OBJECTIVE: To determine the feasibility and safety of resectoscopic treatment for uterine evacuation of first-trimester miscarriage.
METHODS: A single-centre prospective study performed between April 2021 and October 2021 at a university-affiliated tertiary medical centre. Patients diagnosed with early miscarriage of up to 12 weeks from the last menstrual period were eligible for participation. Recruited patients underwent hysteroscopic uterine evacuation under general anaesthesia by a Versapoint 2 bipolar resectoscope 24Fr (Johnson and Johnson, Germany).
RESULTS: A total of 15 patients were recruited for the study. The procedural characteristics as well as intra- and postoperative adverse events were recorded. The mean duration of the procedure was 14.3 ± 3.7 minutes. The achievement of complete evacuation was recorded in all cases, and no adverse events occurred during any procedure. Post-procedure follow-up 6 weeks after treatment was conducted by office hysteroscopy in 10 women and by ultrasonography in 4 women. One woman had conceived prior to her scheduled follow-up visit. In total, 2 (13.3%) cases of retained products of conception were diagnosed during office hysteroscopy and they were removed by the \"see-and-treat\" technique without anaesthesia. The diagnosis was confirmed pathologically. No intrauterine adhesions were detected and none of the women required a second hysteroscopy under anaesthesia due to retained products of conception.
CONCLUSIONS: Hysteroscopic evacuation of first-trimester miscarriage by a standard resectoscope is a safe and feasible technique.

Hysteroscopic resection of ectopic cornual pregnancy following MRI imaging is a safe and effective treatment option without significantly impacting fertility potential or increasing the risk of future obstetrical complications.

OBJECTIVE: To evaluate maternal and neonatal outcomes of pregnancies following a uterine evacuation in the second trimester, in comparison to a first trimester spontaneous pregnancy loss.
METHODS: A retrospective analysis of data of women who conceived ≤6 months following a uterine evacuation due to a spontaneous pregnancy loss and subsequently delivered in a single tertiary medical center between 2016 and 2021. Maternal and neonatal outcomes were compared between women with second trimester (14-23 weeks) and first trimester (<14 weeks) pregnancy loss. The primary outcome of this study was the preterm delivery (<37 weeks) rate. Secondary outcomes were adverse maternal and neonatal outcomes. Univariate analysis was followed by multiple logistic regression models; adjusted odds ratios (aORs) and 95 % confidence intervals (CIs) were calculated.
RESULTS: During the study period, 1365 women met the inclusion criteria. Of those, 272 (19.9 %) women gave birth following a second trimester uterine evacuation and 1093 (80.1 %) women following a first trimester uterine evacuation. There were no demographic differences between the two groups. No difference was found in the preterm delivery rate in the subsequent pregnancy (5.1 % vs. 5.3 %, p = 0.91), further confirmed in the multivariate analysis [aOR 1.02 (0.53-1.94), p = 0.96]. No differences were identified with respect to other maternal and neonatal parameters examined, including hypertension disorders of pregnancy, third stage placental complications, mode of delivery and neonatal birth weight.
CONCLUSIONS: Pregnancy conceived shortly after second trimester uterine evacuation as compared to first trimester, confers no additional risk for preterm delivery or other adverse perinatal outcomes. Further studies to strengthen these findings are needed.

暂无摘要。

BACKGROUND: Bimanual clot evacuation (BCE) is a simple clinical manoeuvre that may reduce need for surgical intervention in the management of severe postpartum haemorrhage (PPH). We sought to determine whether performing BCE in cases of severe PPH after vaginal birth reduces the need for surgical intervention.
METHODS: A retrospective chart review of women who delivered vaginally with a severe PPH between January 1, 2011 and December 31, 2014 in a single tertiary women\'s hospital in Sydney, Australia was conducted. Severe PPH was classified as a blood loss ≥1000mls. The need for surgical management (including operating theatre uterine exploration or evacuation, intrauterine balloon tamponade, repair of significant trauma, uterine or internal iliac artery ligation, B-Lynch suture insertion or hysterectomy) was the primary outcome measure, as expressed by need for operating theatre utilisation.
RESULTS: From a cohort of 438, 149 women (34.0%) had BCE, of whom 29 (19.5%) required surgical management compared to 103 of 289 women with no BCE (35.6%); an odds ratio (OR) of 0.38 for BCE (confidence interval 0.20-0.72; p = 0.003). Early BCE (< 1 h of delivery) was associated with a further reduction in surgery (OR 0.24; confidence interval 0.08-0.70; p = 0.009) compared to late BCE (> 1 h of delivery). There was no reduction in estimated blood loss (p = 0.86) or blood transfusion (p = 0.71) with BCE.
CONCLUSIONS: Our study suggests BCE reduces theatre utilisation in the context of severe PPH following vaginal delivery. Prospective trials are needed to determine whether BCE should be endorsed as a treatment modality for PPH post-vaginal delivery.

BACKGROUND: The clinical value of total hysterectomy for patients with hydatidiform mole (HM) being at least 40 years old remains highly controversial. Since the practice of hysterectomy has been applied globally for decades, there is an urgent need to perform a systematic review to assess its risks and benefits.
METHODS: Six electronic databases, including four English databases and one Chinese database, were searched from the inception of each database till October 6th 2017. Studies were included if they: 1) were human studies, 2) explicitly indicated exposure to hysterectomy, 3) explicitly indicated control to uterine evacuation, 4) explicitly indicated the participants were older patients with HM being at least 40 years in age, 5) compared the outcome of interest as the incidence of post-molar GTN. Two authors independently conducted the literature search, study selection, data extraction. Pooled odds ratios were analyzed using Review Manager 5.3.
RESULTS: The overall pooled effect size of total hysterectomy had a significant advantage in preventing post-molar gestational trophoblastic neoplasia over uterine evacuation with an OR of 0.19 (95% CI, 0.08-0.48; P = 0.0004) and a low heterogeneity (I2 = 21%, P = 0.28). Subgroup analysis and sensitivity analysis also showed similar results.
CONCLUSIONS: Total hysterectomy, as compared to uterine evacuation, is a better therapeutic method for patients with HM being at least 40 years old unless fertility is still desired.

Pregnancy of unknown location (PUL) is not a diagnosis but a transient state used to classify a woman when she has a positive pregnancy test without definitive evidence of an intra-uterine or extra-uterine pregnancy on transvaginal ultrasonography. Management of a persisting PUL varies substantially, including expectant or active management. Active management can include uterine cavity evacuation or systemic administration of methotrexate. To date, no consensus has been reached on whether either management strategy is superior or non-inferior to the other.
Randomized controlled trial.
Academic medical centers.
We plan to randomize 276 persisting PUL-diagnosed women who are 18 years or older from Reproductive Medicine Network clinics and additional interested sites, all patients will be followed for 2 years for fertility and patient satisfaction outcomes.
Randomization will be 1:1:1 ratio between expectant management, uterine evacuation and empiric use of methotrexate. After randomization to initial management plan, all patients will be followed by their clinicians until resolution of the PUL. The clinician will determine whether there is a change in management, based on clinical symptoms, and/or serial human chorionic gonadotropin (hCG) concentrations and/or additional ultrasonography.
The primary outcome measure in each of the 3 treatment arms is the uneventful clinical resolution of a persistent PUL without change from the initial management strategy. Secondary outcome measures include: number of ruptured ectopic pregnancies, number and type of re-interventions (additional methotrexate injections or surgical procedures), treatment complications, adverse events, number of visits, time to resolution, patient satisfaction, and future fertility.
This multicenter randomized controlled trial will provide guidance for evidence-based management for women who have persisting pregnancy of unknown location.

Malawi has a high maternal mortality rate, of which unsafe abortion is a major cause. About 140,000 induced abortions are estimated every year, despite there being a restrictive abortion law in place. This leads to complications, such as incomplete abortions, which need to be treated to avoid further harm. Although manual vacuum aspiration (MVA) is a safe and cheap method of evacuating the uterus, the most commonly used method in Malawi is curettage. Medical treatment is used sparingly in the country, and the Ministry of Health has been trying to increase the use of MVA. The aim of this study was to investigate the treatment of incomplete abortions in three public hospitals in Southern Malawi during a three-year period. All medical files from the female/gynecological wards from 2013 to 2015 were reviewed. In total, information on obstetric history, demographics, and treatment were collected from 7270 women who had been treated for incomplete abortions. The overall use of MVA at the three hospitals during the study period was 11.4% (95% CI, 10.7-12.1). However, there was a major increase in MVA application at one District Hospital. Why there was only one successful hospital in this study is unclear, but may be due to more training and dedicated leadership at this particular hospital. Either way, the use of MVA in the treatment of incomplete abortions continues to be low in Malawi, despite recommendations from the World Health Organization (WHO) and the Malawi Ministry of Health.

OBJECTIVE: To determine whether a prior uterine evacuation procedure is associated with an increased risk of short cervical length (≤20 mm) in women without prior spontaneous preterm birth.
METHODS: This work was a retrospective cohort study from January 2012 to December 2014 of singletons without prior spontaneous preterm birth with cervical length screening between 18 weeks and 23 weeks 6 days. Women with a prior miscarriage/abortion were excluded if management (medical, surgical, or expectant) was not specified. Prior uterine evacuation was defined as dilation and curettage or dilation and evacuation of a spontaneous or induced abortion. The primary outcome was the risk of short cervical length (≤20 mm) among women with and without 1 of more prior uterine evacuations at any gestational age, assessed by the odds ratio and adjusted odds ratio for confounders.
RESULTS: Of 2672 women included, 714 (27%) had at least 1 prior uterine evacuation. The overall incidence of short cervical length in the cohort was 1% (n = 27). Women with at least 1 prior uterine evacuation were more likely to be African American (64% versus 41%; P < .001), smoke (14% versus 8%; P < .001), have a higher body mass index (mean ± SD, 28.1 ± 7.1 versus 26.8 ± 7.1 kg/m2 ; P < .001), and have had prior full-term delivery (60% versus 41%; P < .001). Women with at least 1 prior uterine evacuation had a significantly higher incidence of short cervical length (2% versus 0.7%; P = .003; odds ratio, 2.99 [95% confidence interval, 1.40-6.40]). After adjustment for confounders, prior uterine evacuation remained a source of increased risk of short cervical length (adjusted odds ratio, 2.63 [95% confidence interval, 1.19-5.80]).
CONCLUSIONS: Although the overall incidence of short cervical length is low (1%-2%), women with at least 1 prior uterine evacuation have at least a 2-fold increased risk of a short second-trimester cervical length compared to women without a prior uterine evacuation.

UNASSIGNED: Outpatient manual vacuum aspiration (MVA) is a safe and equally effective alternative to electric vacuum aspiration (EVA) in the operating room. This project was conducted to determine whether outpatient MVA expedites care while maintaining patient satisfaction.
UNASSIGNED: A cross-sectional study of a convenience sample of patients undergoing surgical management of spontaneous abortion, induced abortion, or retained products of conception with either outpatient MVA under local anesthesia or EVA in the operating room was conducted. Of 138 women completing surveys, 48 (34.8%) underwent outpatient MVA and 90 (65.2%) underwent EVA in the operating room. Procedure length, time from decision to procedure, and patient satisfaction were assessed through a self-administered questionnaire completed post-procedure.
UNASSIGNED: Most (77%) patients in the MVA group reported waiting fewer than 2 h from the time of their decision to the procedure, while most (74%) EVA patients reported waiting over 12 h (P < 0.001); the MVA group reported higher satisfaction with time to procedure (P = 0.02). The median procedure length was significantly shorter in the EVA group (10 vs. 20 min, P < 0.001). There was no significant difference between groups in overall satisfaction with the procedure (P = 0.16).
UNASSIGNED: Outpatient MVA under local anesthesia is a suitable alternative to operating room-based EVA for management of spontaneous abortion, induced abortion, and retained products of conception. Outpatient MVA is associated with shorter decision-to-procedure time and is highly acceptable to patients. Integration of outpatient MVA into clinical settings can add time- and resource-saving options for uterine evacuation while maintaining a positive patient experience.