purpose of this study was to investigate the efficacy of 200 mg of prophylactic doxycycline in preventing pelvic infection after curettage for spontaneous (incomplete) abortion.Methods: A randomized, prospective, double-blinded study was carried out involving 300 women with an incomplete abortion who were given either placebo or 200 mg of doxycycline orally 30-60 min prior to curettage. A hematocrit, WBC count, pregnancy test, syphilis serology, Neisseria gonorrhoeae culture, and Micro Trak (monoclonal antibody test, Syba, San Jose, CA) for Chlamydia trachomatis were performed. The patients were scheduled for follow-up 2 weeks later. Antibiotic administration for any reason as well as the postoperative infection rate in these women was assessed.Results: Eleven women were excluded from analysis, leaving 289 evaluable. N. gonorrhoeae was isolated from 6 (2%) women and C. trachomatis from 8 (3%) women, and the syphilis serology was serofast in 4 (1%) women. Endometritis complicated the procedure in 4 women who received placebo and in 1 woman who received doxycycline (P = 0.22).Conclusion: Prophylactic doxycycline is not effective in preventing pelvic infection after curettage for spontaneous (incomplete) abortion.     

Preventing febrile complications of suction curettage abortion

To identify risk factors for febrile complications after suction curettage abortion, we analyzed the data of 26,332 women who underwent suction curettage abortion at five participating centers in the Joint Program for the Study of Abortion, Part III, from 1975 to 1978. We defined febrile morbidity as an oral temperature of greater than or equal to 38 degrees C for 2 days or longer. The febrile morbidity rate was 0.34 per 100 abortions. We performed a multivariate analysis using a linear logistic regression model. Prophylactic antibiotics proved to be the most protective factor, reducing the rate of febrile complications to about one third that of women who received no prophylactic antibiotics (relative risk 0.36; 95% confidence interval 0.18 to 0.70). Patients who had had one or more previous births also had a significantly lower risk of febrile morbidity (relative risk 0.54; 95% confidence interval 0.33 to 0.88). Other factors did not significantly affect the febrile complication rate.     

Ultrasound diagnosis of complete uterine inversion in a nulliparous woman

Non-puerperal uterine inversion is an extremely rare event, and the diagnosis is made during vaginal examination or exploratory laparotomy. We report a case of complete uterine inversion which was diagnosed on abdominal ultrasound examination in a 50-year-old nulliparous virgin who was admitted to the hospital because of profuse vaginal bleeding, lower abdominal pain and anuria. The confirmatory diagnosis of complete uterine inversion secondary to a fundal fibroid was made at exploratory laparotomy. Total abdominal hysterectomy was performed, and the pathological examination confirmed its benign nature. Ultrasound evaluation is useful in the diagnosis of non-puerperal uterine inversion.     

Ultrasound and semiquantitative chorionic gonadotropin secretin in the diagnosis of abortion

191 patients with signs of threatened abortion were assessed by means of ultrasound (Kretz-Technik, Vidoson, Siemens) and semiquantitative assay of urinary HCG-excretion. Sonar examination was able to establish an accurate diagnosis of fetal life (heart action and/or movements) in all pregnancies showing a gestation sac suitable to the 11th week. The remainder cases required a repeated investigation including HCG-levels and growth rate of the gestational sac. Thus the diagnosis of blighted ovum could be made within one or occassionally two weeks.     

Decreasing the need for abortion: challenges and constraints.

Voluntary abortion is the most controversial act in the entire field of medical practice, although today, it is a practice that, under different conditions, has been legalized in more than 100 countries, mostly in the developed world. The United Nations has agreed that in no case should abortion be promoted as a method of family planning and, therefore, it should be utilized only when contraception has failed. Overall, 61% of humanity lives in countries where abortion is legal and widely available; 14% in countries where termination is allowed to protect a woman's health; physical, mental, or both; 21% in countries where it can be performed only to save the mother's life and 4% in countries where abortion is not permitted at all. Restrictive legislation, per se, does not represent a valid deterrent to prevent abortion, while it may contribute to an increase in morbidity and mortality associated with pregnancy. In addition, because abortion is outlawed, nothing is done to actively reduce the reasons leading to it. Indeed, the countries with the lowest abortion rates are those where, on the one hand, pregnancy termination is legal and, on the other, sex education and contraceptive knowledge are widely spread.     

Evaluation of a balloon dilator before second-trimester abortion by vacuum curettage.

We evaluated the cervical dilator device (CDD), an expanding balloon, as a substitute for laminaria tents before abortion at 13 to 16 1/2 weeks by extraction and vacuum curettage. The CDD was found to be an effective dilator, although it did not appear to have any advantage over laminaria tents when placed overnight and was associated with significant pain upon insertion and an apparent increased risk of endometritis. The present CDD or a subsequent modification may offer advantages over laminaria tents for short-term placement.     

Current dilatation and curettage practice: a need for revision

A ten-year retrospective review of 1383 diagnostic dilatation and curettages (D&C) was done at a university hospital. It was found that the detection or diagnosis of uterine cancer did not significantly increase until after the age of 50. No significant pathologic findings were detected in 60% or more of the women until the age of 70. Premalignant or other than benign tissue was observed to increase from 4% in the age 29 or less group to a peak of 16% in the age 45 to 49 group. The authors conclude that the current practice of routine D&C for abnormal uterine bleeding provides a low yield of cancer diagnoses, and that the indications for this procedure should be sharply reduced or replaced by simpler methods.     

Prophylactic antibiotics for suction curettage abortion: results of a clinical controlled trial

The prophylactic use of 300 mg doxycycline at the time of an abortion was evaluated in a randomized controlled trial. In the group with negative chlamydia screening results, only two (0.4%) of 502 patients who received prophylactic treatment developed pelvic infection, compared with 15 (3.0%) of 497 patients who received placebos (p = 0.001). The same effectiveness was found in women with positive chlamydia screening results. Vomiting was the major side effect of the medication and could limit its use. A simulation of selective prophylaxis in women with negative chlamydia screening results showed that its selective use in patients with a history of gonorrhea or in nulliparous women with multiple sex partners could be nearly two thirds as effective as general prophylaxis.     

The value of curettage in diagnosis of endometrial hyperplasia.

OBJECTIVES: The aim of this study was to assess the value of diagnosis of endometrial hyperplasia by curettage and to determine the results of proliferating cell nuclear antigen (PCNA) immunostaining in differentiating endometrial carcinoma from endometrial hyperplasia. METHODS: According to Kurman's criteria, we treated 150 patients with endometrial hyperplasia detected by curettage and compared retrospectively the diagnosis by curettage with that by hysterectomy. PCNA expression was examined using immunohistochemostaining on 60 patients with complex atypical hyperplasia detected by curettage. RESULTS: Simple hyperplasia was found by curettage in 53 patients, complex hyperplasia in 11, simple atypical hyperplasia in 26, and complex atypical hyperplasia in 60. All patients were rediagnosed after hysterectomy. As a result, 65 were found to have simple hyperplasia, 7 complex hyperplasia, 15 simple atypical hyperplasia, 29 complex atypical hyperplasia, and 34 endometrial carcinoma. The accuracy of histological diagnosis by curettage was 76.7-92.0% and was dependent on different types of hyperplasia. Simple atypical hyperplasia and complex atypical hyperplasia were more likely to coexist with endometrial carcinoma than both simple hyperplasia and complex hyperplasia (chi2 = 26.3, P < 0.001), and complex atypical hyperplasia was more likely to coexist with endometrial carcinoma than simple atypical hyperplasia (chi2 = 9.78, P < 0.005). In complex atypical hyperplasia patients, coexistence with endometrial carcinoma was more common after menopause than before menopause (chi2 = 3.93, P < 0.05). In complex atypical hyperplasia patients, the expression of PCNA in cases associated with endometrial carcinoma was higher or stronger than in cases associated without endometrial carcinoma (chi2 = 7.68, P < 0.01, or U = 252.00, P < 0.01). Conclusions. Curettage tends to be more highly accurate in diagnosing simple hyperplasia than complex atypical hyperplasia, which is often found by hysterectomy to be associated with endometrial carcinoma. The expression of PCNA may be helpful in differentiating complex atypical hyperplasia from endometrial carcinoma.     

Innovative methods in prevention of the need for abortion

Since conception often occurs as an unplanned consequence of coital behavior, there is a need for postconceptive family planning. 1 survey of women seeking abortion (Washington State) showed that 74% were not using contraceptives at the time of conception. Postconceptive methods currently available include the morning-after pill, dilatation and curettage, suction curettage, intra or extraovular manipulation, and hysterotomy and hysterectomy. New techniques of inducing endometrial shedding even before pregnancy has been ascertained should be explored and communicated. Prostaglandins may be 1 method.     

Panoramic hysteroscopy with directed biopsies vs. dilatation and curettage for accurate diagnosis

Sixty-six women underwent panoramic hysteroscopy prior to dilatation and curettage. In 51 of these patients, a directed biopsy was performed through the hysteroscope. The indications for surgery were abnormal bleeding, postmenopausal bleeding, leiomyoma with bleeding, follow-up for adenomatous hyperplasia, infertility with bleeding and lost intrauterine devices with bleeding. In 48 cases the results of hysteroscopy and curettage were in agreement. Hysteroscopy revealed more information than curettage in 16 patients, whereas curettage revealed more information than hysteroscopy in only 2. Thus, panoramic hysteroscopy may prove to be superior to curettage in making an accurate diagnosis of pathology in the uterine cavity.