OBJECTIVE: To investigate whether routine intraoperative ultrasonographic guidance during second-trimester dilatation and evacuation (D&E) reduces procedure-related complications in an Ethiopian setting.
METHODS: We conducted a pre-post study on routine ultrasonography during second-trimester D&E at St. Paul\'s Hospital Millennium Medical College (Ethiopia). Second-trimester D&E cases that were managed at the hospital between 2017 and 2022 were retrospectively analyzed by grouping them into an intervention group (using routine ultrasound intraoperatively for all cases) and a non-intervention group (problem-based intraoperative use of ultrasound, where ultrasound was used in problem cases only). SPSS version 23 was used for analysis and simple descriptive statistics, χ2 test, multivariate regression analysis, and Fisher exact test were performed as appropriate. P values less than 0.05 and odds ratio with 95% CI were used to present the results\' significance.
RESULTS: A total of 242 second-trimester D&E cases were analyzed (84 cases managed under routine intraoperative ultrasound guidance and 158 cases managed with a problem-based intraoperative use of ultrasound). Compared with problem-based intraoperative use of ultrasound (using it only in selected cases), routine intraoperative ultrasound use was not associated with a decrease in D&E complications (adjusted odds ratio [aOR] 0.22, 95% confidence interval [CI] 0.04-1.16). The two factors associated with increased D&E procedure complications were advanced gestational age (aOR 13.52, 95% CI 1.86-98.52), and need for additional mechanical cervical dilatation during the D&E procedure (aOR 9.53, 95% CI 1.32-69.07). Provider experience, cervical preparation methods (laminaria vs Foley), and maternal age were not associated with occurrence of D&E complications.
CONCLUSIONS: Our study does not support the preference of routine intraoperative ultrasound guidance over problem-based (in selected cases) intraoperative ultrasound use during the second-trimester D&E procedure. More research is needed to make a strong clinical recommendation on using routine intraoperative ultrasound guidance during all second-trimester D&E procedures.

暂无摘要。

High-quality care for termination of pregnancy (TOP) requires pain to be effectively managed; however, practices differ, and the available guidelines do not specify optimal strategies.
To guide providers in effective pain management for second-trimester medical and surgical TOP.
We searched PubMed, Cochrane and Embase databases, and the US National Library of Medicine clinical trials registry, from inception to the end of June 2019, and hand-searched reference lists.
Trials comparing pain management strategies with no treatment, placebo or active interventions during induced medical or surgical TOP, occurring between 13 and 24 weeks of gestation, and reporting direct or indirect measures of pain.
Both authors summarised and systematically assessed the evidence and risk of bias using standard tools.
We included seven medical and four surgical TOP studies, with 453 and 349 participants, respectively. The heterogeneity of interventions and outcomes prevented pooled analyses. Medical TOP: women receiving routine or continuous epidural analgesia experienced mild pain. The prophylactic use of nonsteroidal anti-inflammatory drugs (NSAIDs) decreased pain (mean difference -0.5, P < 0.001) and additional opioid requirements (3.5 versus 7 mg, P = 0.04) compared with placebo/other treatment. Paracervical block was ineffective. No studies assessed intramuscular (IM)/intravenous (IV) opioid or nonpharmacological treatment. Surgical TOP: general anaesthesia/deep IV sedation alleviated pain. Nitrous oxide was ineffective. No studies assessed moderate IV sedation, IV/IM opioid, paracervical block without sedation, NSAID or nonpharmacological treatment.
Based on limited data, regional analgesia and NSAIDs mitigated second-trimester medical TOP pain; general anaesthesia/deep IV sedation alleviated surgical TOP pain.
Although women experience intense pain during second-trimester termination of pregnancy, few data are available to inform their treatment.

Intrauterine retention of fetal bones is a rare complication of unsafe abortion. Patients may present with infertility, chronic pelvic pain, menorrhagia and vaginal discharge. Here, we discuss a management of young female patient with uterine bleeding after miscarriage. Other causes of abnormal uterine bleeding such as infection, polyp, fibroid, malignancy were excluded. Retained intrauterine fetal bones were found as a sole cause of her complaint. Diagnosis was made with pelvic ultrasound and pelvic radiography. Dilatation and curettage was performed to remove the fetal bones with a good subsequent outcome.

Placenta accreta is abnormal placental attachment to the myometrium, and the incidence rate has risen with the increased use of Cesarean sections. First-trimester placenta accreta is a rare, potentially life-threatening condition due to the severe hemorrhage it may cause, necessitating a hysterectomy. We present a case of a 38-year-old woman with a history of two Cesarean section deliveries who developed severe bleeding during curetting due to undiagnosed placenta accreta. Unilateral uterine and ovarian arterial ligations were performed to reduce expected bleeding along with a local resection of the placental implantation site that was invading the old scar. This procedure was effective with fewer complications than traditional procedures and preserved the patient\'s fertility.

UNASSIGNED: Gut prolapse through vagina is rare complication with only few cases reported in the literature. This article highlights untrained professionals induced obstetrical trauma as a cause of vaginal evisceration leading to serious but preventable complications.
UNASSIGNED: Case 1: A 27 years old female, P2L0, had full term vaginal delivery of an IUD baby and presented 4 days later with small bowel evisceration through posterior vaginal wall. Case 2: A 24 years old female, P1A1 had underwent unsafe abortion and presented in shock, with small bowel evisceration through anterior uterine wall. Case 3: A 26 years female, P2A1, underwent evacuation for incomplete abortion and presented with omental prolapse through anterior uterine wall.
UNASSIGNED: Obstetrical trauma with associated evisceration of intraabdominal contents is a potentially serious complication that requires surgical intervention. General awareness may decrease these unsafe practices and thus would have impact in reducing maternal morbidity and mortality.

OBJECTIVE: Women in Scotland who request an abortion (for non-medical reasons) within the legal gestational limit (up to 24 weeks) but beyond the gestational limit of all abortion facilities in Scotland (only up to 20 weeks) must travel to England if they wish to terminate the pregnancy. We wished to determine the number and characteristics of women presenting at ≥16 weeks\' gestation for abortion, and compare the characteristics of those proceeding to abortion with those continuing the pregnancy.
METHODS: Over a period of 12 months we conducted a prospective audit of women presenting at ≥16 weeks\' gestation to abortion services throughout Scotland. The characteristics of women proceeding to abortion and those continuing the pregnancy were compared.
RESULTS: A total of 267 women presented for abortion at ≥16 weeks\' gestation. Their median age was 22 years (range 14 to 47 years); 231 were from deprived areas (86.5%), 128 (47.9%) already had a child and 73 (27.3%) had previously undergone abortion. A total of 175 women (65.5%) proceeded to abortion, locally (n = 125; 46.8%) or in England (50; 18.7%). Those at ≥20 weeks\' gestation were statistically more likely to continue the pregnancy than those at earlier gestations (p < 0.001).
CONCLUSIONS: Relatively few women present for abortion in Scotland at ≥16 weeks\' gestation. Those who are over 20 weeks\' gestation and would need to travel to England for abortion are more likely to continue the pregnancy, suggesting that travel is a barrier to accessing legal abortion for this group of women. Provision of abortion services up to 24 weeks\' gestation should be considered within Scotland.

METHODS: A retrospective analysis of medical records of three consecutive cohorts of women. All cohorts received a digoxin feticide injection on Day 1. Two cohorts were treated with laminaria, cohort A of 151 women over 1-2 days and cohort B of 52 women over 1-3 days, and cohort C of 151 women was treated with Dilapan-S over 1-3 days.
RESULTS: Adequate cervical priming for dilatation and evacuation (D&E) on Day 2 was achieved in 98% of the Dilapan-S cohort and 56% of cohort A and 40% of the cohort B laminaria cohorts. Return to theater for D&E 3-4 hours after dilator insertion on Day 2 occurred in 62.3% of Dilapan-S cohort C and 9.3% of cohort A and 4% of cohort B laminaria cohorts (P = 0.001). A mean D&E theater time of 19 minutes for laminaria cohort A was reduced by 10.1% in the Dilapan-S cohort C (P = 0.02). The incidence of unscheduled overnight delivery outside the clinic was 0% for Dilapan-S and 1.3% for cohort A and 3.8% for cohort B laminaria cohorts (P = 0.14).
CONCLUSIONS: Dilapan-S osmotic dilators are superior to laminaria in producing more cervical priming and dilatation in a shorter time. This enables 17-22 week D&E procedures to be carried out in fewer days and in shorter theater times. They also eliminate the risk of an unscheduled overnight delivery outside the clinic.