Prevention of Uterine Perforation During Curettage Abortion

Grimes, David A.; Schulz, Kenneth F.; Cates, Willard

doi:10.1001/jama.1984.03340400036021

Cited by 167 publications

(4 citation statements)

References 10 publications

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“…This study was performed in a double blind fashion without a control group, which could be a potential weakness. Because it has been proven there are more complications during procedures without cervical ripening compared with cases with cervical ripening (Schulz et al, 1983;Grimes et al, 1984;Healey et al, 2006) [9,10,20] , there should be an ethical problem with a control group. From the results of previous studies that had a control group (Ngai et al, 1997;Preutthipan 2001;Uckuyu et al, 2008) [6,7,17] , the average cervical widths after Misoprostol administration were between 6 and 7.3 mm, which was similar to our results.…”

Section: Discussionmentioning

confidence: 99%

Comparison of sublingual and vaginal misoprostol in cervical ripening before hysteroscopy in infertile patients

Vineeta¹,

Kumar²,

Oby³

2018

Int. J. Clin. Obstet. Gynaecol.

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Objective: To compare the effects of 400 µg Misoprostol administered through vaginal and sublingual route for preoperative cervical ripening in infertile patients prior to hysteroscopy and to study the side effects and complications. Methods: This hospital based prospective double-blind study was conducted on 88 infertile patients posted for hysteroscopy. A pre-treatment Hegar's dilator test was done and findings noted for all patients. Randomization of patients was done by flip of coin method for administration of 400 µg Misoprostol sublingually or vaginally 8-12 hours prior to surgery. The primary outcome in this study was the postoperative cervical width as measured by the largest number of Hegar dilator that could be inserted without resistance. The side effects and complications during surgery for each group were also noted. Results: Patients were randomized to receive sublingual (n = 44) and vaginal (n = 44) Misoprostol. The groups were comparable in terms of age, parity, rural/urban, history of vaginal delivery and surgeon type. The preoperative cervical width in the sublingual group: 0.34 ± 0.67mm and vaginal group: 0.29 ± 0.54 mm was statistically similar among both groups. The post-operative cervical width in the sublingual group was 6.45 ± 1.19 and vaginal group was 8.27 ± 1.11.The difference between the two groups was found to be statistically significant (p value<0.01) though the side effects and complications during the hysteroscopy were comparable. Conclusion:The outcome of cervical ripening with Misoprostol prior to hysteroscopy in young infertility patients by the sublingual and vaginal routes, vaginal administration is more effective than sublingual route.

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Section: Discussionmentioning

confidence: 99%

Comparison of sublingual and vaginal misoprostol in cervical ripening before hysteroscopy in infertile patients

Vineeta¹,

Kumar²,

Oby³

2018

Int. J. Clin. Obstet. Gynaecol.

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“…21 Uterine perforation can occur anteriorly (40%), in the cervical canal (36%), laterally (38%), posteriorly (13%), or at the fundus (13%). 22 Providers should triage patients for office versus inpatient hysteroscopy based on known patient risk factors (Table 2), patient anxiety and comfort level, extent of hysteroscopic surgery needed, and length of procedure.…”

Section: Thinkmentioning

confidence: 99%

Crisis Management of Hysteroscopic Surgical Complications in the Office Setting

Roman

Roberts

Booth

et al. 2021

Obstetrical &Amp; Gynecological Survey

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Importance: As health care providers are increasingly motivated to perform office procedures, there is marginal training and attention related to crisis management (CM).Objective: We review the CM in office gynecology and illustrate the value of applying the STOP (stop, think, observe, plan) mental framework to acute management of office hysteroscopy complications.Evidence Acquisition: We performed a literature review on crisis management in gynecology.Results: Concepts of team leadership, simulation training, awareness of human error, and panic control are implemented in CM.Conclusions: Health care providers need to be cognizant of the importance of CM for optimizing patient safety and quality improvement and consider its application on office-based procedures.Relevance: Crisis management has become increasingly relevant in the outpatient setting, seeking to better equip physicians with the skills to manage adverse outcomes while performing office-based procedures.Target Audience: Obstetricians and gynecologists, family physicians Learning Objectives: At the completion of this article, physicians should be better able to describe the benefits and risks of office hysteroscopy; evaluate CM principles of human error, simulation training, leadership, and panic control; and assess the STOP mental framework for CM.Health care providers are increasingly motivated to convert ambulatory procedures into office procedures. Ambulatory procedures occur in hospital operating rooms or stand-alone surgery centers subject to state regulation, whereas procedures occurring in physician offices are largely unregulated. Both office-based procedures and ambulatory procedures are elective, are low risk, and do not require an overnight stay. Unforeseen surgical and medical complications are inevitable, and a thoughtful approach needs to be formulated. OfficeDr. Bhagavath has disclosed that he is a consultant/adviser to Hologic, Inc and Caldera Medical. The remaining authors, faculty, and staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations relevant to this educational activity.Lippincott CME Institute has identified and resolved all conflicts of interest concerning this educational activity.

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“…Because pre-operative dilation of the cervix with use of osmotic dilators, such as Laminaria or Dilapan-S®, decreases the risk of complications, 1 it has become standard procedure. 2,3 Osmotic dilators are inserted several hours to days prior to a D&E procedure, and are usually inserted with no or mild sedation.…”

Section: Introductionmentioning

confidence: 99%

Paracervical Block for Laminaria Insertion Before Second-Trimester Abortion

Soon

Tschann

Salcedo

et al. 2017

Obstetrics &Amp; Gynecology

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Objectives To evaluate the efficacy of a paracervical block to decrease pain during osmotic dilator insertion prior to a second-trimester abortion. Methods In this double-blind, randomized trial 41 women undergoing Laminaria insertion prior to a second-trimester abortion received either a paracervical block with 18 ml 1% lidocaine and 2 ml sodium bicarbonate or a sham block. Women were between 14 and 23 6/7 weeks of gestation. The primary outcome was pain immediately after insertion of Laminaria. Women assessed their pain on a 100-mm visual analog scale (VAS). Secondary outcomes included assessment of pain at other times during the insertion procedure and overall satisfaction with pain control. To detect a 25 mm difference in pain immediately after Laminaria insertion, at an alpha of 0.05 and 80% power, we aimed to enroll 20 patients in each arm. Results From May 2015 to December 2015, 20 women received a paracervical block and 21 received a sham block. Groups were similar in demographics, including parity, history of surgical abortion, and number of Laminaria placed. The paracervical block reduced pain after Laminaria insertion (median scores 13 mm [interquartile range 2–39] versus 54 mm [interquartile range 27–61], p=0.01, 95% confidence interval [CI] −47.0-−4.0). Women who received a paracervical block also reported higher satisfaction with overall pain control throughout the entire Laminaria insertion procedure (median scores 95 mm [interquartile range 78–100] versus 70 mm [interquartile range 44–90], p=0.05, 95% CI 0.0–37.0). Conclusions Paracervical block is effective at reducing the pain of Laminaria insertion. Additionally, paracervical block increases overall patient satisfaction with pain control during Laminaria placement. Clinical trial registration ClinicalTrials.gov, http;//clinicaltrials.gov, NCT02454296.

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Prevention of Uterine Perforation During Curettage Abortion

Cited by 167 publications

References 10 publications

Comparison of sublingual and vaginal misoprostol in cervical ripening before hysteroscopy in infertile patients

Comparison of sublingual and vaginal misoprostol in cervical ripening before hysteroscopy in infertile patients

Crisis Management of Hysteroscopic Surgical Complications in the Office Setting

Paracervical Block for Laminaria Insertion Before Second-Trimester Abortion

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