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Study objective: Cesarean scar pregnancy (CSP) is a type of ectopic pregnancy associated with severe complications, including significant hemorrhage, the potential need for hysterectomy, and life-threatening risks. Currently, two classification methods exist for CSP: Vial (type Ia and IIa) and Chinese Expert's Consensus (type Ib, type IIb, and type IIIb). However, these methods have limitations in guiding the selection of appropriate treatment plans for CSP. The purpose of this study was to systematically evaluate the effectiveness of various treatments for CSP within our clinic. Method: Our study included 906 patients with CSP from January 2013 to December 2018. The chi-squared test and logistic analysis were used to compare the clinical characteristics. The median and interquartile range (IQR) was calculated. We also analyzed whether preoperative application of methotrexate (MTX) could improve surgical outcomes and the relevant characteristics of misdiagnosed CSP patients. Results: There was a significant difference in gestational age, gestational sac diameter, gestational sac width, gestational sac area, remnant myometrial thickness, vaginal bleeding and preoperative hemoglobin levels (p < 0.001) but not in the incidence of residual tissue (p = 0.053). The other factors (intraoperative blood loss, hemoglobin decline, first hemoglobin after operation, total hospital stay, hospital stay after operation, transfusion and duration of catheter drain) were significantly different (p < 0.001). For type Ia and type Ib CSP, 39.3% and 40.2% of patients were treated with dilatation and curettage (D&E) under ultrasound, respectively. For type IIa and type IIIb CSP, 29.9% and 62.7% of patients were treated with laparotomy, respectively. There were no differences in surgical methods, residual tissue and reoperation between the MTX and non-MTX groups (p = 0.20), but liver damage, hospital stay and pain perception were more remarkable in the MTX group. It is noteworthy that 14% of the patients were misdiagnosed with an intrauterine pregnancy. The incidence of misdiagnosis in type IIa CSP patients was higher than that in type Ia CSP patients (p < 0.001). Conclusion: For type I CSP patients, D&E under ultrasound or D&E under hysteroscopy should be recommended. For type IIIb CSP patients, operative resection should be used. It is currently difficult to choose the appropriate treatment methods for type IIa or type IIb CSP patients. [ABSTRACT FROM AUTHOR]

Introduction. Anaesthesia is frequently administered through Monitored Anaesthesia Care (MAC) utilising various combinations of anaesthetic drugs for moderately painful operations like Dilatation and Curettage (D&C), which is preferably done as a daycare procedure. The hunt for improved drug combinations is always ongoing, and the pharmacological properties of the individual drugs are considered. In this regard, anaesthesiologists all over the world are quite fond of the combination of Ketamine and Propofol, which is also known as Ketofol. Recently, especially in situations involving MRI sedation, the combination of ketamine and dexmedetomidine (Dexket) has gained popularity. This study compares the combinations for MAC during D&C surgeries in a daycare setting. Aim. The primary objective was to estimate the recovery times using either combination. Secondarily, we would also compare the duration of analgesia, the haemodynamics, and the side-effect profi les of the two combinations. Material and methods. This study enrolled 60 patients posted for elective D&C. According to standard institutional protocols, they were administered Ketofol(KP group) or Dexket(KD group), depending on the anaesthesia provider's choice. The Ketofol group received Ketamine 1mg/kg and Propofol 1mg/kg with boluses of Ketamine 0.25mg/kg to maintain the depth of anaesthesia using Ramsay sedation score(RSS) >3. KD group received Dexmedetomidine intravenously 1mic/kg over 10 minutes followed by ketamine 1mg/kg boluses of Ketamine 0.25mg/kg to maintain the adequate anaesthetic depth of RSS > 3. Results. The Recovery time in post-operative period was signifi cantly prolonged in the KD group (mean 22.77 minutes) compared to the KP group (mean 17.8 minutes). The total duration of analgesia was also longer in the KD group (250 minutes vs 220 minutes in the KP group). It was seen that the hemodynamic variables (HR, SBP, DBP) were consistently higher in the KD group compared to the KP group. There was a signifi cant difference in SBP, DBP, and MAP in the intraoperative period between the KP and KD groups till 4hr in the postoperative period. Conclusions. We conclude that a combination of Dexmedetomidine and Ketamine has longer recovery times and analgesia duration than a combination of Propofol and Ketamine. Side effects like postoperative nausea and vomiting are not significant. However, since the recovery times are comparatively longer in a daycare setting, dexmedetomidine and Ketamine may not be the preferred agents compared to the combination of Ketamine and Propofol in the context of a daycare setting. [ABSTRACT FROM AUTHOR]

Aim: Endometrial cancer is diagnosed by obtaining uterine biopsies by pipelle, dilatation and curettage (D&C), or hysteroscopy. In 15%–25% of the cases, the preoperative and postoperative grades do not match. This discrepancy may carry significant clinical and prognostic consequences. We aimed to assess how body mass index (BMI) affects preoperative and postoperative grade mismatches and whether biopsy methods mitigate this effect. Methods: We conducted a retrospective review of patients with endometrial cancer who underwent surgery at our center between 2014 and 2022. We stratified patients into six classes of BMI based on the WHO classification. Preoperative and postoperative grades were compared for concordance with regards to patient BMI and sampling method. Results: A total of 158 patients were included, diagnosed by pipelle (n = 99), hysteroscopy (n = 15), or D&C (n = 44). For all methods, every unit increase in BMI increased the odds of having a gap between histology grades by 5.2%. In the pipelle group, the odds of a larger gap between the histology grades was 62% higher than that of women in the other groups. Among the D&C group, the odds of having a bigger difference between histology grades were 91.8% lower compared to the other groups. Patients with BMI over 30 had nearly 50% discrepancy when diagnosed with pipelle or hysteroscopy, but less than 10% with D&C. Conclusions: Increasing BMI is associated with decreasing concordance between preoperative and postoperative grades in endometrial cancer, especially when it exceeds 30. This effect is much less pronounced, however, when the diagnostic method is D&C. [ABSTRACT FROM AUTHOR]

Key clinical message: Microbiological diagnosis of endometritis and appropriate antibiotic treatment based on the antibiogram is essential. We should remain critical about the potential etiologic pathogens, especially when traveling abroad and during pregnancy. Therefore, it is essential to obtain cultures prior to the administration of antibiotics. We present a case of postoperative endometritis in a patient with incomplete miscarriage, who underwent dilatation and curettage. Blood, cervical and stool cultures revealed the presence of Salmonella hvittingfoss. Gynecological postoperative infections with Salmonella spp. are rare according to the current literature. [ABSTRACT FROM AUTHOR]

Endometrial lesions are common and prevalent gynecological diseases. Endometrial histopathology is the ′gold standard′ for diagnosis, the traditional method of endometrial sampling is dilatation and curettage, which is a blind procedure that can causes missed diagnosis and severe pain. Other methods of endometrial sampling include endometrial tissue sampler, endometrial cytology sampler, microscale endometrial sampler and hysteroscopic-guided biopsy, etc. These various methods of endometrial sampling are commonly used to diagnose abnormal uterine bleeding or chronic endometritis, and some can be used for screening endometrial cancer. Endometrial tissue sampler and microscale endometrial sampler are suitable for screening lesions, but not for patients with focal lesions and atrophy endometrium. Endometrial cytology sampler is also used for screening lesions, especially for patients with atrophy endometrium, but cytology has no diagnostic value. Hysteroscopic-guided biopsy can diagnose focal lesions and is the ′gold standard′ in endometrial sampling, but is not used for screening. The appropriate methods of endometrial sampling should be used for different kinds of condition. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of repeated dilatation and curettage or hysteroscopic biopsy on fetomaternal outcomes in patients receiving progestin treatment for endometrial hyperplasia or early‐stage carcinoma. Method: This was a population‐based study using the Taiwan National Health Insurance Research Database between 2009 and 2017 of women who gave birth and had a history of endometrial hyperplasia and early‐stage carcinoma treated with progestins. Logistic regression analysis was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals (CIs) reflecting the association between repeated procedures and fetomaternal outcomes. Results: A total of 6956 women with 8690 deliveries were identified. Compared with those who had two or fewer procedures, women who received more than two procedures had a significantly higher risk for cervical insufficiency (aOR, 5.09 [95 CI, 2.31–11.24]). Furthermore, women who had more than two procedures were prone to have adverse neonatal outcomes, including Apgar score < 7 at 1 min (aOR, 1.97 [95% CI, 1.13–3.43]) and 5 min (aOR, 3.11 [95% CI, 1.33–7.23]) and preterm delivery <32 weeks (aOR, 2.86 [95% CI, 1.50–5.45]). Conclusion: Undergoing more than two procedures was associated with subsequent maternal cervical insufficiency, preterm delivery <32 weeks, and low neonatal Apgar score. Health care providers should be aware of the potential risks and balance the benefits and harms of repeated procedures. Synopsis: Repeated dilatation and curettage or hysteroscopic biopsy in progestin‐treated patients with endometrial hyperplasia or early‐stage carcinoma increases the risk of cervical insufficiency, preterm delivery, and low Apgar score. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the rate of atypical hyperplasia (AH) underestimating endometrial cancer (EC) comparing endometrial biopsy (EB) accomplished by hysteroscopic biopsy with dilatation and curettage (D&C). Second, to compare the two techniques to foresee EC grading. Methods: This trial was based on the findings of two Gynecological Departments within the same Public Utility, sharing pathological service and database but routinely performing EB under hysteroscopic visualization (group A) or hysteroscopy followed by D&C (group B). We retrieved the clinical data of patients showing EC on hysterectomy throughout a 10-year period. The accuracy of hysteroscopic-view diagnosis and EB pathology were compared, having the pathologic findings of hysterectomy as reference. Results: A total of 161 patients met the inclusion criteria. Among these, 109 and 52 were included in groups A and B, respectively. In group A, 32.1% of patients underwent EB in an out-patient setting. To foresee EC, hysteroscopic view showed a sensitivity of 82.5% and 70.2% in groups A and B, respectively (P = 0.019). An underestimation of EC diagnosed as AH on EB was found in 20 patients (12.4%). Among these, 18 (16.5%) and 2 (3.8%) were included in groups A and B, respectively (P = 0.022). In group A, a fault diagnosis of AH resulted higher when EB was performed as out-patient setting (P = 0.006). EB allowed the grading of EC in 73.3% and 90.3% of patients in groups A and B, respectively. The agreement was 73.7% and 85.1%, leading to moderate (κ = 0.56) and good (κ = 0.77) "κ" coefficient of concordance for groups A and B, respectively. Conclusions: EB performed by D&C lowers the rate of AH underestimating concurrent EC and improves the grading agreement when compared with hysteroscopic sampling. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of endometrial biopsy and diagnostic dilatation and curettage (D&C) in terms of adequate specimen collection for histopathology for diagnosing endometrial carcinoma in patients with abnormal vaginal bleeding. Study Design: Randomized Controlled Trial. Setting: Department of Obstetrics & Gynecology, Bahawalpur Medical & Dental College, Bahawalpur. Period: October 2022 to March 2023. Material & Methods: A total of 172 peri and post-menopausal women with abnormal uterine bleeding of more than 6 months were analyzed. Randomization was 1:1 for biopsy group (n=86) and D&C group (n=86). Patients in biopsy group underwent biopsy endometrial sampling while those in D&C group underwent diagnostic D&C for endometrial sampling. In biopsy group pipelle suction curette was used to collect the specimen. In D&C group, procedures were done employing general anesthesia. Obtained samples were sent for histopathology examination. Results: In a total of 172 women, the mean duration of abnormal vaginal bleeding were 9.267±2.37 months and 9.174±2.33 months in in biopsy and D&C groups respectively. Adequate specimen collection was noted in 93% women in biopsy group as compare to 97.7% in D&C group (p=0.147). Conclusion: Diagnostic dilatation and curettage as well as endometrial biopsy were effective in terms of adequate specimen collection for histopathology. Endometrial sampling using Pipelle was safe and accurate procedure conducted in outpatient department that avoided general anesthesia. [ABSTRACT FROM AUTHOR]

Background: Hydatidiform Mole (HM) is the most common form of gestational trophoblastic disease. Dilatation and curettage is the classical treatment of this affection. Hysteroscopic resection (HsR) is an alternative for the treatment of intra-uterine pathology. Objective: To describe the feasibility of HsR for the management of HM. Result: Case series of patients who had a complete or partial HM confirmed by histological examination of the trophoblastic tissue resected by operative hysteroscopy between 2007 and 2019. After approval of our ethics committee, we evaluated 36 patients who underwent hysteroscopic resection for molar pregnancy. Histological analysis showed partial HM in 28 patients (77.8%) and complete HM in 8 (22.2%). Main surgical complications were uterine perforation in one patient and glycine resorption in 10 patients with two cases of hyponatremia corrected by standard treatment. We performed an ultrasound control 1 month after the intervention in 19 patients (52.8%) as they had slow decrease of HCG or bleeding complaints and found retained product of conception (RPOC) in six patients (16.7%). Conclusion: This first report on a small number of patients demonstrate that hysteroscopic resection is a feasible procedure for the management of molar pregnancy. Direct visualization of the procedure helps the surgeon to control the resection. Further studies are mandatory to compare this technique with D&C in term of RPOC and fertility outcomes as it remains the standard treatment. [ABSTRACT FROM AUTHOR]

Objective: The rising rate of cesarean delivery increases the occurrence of cesarean scar pregnancies (CSP). Early diagnosis and treatment of CSP have become the subject of considerable interest in recent years because of the risk of life-threatening uterine bleeding and rupture. The aim of this study was to share the results of ultrasonography (USG)-guided dilation and curettage (D&C) and hysterotomy in treating early CSP and the long-term reproductive results in these cases. Material and Methods: Patients diagnosed with CSP admitted to the perinatology clinic between January 2016 and April 2020 were included in this study. USG-guided D&C was recommended for all patients diagnosed with CSP in the first trimester (≤12 gestational weeks). Hysterotomy was recommended for patients who could not undergo D&C. All patients' demographic data and procedure results were retrieved retrospectively from electronic records, and reproductive anamneses after the procedure were obtained from patient files and telephone calls. Results: Sixty-three patients who underwent USG-guided D&C and hysterotomy were included in the study. While D&C was successful in 93.65% (n=59) of these patients, 6.35% (n=4) underwent hysterotomy. In the USG-guided D&C group, the infertility rate was 15.78% (n=6), the rate of the recurrent scars was 9.3% (n=3), and the rate of placenta accreta spectrum was 6.25% (n=2). The term healthy pregnancy rate was 64%. Conclusion: In experienced hands, USG-guided D&C can be considered the first choice in early scar pregnancies. We believe that similar reproductive results would be obtained when D&C and other treatment modalities were compared in CSP treatment. [ABSTRACT FROM AUTHOR]

Background: Hydatidiform Mole (HM) is the most common form of gestational trophoblastic disease. Dilatation and curettage is the classical treatment of this affection. Hysteroscopic resection (HsR) is an alternative for the treatment of intra-uterine pathology. Objective: To describe the feasibility of HsR for the management of HM. Result: Case series of patients who had a complete or partial HM confirmed by histological examination of the trophoblastic tissue resected by operative hysteroscopy between 2007 and 2019. After approval of our ethics committee, we evaluated 36 patients who underwent hysteroscopic resection for molar pregnancy. Histological analysis showed partial HM in 28 patients (77.8%) and complete HM in 8 (22.2%). Main surgical complications were uterine perforation in one patient and glycine resorption in 10 patients with two cases of hyponatremia corrected by standard treatment. We performed an ultrasound control 1 month after the intervention in 19 patients (52.8%) as they had slow decrease of HCG or bleeding complaints and found retained product of conception (RPOC) in six patients (16.7%). Conclusion: This first report on a small number of patients demonstrate that hysteroscopic resection is a feasible procedure for the management of molar pregnancy. Direct visualization of the procedure helps the surgeon to control the resection. Further studies are mandatory to compare this technique with D&C in term of RPOC and fertility outcomes as it remains the standard treatment. [ABSTRACT FROM AUTHOR]

Background: Cesarean scar ectopic pregnancy (CSP) is an exceptional subtype of ectopic pregnancy that results in a critical life-threatening outcome. In addition to magnetic resonance imaging in challenging scenarios, prompt diagnosis with sonography can restrict maternal morbidity and mortality. Quick detection had a powerful impact on the success of available treatment options. Local injection of methotrexate under sonographic guidance looks to be an actual substitute modality for its management. The goal of this research is to highlight the task of US and MRI in the diagnosis and interventional radiological management of this ectopic pregnancy. Methods This study included thirteen pregnant females in the first trimester diagnosed with CSP, their ages range from 28-41 years with a mean age of 34.6±4.3. It was carried out in the period from February 2014 to November 2021. All thirteen patients were examined by pelvic ultrasound and only two of them required complementary MRI study. Results: The mean thickness of the myometrium between the sac and urinary bladder in all our cases by pelvic ultrasound was 2.4±0.9 mm. Only two cases had a suspicion of marked myometrial thinning with questionable urinary bladder invasion. MRI was done for confirmation of CSP and exclusion of urinary bladder invasion. Among thirteen cases, twelve were managed conservatively, nine of them treated by local methotrexate (MTX) and potassium chloride (KCL) injection under ultrasound guidance. Three cases were managed by dilatation and curettage (D&C) under intra-operative ultrasound guidance. Conclusions: Pelvic ultrasound has a magic role in the diagnosis of CSP and its management. Either local injection of MTX and KCL or D&C under ultrasound guidance consider successful conservative modalities with significant radiology incorporation. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the feasibility of Pipelle endometrial sampling and to explore factors influencing Pipelle success rate in the clinical settings of Kazakhstan. This prospective analysis included 87 patients who had undergone Pipelle biopsy due to medical indications for endometrial sampling. We analysed physician and patient-related factors potentially influencing the success rate of this method. Pipelle endometrial biopsy overall success rate was 82.76%. The indications for the procedure and patients' age were key factors influencing Pipelle sampling success (p <.001). The success rate was the highest in the group with abnormal uterine bleeding as a biopsy indication in the reproductive age group (93.19%; p <.001). Pipelle biopsy was found to be an acceptable option for endometrial sampling in our clinical setting; at the same time, physicians should consider the potential influencing factors on its success rate like indications for the procedure, BMI and patients' age as well as their menopausal status. In order to provide precise future directions, there is a need to study a larger number of patients. What is already known on this subject? Compared to dilation and curettage sampling conducted in the operation room, Pipelle endometrial sampling is relatively inexpensive, associated with less morbidity, safe, accurate, and can be performed in an office setting. What do the results of this study add? This is the first prospective data analysis about Pipelle endometrial sampling in Kazakhstani population. What are the implications of these findings for clinical practice and/or further research? Enabling the timely diagnosis of current endometrial pathology, Pipelle endometrial sampling approach may have an important impact on healthcare safety and efficiency, and improve overall treatment outcomes and the quality of life of Kazakhstani population if used consistently. [ABSTRACT FROM AUTHOR]

Background: A thickened endometrium upon trans-vaginal ultrasound in asymptomatic post-menopausal women always poses a clinical dilemma. Objectives: To investigate the frequency of endometrial malignancies by histopathological examination and identify the associated factors influencing the thickened endometrium in asymptomatic post-menopausal women. Methods: In trans-vaginal ultrasonography, we enrolled 72 asymptomatic post-menopausal women with a thickened endometrium (>5 mm). Dilatation and curettage were performed for all cases, and the specimen was sent for histopathological examination. According to the data distribution, all the continuous variables were stated as mean ± standard deviation/median (inter-quartile range), categorical variables were expressed in frequency, and percentage will be compared using the Chi-square test/Fisher exact test. Results: In our study, most of the women were multipara. The age of post-menopausal women ranged from 46 to 68 years, and the mean duration of menopause was 8.10. The most common histological findings were benign in 72.22% of the cases. We identified pre-malignant and malignant lesions of the endometrium in 18.05% and 9.72% of the cases, respectively. To predict the condition of the lesion, we noticed no definite cut-off value of endometrial thickness to indicate the state of the lesion. We observed that none of the patient's characteristics showed a significant difference with a thickened endometrium. Conclusion: We observed an increased frequency of endometrial pathology irrespective of the presence or absence of risk factors. The result of this study is justified enough for the need of further evaluation of a thickened endometrium in asymptomatic post-menopausal women. [ABSTRACT FROM AUTHOR]

Arteriovenous malformation of the uterus is a rare encounter with sporadic incidence. They are usually acquired following events like dilation and curettage or abortions. It should always be considered as a diagnostic possibility in women presenting with torrential vaginal bleeding. We report a case of 24-years-old woman presenting with excessive bleeding following dilation and curettage. She was diagnosed with an acquired uterine arteriovenous malformation after conducting Doppler angiography. She was meticulously managed by performing uterine artery embolization. Embolization technique for uterine arteriovenous malformation (AVM) is generally used in fewer crisis circumstances as well as in emergency situations. Management by selective arterial embolization reduces the morbidity of surgery and hospital stay. [ABSTRACT FROM AUTHOR]

Background and Aims: Propofol is the drug of choice for sedation in daycare procedures due to its pharmacokinetic properties. Propofol delivery using target-controlled infusion (TCI) pump reduces adverse effects like hypotension and apnoea. In this study, we estimated the median effective effect-site concentration of propofol in patients undergoing dilatation and curettage. Methods: Patients of the American Society of Anesthesiologists physical status class I–III, aged 40–70 years, undergoing elective dilatation and curettage were recruited for the study. All patients received 1 μg/kg fentanyl and 20 mg lignocaine. The first patient received an effect-site concentration of propofol at 4 μg/mL with TCI Schneider pharmacokinetic model. Failure was defined as patient movement at any time during the procedure. According to the 'BiasedCoin Design' up-and-down sequential method, the response of the previous patient determined the effect-site concentration of propofol of the next patient. The study was terminated once forty patients completed the procedures successfully. Probit analysis was used to determine EC50. Results: Fifty-three patients were recruited for the study. The various effect-site concentrations of propofol EC50, EC90, and EC95 in providing sedation for dilatation and curettage were 3.38 μg/mL, 4.29 μg/mL, and 4.60 μg/mL, respectively. The incidence of hypotension and apnoea were comparable among the various concentrations of propofol. The mean duration of the propofol infusion was 20 ± 2.86 min. The time to recovery from propofol sedation was 6.97 ± 1.76 min. Conclusion: A median effective effect-site concentration of 3.38 μg/mL of propofol is required to prevent patient movement during uterine dilatation and curettage. [ABSTRACT FROM AUTHOR]

Aim: In Japan, dilatation and curettage (D&C) is a common procedure for spontaneous miscarriage and induced abortion, and its safety has long been an issue. Electric vacuum aspiration (EVA) is also common, but manual vacuum aspiration (MVA) was introduced recently, with medical abortions using mifepristone or misoprostol which are not yet legally accepted. This nationwide retrospective study surveyed the surgical methods and complications associated with spontaneous miscarriage and induced abortion at less than 12 weeks of gestation in Japan to assess their safety, in comparison with a similar survey for induced abortions in 2012. Methods: Questionnaires were sent to 4176 facilities with a license for induced abortion surgeries in 2019. The questions included were the methods used, number of spontaneous miscarriages and induced abortions, and number of complications (uterine perforation, incomplete abortion, and gross bleeding requiring blood transfusion). Results: Responses were received from 1706 facilities (40.9%). Although EVA with sharp curettage was the most common surgical method, which was used for 11 953 spontaneous miscarriages (28.9%) and 24 045 induced abortions (37.3%), the most common surgical method per facility was D&C, and the rates of D&C for spontaneous miscarriages (38.4%) and induced abortions (44.7%) performed in general hospitals were significantly higher than those in clinics (24.1% and 22.0%, respectively). There was no significant difference in the complication incidence rate among surgical methods for spontaneous miscarriages. However, in induced abortion surgery, the total complication and incomplete abortion incidence rates for D&C were significantly higher than those for EVA without sharp curettage (47/15 162 [0.31%] vs. 29/18 693 [0.16%], p = 0.00362, 45/15 162 [0.30%] vs. 27/18 693 [0.14%], p = 0.00285, respectively). There was no significant difference in the complication incidence rate between MVA and other surgical methods for each abortion surgery. Conclusion: In Japan, especially in general hospitals, D&C is still widely used for miscarriage and induced abortion surgery. Its complication‐incidence rates significantly decreased compared with that of the nationwide survey in 2012, but were still significantly higher than EVA without sharp curettage. Few facilities used MVA, but its complication rate was comparable with those of other surgical methods. [ABSTRACT FROM AUTHOR]

Objective: To compare the adequacy of endometrial sampling with pipelle versus conventional dilatation and curettage in patients with abnormal uterine bleeding. Study Design: Randomized Control Trial. Settings: Department of Obstetrics and Gynecology Madina Teaching Hospital affiliated with University Medical and Dental College Faisalabad. Period: July 2019 to June 2020. Material & Methods: A total of 90 patients with abnormal uterine bleeding were included in the study. Patients in Group A underwent endometrial sampling in OPD without anesthesia using pipelle. Patients in Group B were admitted, dilatation and curettage was done in operation theatre under anesthesia, endometrial tissue sent for histopathology. Patients were called in OPD on follow up visit with histopathology report. Results: Comparison of adequacy of endometrial sampling with pipelle versus conventional dilatation and curettage in abnormal uterine bleeding shows that 84.44% (n=38) in Group A and 91.11% (n=41) in Group B have adequate sample. P value was 0.33, showing insignificant difference. Conclusion: Pipelle has acceptable adequacy for endometrial sampling as compare to dilatation and curettage. It is an outpatient procedure, no need of anesthesia and cervical dilatation. Pipelle can be safely used as an alternative to conventional dilatation and curettage. [ABSTRACT FROM AUTHOR]

Objectives: to compare the accuracy of preoperative and postoperative endometrial sampling obtained by dilatation and curettage (D&C), Pipelle and hysteroscopy to diagnose endometrial malignancies and to evaluate the adequacy of surgical treatment for these patients.Study Design: This retrospective record-based study was conducted at Gynecology Oncology Unit, Ain Shams University Maternity Hospital, Cairo, Egypt. Records of patients with an initial preoperative or a final postoperative pathological diagnosis of endometrial hyperplasia or endometrial malignancies were retrieved over a six year period from January 2013 until March 2019. The preoperative biopsy methods, results, postoperative pathology diagnosis and treatment received were recorded and analyzed.Results: Records of 395 patients were retrieved. Rates of agreement between initial and postoperative pathology for endometrial hyperplasia (with and without atypia) were 10% by D&C, 7.8% by Pipelle and zero % by hysteroscopy; for endometrioid adenocarcinoma grade 1, they were 40.7% by D&C, 40.6% by Pipelle and 20% by hysteroscopy; for endometrioid adenocarcinoma grades 2 and 3, they were 83.7% and 84.6% by D&C, 97% and 60% by Pipelle, and 100% by hysteroscopy, respectively. For type II endometrial cancer and endometrial stromal sarcoma, agreement rates were 100% by all biopsy methods. Out of 13 cases diagnosed with atrophic endometrium preoperatively, 11 cases were diagnosed as endometrial stromal sarcoma. Comparing accuracy of the three biopsy methods, D&C had highest sensitivity of 61.9%; hysteroscopy showed 100% specificity, while Pipelle was the least accurate method. Finally, 61.4% of the patients received adequate surgical treatment.Conclusion: There were excellent concordance rates between initial biopsy and postoperative pathology in diagnosis of high grade endometrioid and other endometrial malignancies compared to endometrial hyperplasia and low grade endometrioid adenocarcinoma. Patients diagnosed initially with atrophic endometrium or hyperplasia warranted more surveillance before their surgical treatment. It is crucial to develop protocols for increasing accuracy of endometrial sampling such as performing molecular studies for preoperative pathology. [ABSTRACT FROM AUTHOR]

Introduction: Women who have undergone radical trachelectomy as a fertility‐sparing treatment for early‐stage cervical cancer may be at higher risk for retained tissues after early‐term miscarriage due to cervical cerclage or cervical necrosis. Dilatation and curettage or aspiration may present additional risks in these women. The aim of this study was to assess the efficacy of expectant management for early pregnancy miscarriage after radical trachelectomy. Material and methods: Keio University Hospital records were reviewed for women who conceived after abdominal radical trachelectomy and received perinatal care between 1 April 2012 and 31 March 2020. A total of 62 women (76 pregnancies) were identified, and 13 of these women experienced miscarriage before 12 gestational weeks. The management and outcome of these cases were reviewed in detail. Results: The median maternal age at miscarriage was 39 years (range 31–42 years) and the median duration from abdominal radical trachelectomy to conception was 2.60 years (range 0.49–7.30 years). Cervical necrosis before conception occurred in one case (8%). One patient requested treatment with aspiration and the remaining 12 cases were managed with observation for a median of 23 days (range 7–50 days). There were no cases of endometritis or cases requiring dilatation and curettage for residue tissue. Further, no cases developed laceration of the residual cervix and no loss of cerclage sutures after discharge was noted. Conclusions: Expectant management seems to be safe and appropriate for first trimester miscarriage after abdominal radical trachelectomy. [ABSTRACT FROM AUTHOR]

Aim: Conventional endometrial examination by dilatation and curettage (D&C) is not accepted by many patients because it is associated with pain and risk of injury and typically requires anesthesia and hospitalization. While several less invasive endometrial screening tools have been developed, their diagnostic value is generally inferior to D&C. Therefore, the purpose of this study was to evaluate the effectiveness of a new, minimally invasive device, called the ES Sampler, for outpatient endometrial screening. Methods: This was a single‐blind study of 96 patients (age: 36.8 ± 8.1 years) who attended Peking Union Medical College Hospital from March 2015 to August 2016. Specimens were collected from each participant using the ES Sampler, followed by traditional D&C by hysteroscopy, and evaluated by histology and/or cytology. The sampling adequacy, sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy were compared, and patient acceptability was assessed. Results: Compared to traditional D&C, the ES Sampler exhibited 99.0% sampling adequacy, and the combined (histology and cytology) results demonstrated 88.9% sensitivity, 95.6% specificity, 88.9% positive predictive value, 95.6% negative predictive value, and 93.7% accuracy. Moreover, the majority of study participants reported mild or no pain associated with the ES Sampler, and blood loss was minimal. Conclusions: Our findings suggest that the minimally invasive ES Sampler is a reliable and accurate endometrial screening tool that is easily accepted by patients. The ES Sampler could be useful for screening high‐risk patients who may need further, more invasive examination, thereby conserving medical resources and minimizing patient discomfort. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the risk factors and incidence of Asherman Syndrome in women with post‐abortion uterine evacuation and curettage. Methods: A total of 2546 patients who had surgical abortion (uterine evacuation and curettage) before the 20th gestational week with indications of missed abortion, anembryonic pregnancy, incomplete abortion, and elective curettage in a tertiary antenatal care center were recruited. The patients were called and surveyed for their symptoms; including infertility, oligo‐amenorrhea and recurrent pregnancy loss, preterm birth and intrauterine growth retardation and abnormal placentation as criteria of Asherman Syndrome. Diagnostic (office) hysteroscopy was performed for 177 who had one of those complaints. Results: The incidence of Asherman Syndrome was 1.6% (n = 43/2546). History of ≥3 abortions was the main factor that increased the risk of Asherman Syndrome for by 4.6 times. Use of vacuum aspiration or sharp curettage, premedication for cervical priming, and having a pregnancy >10th gestational weeks were not risk factors for Asherman Syndrome. Conclusion: When the diagnosis was based on presence of symptoms who underwent uterine instrumentation, the incidence of Asherman Syndrome was found to be 1.6%. Repeated abortions were the main risk factor for Asherman Syndrome and avoiding from repeated uterine instrumentations may have a role in prevention. [ABSTRACT FROM AUTHOR]

Background: To compare the diagnostic accuracy of aspiration biopsy and dilatation and curettage (D&C) in patients diagnosed with endometrial hyperplasia prior to hysterectomy. Methods: We retrospectively reviewed medical records of 250 patients diagnosed with endometrial hyperplasia by endometrial sampling between July 2003 and March 2020. Endometrial sampling was performed by aspiration biopsy (n = 150) or D&C (n = 100), followed by hysterectomy within 6 months. Pathological findings of hysterectomy specimens of the two groups were compared to preoperative findings. Results: The overall diagnostic concordance between endometrial sampling specimen including D&C and aspiration biopsy, and hysterectomy specimen was 51.0% (51/100) and 41.3% (62/150), respectively. Patients whose preoperative specimen was obtained by D&C were upgraded less significantly than those who underwent aspiration biopsy (21.0% vs 36.7%; P = 0.008). In particular, significantly fewer patients were upgraded after D&C than after aspiration biopsy in hyperplasia without atypia (12.5% vs 29.0%; P = 0.028). In addition, when the final pathological upgrade rate to endometrial carcinoma was evaluated between the two methods of endometrial sampling, significantly fewer cases were noted after D&C than after aspiration biopsy (15.0% vs 27.3%; P = 0.022). Conclusions: In our study, D&C more accurately reflected the final diagnosis in patients with endometrial hyperplasia than aspiration biopsy based on the histological examination of hysterectomy specimens. When considering the management strategy for women with an endometrial hyperplasia diagnosis obtained by aspiration biopsy, physicians should consider the significant rate of upgraded diseases with this method of endometrial sampling. [ABSTRACT FROM AUTHOR]

Study Question: Are the long-term reproductive outcomes following recurrent dilatation and curettage (D&C) for miscarriage in women with identified and treated intrauterine adhesions (IUAs) comparable to women without IUAs.Summary Answer: Reproductive outcomes in women with identified and treated IUAs following recurrent D&C for miscarriage are impaired compared to women without IUAs; fewer ongoing pregnancies and live births are achieved with a prolonged time to a live birth.What Is Known Already: The Prevention of Adhesions Post Abortion (PAPA) study showed that application of auto-crosslinked hyaluronic acid (ACP) gel, an absorbable barrier in women undergoing recurrent D&C for miscarriage resulted in a lower rate of IUAs, 13% versus 31% (relative risk 0.43, 95% CI 0.22 to 0.83), lower mean adhesion score and significant less moderate to severe IUAs. It is unclear what the impact is of IUAs on long-term reproductive performance.Study Design, Size, Duration: This was a follow-up of the PAPA study, a multicenter randomized controlled trial evaluating the application of ACP gel in women undergoing recurrent D&C for miscarriage. All included women received a diagnostic hysteroscopy 8-12 weeks after randomization to evaluate the uterine cavity and for adhesiolysis if IUAs were present. Here, we present the reproductive outcomes in women with identified and treated IUAs versus women without IUAs, 46 months after randomization.Participants/materials, Setting, Methods: Between December 2011 and July 2015, 152 women with a first-trimester miscarriage with at least one previous D&C, were randomized for D&C alone or D&C with immediate intrauterine application of ACP gel. Participants were approached at least 30 months after randomization to evaluate reproductive performance, obstetric and neonatal outcomes and cycle characteristics. Additionally, the medical files of all participants were reviewed. Main outcome was ongoing pregnancy. Outcomes of subsequent pregnancies, time to conception and time to live birth were also recorded.Main Results and the Role Of Chance: In women pursuing a pregnancy, 14/24 (58%) ongoing pregnancies were recorded in women with identified and treated IUAs versus 80/89 (90%) ongoing pregnancies in women without IUAs odds ratio (OR) 0.18 (95% CI 0.06 to 0.50, P-value <0.001). Documented live birth was also lower in women with IUAs; 13/24 (54%) with versus 75/89 (84%) without IUAs, OR 0.22 (95% CI: 0.08 to-0.59, P-value 0.004). The median time to conception was 7 months in women with identified and treated IUAs versus 5 months in women without IUAs (hazard ratio (HR) 0.84 (95% CI 0.54 to 1.33)) and time to conception leading to a live birth 15 months versus 5.0 months (HR 0.54 (95% CI: 0.30 to 0.97)). In women with identified and treated IUAs, premature deliveries were recorded in 3/16 (19%) versus 4/88 (5%) in women without IUAs, P-value 0.01. Complications were recorded in respectively 12/16 (75%) versus 26/88 (30%), P-value 0.001. No differences were recorded in mean birth weight between the groups.Limitations, Reasons For Caution: In the original PAPA study, randomization was applied for ACP gel application. Comparing women with and without IUAs is not in line with the randomization and therefore confounding of the results cannot be excluded. IUAs, if visible during routine hysteroscopy after randomization were removed as part of the study protocol; the influence of IUAs on reproductive outcome may therefore be underestimated. Women undergoing a recurrent D&C for miscarriage were included, a specific group likely to generate clinically significant adhesions. The findings should therefore not be generalized to all women undergoing D&C for miscarriage.Wider Implications Of the Findings: As IUAs have an impact on reproductive performance, even after hysteroscopic adhesiolysis, primary prevention is essential. Expectative and medical management should therefore be considered as serious alternatives for D&C in women with a miscarriage. In case D&C is necessary, application of ACP gel should be considered.Study Funding/competing Interest(s): The original PAPA study (NTR 3120) was an investigator initiated study that was funded by the Foundation for scientific investigation in Obstetrics and Gynaecology of the Saint Lucas Andreas Hospital (currently renamed OLVG Oost), SWOGA. The syringes containing ACP gel were received from Anika Therapeutics, the manufacturer of Hyalobarrier® Gel Endo. The current follow-up study was also an investigator-initiated study without funding. The funder and sponsor had no role in the design of this follow-up study, data collection, data analysis, data interpretation, trial design, patient recruitment, writing of the report or any aspect pertinent to the study. ABH, RAL, JAFH and JWRT have no conflict to declare. HAMB reports being a member of safety board research Womed.Trial Registration Number: Netherlands Trial Register NTR 3120. [ABSTRACT FROM AUTHOR]

Background: Cervical ectopic pregnancy is a rare condition, historically treated by hysterectomy. Case Report: A 33-year-old female at 13weeks 3 days'gestation was diagnosed with a cervical ectopic pregnancy. She underwent a uterine artery embolization, fetal intrathoracic potassium chloride injection, amniocentesis, and ultrasound-guided suction dilation and curettage with the use of intracervical vasopressin, flowable gelatin with thrombin, and cervical cerclage. Conclusion: Advanced cervical ectopic pregnancy can be successfully managed in a conservative fashion in a patientwho strongly desires future fertility. [ABSTRACT FROM AUTHOR]

Objective: Immigration may affect the incidence of hydatidiform mole (HM). In this study, we aim to compare Syrian immigrant and Turkish pregnant women in terms of HM due to abortion and termination of pregnancy. Method: An analysis of 907 endometrial curettage materials due to abortion or termination of pregnancy between the years 2016- 2018 were performed. These curettage materials were examined with routine histopathologic methods. Examination of the curettage materials was repeated by a pathologist to confirm the diagnosis. Results: HM was diagnosed in 56 of 768 Turkish pregnant women (7.30%) and it was diagnosed in 22 of 139 Syrian immigrant pregnant women (15.80%). HM incidence in Syrian immigrant pregnant women was significantly higher (2.06 times) than in Turkish women (p=0.001). The rate of Syrian pregnant women in the group aged 20 or younger was significantly higher than Turkish pregnant women (p<0.001). The rate of Turkish pregnant women aged between 30-34 and older was high in the group. Conclusions: The incidence of HM is higher in Syrian pregnant women. The main causes affecting the incidence of HM in Syrian immigrants are nationality and age. Migration, with all its components, may explain the difference in HM incidence between these two neighboring communities. [ABSTRACT FROM AUTHOR]

Objective: To see the efficacy of the gynecological procedure of outdoor endometrial biopsy using pipelle biopsy. Study Design: Prospective observational study. Place and Duration of Study: Sampling was done at obstetrics and gynecology department Pak-Emirates Military Hospital Rawalpindi, from Jan 2018 to Aug 2018. Methodology: A 100 cases of perimenopausal/postmenopausal women presenting with menorrhagia/menorrhagia after the age of 40 years were selected for the study. Pipelle biopsy was employed in all the cases. Results: The patients presenting with metorrhagia, menorrhagia, polymennorrhagia and postmenopausal bleeding with mean age of 46 ± 3.26 were included in the study. Sixty eight (68%) patients had metorrhagia, 10 (10%) presented with menorrhagia, 10 (10%) patients had polymennorrhagia while 12 (12%) patients had postmenopausal bleeding. Histopathological results showed that 5 (5%) patients were suffering from chronic endometriosis, 20 (20%) had hormonal imbalances, 45 (45%) had proliferative endometrium, 18 (18%) had endo-metrial benign hyperplasia. Conclusion: It is concluded that outdoor endometrial conventional biopsy using pipelle biopsyis cost-effective and convenient method for diagnosing endometrial diseases. The procedure while providing reliable histopathological results in all cases is cheap and causes minimal discomfort to patients. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the hemodynamic and recovery characteristics of dexmeditomidine and propofol in dilatation and curettage. Study Design: Randomized control trial. Setting: Department of Anaesthesia, DHQ Teaching Hospital Sargodha. Period: March 2016 to December 2017. Material & Methods: Patients undergoing dilatation & curettage were randomly divided into two groups, group P received IV propofol 1.5mg/kg slowly over 5 min and group D received dexmeditomidine at a loading dose of 1µg/kg followed by 0.5 µg/kg/h. During the procedure blood pressure and heart rate were compared in both groups. In the recovery room, recovery time was compared in both groups by using modified aldrete score. Results: In Group D, the decrease in heart rate was statistically significant when compared with group P. Both groups showed a decrease in MAP but results were not statistically significant when compared in both groups. Patients in group D were discharged earlier from recovery room than group P and results were statistically significant. Conclusion: Dexmeditomodine provides better recovery than propofol so it is a suitable drug for day care minor surgical procedures. Similarly dexmeditomidine is superior to propofol by providing less respiratory depression intraopertaively. [ABSTRACT FROM AUTHOR]

Objective: To compare the diagnostic accuracy of dilatation and curettage (D&C) versus endometrial aspiration biopsy in follow-up evaluation of patients treated with progestin for endometrial hyperplasia (EH) Methods: A prospective multicenter study was conducted from 2015 to 2018. Patients with EH were treated with progestin, one of the following three treatment regimens: oral medroxyprogesterone acetate (MPA) 10 mg/day for 14 days per cycle, continuous MPA 10 mg/day or the levonorgestrel-releasing intrauterine system (LNG-IUS). At 3 or 6 months of treatment, endometrial tissues were obtained via 2 methods in each patient: aspiration biopsy, followed by D&C. The primary outcome was the consistency of the histologic results between the 2 methods. The secondary outcome was the regression rate at 6 months of treatment. Results: The study population comprised 65 patients (55 with non-atypical hyperplasia, 10 with atypical hyperplasia). During the follow-up, a comparison of the pathologic results from aspiration biopsy and D&C was carried out for the 65 cases. Thirty-eight cases were diagnosed as EH by D&C. Among these, only 24 were diagnosed with EH from aspiration biopsy, for a diagnostic concordance of 63.2% (ĸ=0.59). Forty-four patients were followed up at 6 months, and the regression rate was 31.8% (14/44). Responses were obtained for 41.7% (5/12) of the cyclic MPA group, 58.3% (7/12) of the continuous MPA group and 10% (2/20) of the LNG-IUS group. Conclusion: As a follow-up evaluation of patients treated with progestin for EH, aspiration biopsy is less accurate than D&C and might not be a reliable method. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to determine a cutoff level for a decrease in human chorionic gonadotropin (hCG) on postoperative day 1 to confirm intrauterine pregnancy (IUP) in patients who have undergone dilatation and curettage (D/C) with a presumptive diagnosis of nonviable pregnancy of unknown location (PUL). Material and Methods: This retrospective case-control study included patients who underwent D/C with a presumptive diagnosis of failing PUL between January 2010 and June 2015. Patients with failing PUL or confirmed to have an IUP were placed in Group 1 (n=164) and patients subsequently diagnosed with ectopic pregnancy were placed in Group 2 (n=19). In all patients, serum hCG levels were obtained on the day of D/C and on the following day. Results: The decline in serum hCG percentage on day 1 after D/C was 54.2% in patients with failing PUL/abortion and 14.3% in patients with ectopic pregnancy (p<0.001). A decrease in hCG of more than 35% was the most sensitive marker, with sensitivity, specificity, and positive and negative predictive values of 90%, 89%, 99%, and 50%, respectively. Conclusion: Determining post curettage day 1 hCG might aid clinicians in confirming failing IUP and in ruling out an ectopic pregnancy at an earlier date. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: It is estimated that 25% of pregnancies worldwide end in induced abortion. In Romania, the abortion situation shows a specific pattern. Following the fall of the communist regime, first‐trimester abortions were legalized, and between 1990 and 1992, the country's abortion rate was the highest in the world, with 182 abortions per 1000 women of reproductive age. However, there are currently no statistically reliable data, as some abortions are not reported. The purpose of this study was to identify the main circumstances that determine the choice to undergo abortion with all related potential risks, rather than using contraception. Method: We conducted a prospective type 1 cohort study based on a Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement that included women who presented at Bucur Maternity, Saint John Hospital, Bucharest, for abortion during the first trimester, between July and December 2018. The patients were asked to complete a 21‐item questionnaire based on psychosocial data. Results: The study included 119 patients, with a mean age of 29.57 years. Their educational level was average (ie, 51.3%, 4.2%, and 8.4% had completed high school, elementary school, and college or university, respectively). Most women were married (46.2%), and 47.9% were unemployed. The main reason for deciding to undergo an abortion was poverty (P =.014), and guilt was correlated with this decision (P =.004). Conclusion: The profiles of the women who chose to undergo an abortion as a family planning method were as follows: in the third decade of life, resident of urban areas, married, unemployed, and with a low family income. The main reasons for abortion were financial status, advanced maternal age, incompatibility of pregnancy with future plans, and the desire to postpone conception. [ABSTRACT FROM AUTHOR]

Introduction: A caesarean scar pregnancy is a complex iatrogenic pathology, which represents a consequence of a previous caesarean section. It increased in recent years due to parallel increase of cesarean sections. Material and methods: We present a retrospective study on patients with caesarean scar pregnancy diagnosed in our department from June 2016 to June 2019. Stable women with an embryo (with or without cardiac activity) who accepted our experimental protocol were treated with single dose of methotrexate (50 mg administered locally intracavitary + 50 mg administered intramuscularly) and folinic acid (15 mg/day orally for 30 days). Clinically stable women with embryo (without cardiac activity) who decided to wait, were monitored by serial assays of β-hCG and clinical and ultrasonographic follow up. Women who were clinically unstable with embryo (without cardiac activity), were referred for urgent surgical treatment with dilation and curettage. Results: Caesarean scar pregnancy was diagnosed in sixteen women. Among these women, seven were treated according to our experimental protocol with methotrexate and folinic acid and only one had profuse bleeding, which required a laparotomic hysterectomy. Four women were treated urgently with dilatation and curettage. Five women chose to wait: they were monitored and all spontaneously had a miscarriage. Conclusions: In our preliminary study, we highlighted how our experimental protocol gave encouraging results in the first 10 weeks of caesarean scar pregnancy. However, caution is needed in patients with advanced gestational age, a gestational sac with large diameter, higher CRL and presence of embryonic cardiac activity. [ABSTRACT FROM AUTHOR]

Background: Endometrial osseous metaplasia (EOM) is an uncommon condition characterised by metaplastic transformation of endometrial tissue into osteoblasts (mature or immature bone in the endometrium). Etiopathogenesis of EOM is explained by multiple putative mechanisms like dystrophic calcification, metaplastic ossification, retained foetal bones after abortions and genito-urinary tuberculosis. EOM has varied clinical presentation ranging from patient being asymptomatic to secondary infertility. Although hysteroscopy is the gold standard for its diagnosis and treatment, non-invasive imaging comprising chiefly of ultrasonography (USG) is increasingly becoming the mainstay of diagnosis. We aim to present the imaging findings in EOM to acquaint radiologists and gynaecologists with this condition to avert misdiagnosis of this uncommon yet treatable cause of infertility. Results: Mean age of patients was 31.4 ± 5.4 (S.D) years. USG revealed linear or tubular densely echogenic endometrium with posterior acoustic shadowing in all the 14 patients. MRI in 3 patients revealed diffuse or patchy areas of T1W and T2W hypointense signal intensity with unilateral (n = 2) and bilateral (n = 1) ovarian cysts. One patient who underwent CT scan revealed dense endometrial calcification. Histopathologic examination (HPE) revealed lamellar (n = 6) or trabecular (n = 4) bone within endometrium (EOM) and inflammatory cells with calcification in four patients (calcific endometritis). Twelve patients conceived after dilatation and curettage within 15 months. Conclusion: Familiarity with the imaging appearances of EOM is indispensable to clinch this diagnosis and avert misdiagnosis of this rare but potentially treatable cause of infertility. USG is usually sufficient for diagnosis. MRI and CT are only supplementary tools in difficult clinical scenarios. [ABSTRACT FROM AUTHOR]

Background: Difficulty in cervical dilatation is a hard situation during the procedure of diagnostic dilatation and curettage in some cases. Aim: Aim of the present study was to evaluate the use of Misoprostol for cervical dilatation before D&C in Gynecological cases. Dilatation of cervix is performed as a preliminary step to curette the uterine cavity. Endometrial sampling is often performed either by D&C or by hysteroscopy as an office procedure. Materials and methods: The study was performed at Department of Obstetrics and Gynecology, Victoria Hospital, Visakhapatanam, Andhra Pradesh from June 2018 to May 2019. The study comprised of 150 patients recruited from Gynecology Department with different indications for D&C. Selected cases had a full history of menstrual, Gynec, Obstetric, Personal and Family. A per abdomen and per speculum examination were done to note the Vaginal and Cervical condition. A bimanual pelvic examination was done to estimate size, position and mobility of uterus. In this study, the patients were allocated to receive either oral or vaginal misoprostol or no drug. All the subjects allocated to receive either oral or vaginal Misoprostol were instructed to take the medication at home, the night before the operative procedure. They were given 200 micro grams Misoprostol orally or vaginally 12 hours prior to the procedure. Results: In present study, majority of cases (57.33%) fall in age group of 30-39 years and 34% cases fall in age group of 40-49 years. 83% in Misoprostol group and 90% cases in control group had previous vaginal deliveries. 19% cases in Misoprostol and 20% cases in control group had a prior uterine surgery. Indication for D&C, in majority of cases 66 cases (44%) Heavy menstural bleeding was an indication, followed by Irregular bleeding 53 cases (35.33%), Intermenstural bleeding 29 cases (19.33%). Cervical dilatation effectively achieved in 62.5% in Nulliparous 69.2% in Primiparous, 94.93% in Multiparous. Conclusion: Both Oral and Vaginal Misoprostol are equally effective in inducing Cervical priming prior to Dilatation and Curettage. [ABSTRACT FROM AUTHOR]

As one of ectopic pregnancies, cervical ectopic pregnancy, which is rare in clinic, may cause severe bleeding and other adverse outcomes because the embryo is implanted in the cervical mucosa. In some severe cases, hysterectomy is necessary and it would be even life -threatening while there is no specific method to treat the disease and individualized treatment is needed. At present, there are few reports on the treatment of cervical ectopic pregnancy by high intensity focused ultrasound. Now, a female diagnosed with cervical ectopic pregnancy who was hospitalized in the Department of Obstetrics and Gynecology, The Characteristic Medicine Center of The Chinese People′s Armed Police Forces in 2020 cured by high intensity focused ultrasound combined with curettage is reviewed. We hope to share the treatment experience in order to attract the attention of obstetricians and gynecologists, and strive for more effective, safer and more economic treatment for cervical ectopic pregnancy patients. [ABSTRACT FROM AUTHOR]

Background and Aims: Endometrial cancer is a common gynecological malignancy, with a chief complaint of vaginal bleeding. Dilation and curettage (D&C) prior to performing definite surgical procedure is the gold standard pre-operative diagnostic method. This is a retrospective comparative study that aims is to determine the accuracy rate of D&C in diagnosing cancer at our institution. Materials and Methods: Endometrial cancers with pre-operative D&C diagnosed and underwent definite surgical procedures at our institution during the last 10 years were included. Corresponding slides for pre-operative D&C and final post surgical diagnosis were reviewed for histopathological characteristics. Any pre-operative cervical smears within one year of diagnosis were also reviewed. Results: 54cases of endometrial cancer were studied. Mean age =62.5 years. 79.6% of patients were menopausal. 32 had available follow up(mean period = 16.5 months). Most common histopathological types were endometrioid carcinoma (74%); followed by serous carcinoma (11%) and 4carcinosarcoma (7.4%). Accuracy rate of D&C was 87 %. Cases with discrepancy were 3 endometrioid cancers, and one each of serous carcinoma, leiomyosarcoma, endometrial stromal sarcoma, and placental site trophoblastic tumor. Conclusions: accuracy rate of D&C in detecting endometrial epithelial cancers is high; but is low for sarcomas. Potential factors that reduce accuracy include interpretation errors, sampling issues, and lack of ancillary immunohistochemistry. [ABSTRACT FROM AUTHOR]

Objective: To determine agreement on the adequacy of a sample by pipelle biopsy and conventional dilatation and curettage in patients with abnormal uterine bleeding. Study design: Cross-sectional study Setting and Duration of Study: Department of Obstetrics and Gyneacology, Islamic International Medical College Trust, Railway Hospital Rawalpindi. The study was carried out over a period of six months (11-07-2012 to 14-01-2013). Patients and Methods: 84 patients presented with abnormal uterine bleeding age 45 years and older, attended Gyneacology department of Railway Hospital Rawalpindi. Who qualified the inclusion criteria were enrolled in this study by non-probability consecutive sampling technique. The diagnostic intervention for endometrial sampling was by pipelle device and by conventional D&C (Dilatation & Curettage). Both procedures were performed in the OT at the same time. First, the pipelle sample was taken and was labeled as "A" then conventional D&C was performed and was labeled as "B". Both samples were sent to the pathologist, who was blinded as to the method of sample collection for histopathology assessment. Adequacy of the sample was assessed as per the operational definition. A database was made in SPSS version 17. Kappa statistics were applied to assess the agreement. Results: Out of 84 patients, 80 (98.8%) of the patients had an adequate sample with Pipelle Biopsy as compared to conventional curettage and dilatation (D&C). We, therefore, recommend the use of pipelle biopsy as a first-line tool for endometrial assessment for our setups instead of D&C. Conclusion: Our study concluded that the Pipelle biopsy is a useful and convenient method for the patients and physicians as compared to D&C performed in the operating theatre. It is useful in obese and high-risk patients with minimum chances of perforation of the uterus due to its soft flexible tip. [ABSTRACT FROM AUTHOR]

Aim: Endometrial biopsy is one of the most commonly performed gynecological procedures. Apart from patient safety, the most important is to obtain an adequate specimen allowing histopathological diagnosis. The aim of the study was to determine the rate of endometrial sampling failure and factors affecting the quality of specimen obtained for histopathological examination among patients who underwent Pipelle biopsy and dilatation and curettage (D&C). Methods: Patients who underwent endometrial biopsy (Pipelle, D&C) at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, between June 2013 and July 2017, were included in the study. The influence of menopausal status, body mass index, obstetric history, endometrial thickness, indications for the biopsy and doctors' experience were analyzed with regard to the effectiveness of the procedure. Results: Overall, 895 endometrial sampling procedures were performed. Three hundred and thirty‐nine (37.9%) patients underwent Pipelle biopsy, while 556 (62.1%) had D&C. Insufficient samples were found in 60 (17.3%) and 88 (15.8%) patients, respectively. Age, menopausal status and indications were factors affecting both procedures, while the number of previous vaginal deliveries, body mass index and endometrial thickness influenced the effectiveness of Pipelle biopsy. Doctors' experience did not influence the specimen adequacy. Conclusion: None of the methods guarantee obtaining adequate specimens. D&C might be preferred in postmenopausal women. The effectiveness of both procedures is independent of doctors' experience. [ABSTRACT FROM AUTHOR]

The management of a caesarean scar pregnancy ranges from conservative medical therapy to surgical treatment. The aim of this study is to present our experience of caesarean scar ectopic pregnancies treated with different modalities and to develop a management algorithm. This retrospective clinical analysis included 21 caesarean scar pregnancies. The clinical data, ultrasonographic characteristics, b-human chorionic gonadotropin concentrations, the treatment options and complications were noted. One patient was managed expectantly, six patients were treated with D and C, seven patients were treated with systemic methotrexate, eight patients underwent a caesarean scar pregnancy removal with a laparoscopy, three patients were treated with a hysteroscopy. Three patients who recieved a methotrexate required additional treatment methods including a laparoscopy, hysteroscopy and D and C. Surgery was successful in all cases. An intra-abdominal haemorrhage from the vessels in the scar area occured in the patient managed expectantly, and a laparatomy and removal was performed. A systemic methotrexate, dilatation and curettage, hysteroscopic resection and laparoscopic resection are feasible methods for scar pregnancy treatment depending on the gestational age, β-hCG level, the type of scar pregnancy and the clinical status of the patient. IMPACT STATEMENT What is already known on this subject? CSP has increased gradually parallel to the increased rates of CS worldwide. There is no treatment consensus on that rare entity. What do the results of this study add? We aimed to present our cases and to discuss a proposal algorithm with further studies. What are the implications of these findings for clinical practice and/or further research? Our cases and proposal algorithm could help to determine the treatment options for CSP. [ABSTRACT FROM AUTHOR]

Uterine perforation related with dilatation and curettage (D&C) is an uncommon event. Combined complications such as hemorrhage, adjacent organ injury, and omental incarceration may require an emergent surgical treatment. These are usually evident immediately or several days after the D&C, and a delayed presentation of uterine perforation are extremely rare. Herein, we report a rare case of omental incarceration presenting as a hyperechoic endometrial mass in a postmenopausal woman, diagnosed twenty-three years after the D&C. According to this case, when we encounter a hyperechoic endometrial lesion penetrating the uterine wall in women with a history of an intrauterine procedure such as D&C, we need to consider the possibility of an incarcerated omentum. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of Manual Vacuum Aspiration (MVA) with Dilatation and Curettage (DNC) in miscarriages of the first trimester. Study Design: Quasi-experimental study. Place and Duration of Study: Department of Obstetrics and Gynaecology CMH, Peshawar Pakistan, from Feb to Aug 2018. Methodology: A total number of 182 Adult female (20-35 years of age) patients having miscarriage during the first trimester who were either primigravida or with previous history of spontaneous vaginal delivery were included in this study. Patients were assigned randomly into Manual vacuum aspiration (MVA) and Dilatation and Curettage (DNC) groups using the draw randomization technique. Data regarding the efficacy of both procedures and procedural success rate was measured in all patients. Results: A total of 182 Adult female patients, with a mean age of 30.53+5.23 years, having miscarriage in the first trimester, were evaluated. The mean gestational age at the time of abortion was 8.64+1.30 weeks, and the mean parity of study females was 1.96±0.82. The procedure was successfully done in 87(95.6%) patients in the MVA Group versus 84(92.3%) in the DandC Group (p-value 0.35). Conclusion: Manual vacuum aspiration (MVA) is an effective and safe method of abortion with a success rate comparable to that of Dilatation and Curettage (DandC). [ABSTRACT FROM AUTHOR]

Objective：To explore the effect of pharmacological preconditioning and uterine arterial embolization on the curative effect of hysteroscopic uterus curettage for cesarean scar pregnancy (CSP). Methods：The clinical data of 120 patients with CSP treated in the department of gynaecology of Xinyang Central Hospital of Henan Province from January 2016 to November 2017 were collected retrospectively. According to different treatment methods, the patients were divided into the study group (72 cases) and the control group (48 cases). The two groups were treated by pharmacological preconditioning with mifepristone + methotrexate (MTX) and uterine arterial embolization, respectively, and then they were treated by hysteroscopic uterus curettage. The completion of operation, postoperative recovery progress and occurrence of complications were observed and statistically analyzed. Results：There was no statistically significant difference in the incidence of secondary uterus curettage, massive hemorrhage, conversion to laparotomy or hysterectomy, operative time or intraoperative blood loss between the 2 groups (P＞0.05). The postoperative length of hospital stay, vaginal bleeding time, menstrual recovery time and blood β- subunit of human chorionic gonadotropin (β-HCG) recovery time of the study group were significantly shorter than those of the control group (P＜0.05). In the study group, the main complications were gastrointestinal reactions, and the incidence rate (22.22%) was significantly higher than that in the control group (7.14%) (P＜0.05). The incidence rates of fever and pain in the control group (18.75% and 33.33%) were significantly higher than those in the study group (2.78% and 8.33%) (P＜0.05). There was no statistically significant difference in the incidence of infection, liver function damage, intrauterine adhesion or uterine perforation between the 2 groups (P＞0.05). Conclusions：The application of pharmacological preconditioning with mifepristone+ MTX before hysteroscopic uterus curettage could improve the clinical curative effect of patients with CSP. Postoperative recovery is fast and complications are few. Attention should be paid to control of complications such as gastrointestinal reactions. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the diagnostic efficacy and utility of liquid-based cytology in ThinPrep (Cytyc Corporation, Boxborough, MA) for endometrial lesions in patients presenting with abnormal uterine bleeding.Materials and Methods: Two hundred and thirteen women scheduled for dilatation and curettage because of abnormal uterine bleeding were enrolled in the study. After providing informed consent, all the women proceeded sequentially to endometrial cytology and then dilatation and curettage.Results: In the premenopausal group, cytological failure was 4.8%, histopathological failure was 2.4%; cytologic insufficiency in the postmenopausal group was 2.1%, and histopathologic insufficiency was 19.6%. When cytologic and histopathological sufficiency rates were compared in all cases, cytologic insufficiency was 4.2% and histopathologic insufficiency was 6.1%. This difference was statistically significant (p < 0.039). The diagnostic accuracy, sensitivity, specificity, PPV, and NPV of the liquid-based endometrial cytology for premenopausal patients were 96.79, 58.33, 97.92, 70, and 96.58%, respectively. In the postmenopausal cases, the accuracy of diagnosis of endometrial cytology was 97.30%, sensitivity 100%, specificity 96.67%, PPV 87.50%, and NPV 100%. When cytologic and histopathologically inadequate cases were excluded, no cytologic and histopathological abnormal findings were found in endometrial thickness cutoff ≤ 5 mm for all patients.Conclusion: The use of liquid-based cytology with TVS may contribute to increasing the diagnostic accuracy of the test and reduce unnecessary D&C for women. When TVS is used as a triage indicator, regardless of menopausal status in ≤ 5 mm endometrial thickness cases, endometrial cytology is an absolutely reliable method for detecting cancer. [ABSTRACT FROM AUTHOR]

Introduction: Abnormal Uterine Bleeding (AUB) is a major clinical problem among women in peri and postmenopausal age groups which needs complete scrutiny. Various methods are in vogue for the assessment of endometrium. Histopathological interpretation of endometrial tissue is the gold standard investigation. Studies have raised concern about diagnostic accuracy and adequacy of pipelle endometrial sample. Aim: To compare the efficacy of pipelle endometrial sampling method with conventional Dilatation (D) and Curettage (C) in diagnosis of AUB. Materials and Methods: This comparative cross-sectional study was carried out at DM Wayanad Institute of Medical Science, Kerala, India (January 2016 to June 2017). Endometrial samples collected from 210 patients with AUB initially by pipelle method followed by D and C formed the material for this study. Slides were prepared after routine histopathological processing and sectioning. Staining was done using Haematoxylin and Eosin (H&E) stains and the slides were subjected to thorough and independent microscopic examination for comparative analysis. Data analysis was performed using IBM SPSS Software version 21.0. Results: Histopathological examination of endometrial samplings by pipelle method revealed endometrial carcinoma in seven cases, atypical endometrial hyperplasia in seven cases, endometrial hyperplasia in 85 cases and disordered proliferative endometrium in 30 cases. These were correlated with histopathological findings of conventional D and C sampling method which showed pipelle sampling method had sensitivity and specificity in endometrial carcinoma (80% and 100% respectively), atypical endometrial hyperplasia (100% and 99.5% respectively), endometrial hyperplasia (100% and 93.98% respectively) and disordered proliferative endometrium (81.1% and 100% respectively). There was significant positive correlation (p<0.01) between the two techniques. Endometrial sampling by pipelle method had a high sensitivity and negative predictive value in diagnosing abnormal endometrium. Conclusion: Endometrial sampling by pipelle method is a safer and simpler alternative for diagnosis of endometrial lesions in patients with AUB. It has a fair degree of diagnostic accuracy almost comparable to that of curettage material. The diagnostic accuracy is high if interpreted by an experienced pathologist. [ABSTRACT FROM AUTHOR]

Objective：To evaluate the effect and the best administration of suction curettage under ultrasound guidance after methotrexate (MTX) treatment combined uterine artery embolization(UAE) for cesarean scar pregnancy (CSP). Methods： This was a retrospective case study of 51 cases who were diagnosed as CSP and treated by suction curettage under transabdominal ultrasound guidance after MTX treatment combined uterine artery embolization as an initial treatment of CSP in Chaoyang Hospital, Capital Medical University from January 2011 to December 2014. 51 patients were divided into three groups. Group A (23 cases): MTX systemic administration followed by UAE, and then fixed-point suction surgery. Group B (11 cases): Uterine arterial chemoembolization (UACE) followed by fixed-point suction surgery. Group C (17 cases): MTX systemic administration combined with UACE, and then fixed-point suction surgery. The basic information, the situation before treatment, intraoperative situation and assessment of therapeutic effect indicators of each group of patients were compared. Results：The three groups of patients were all one -time successful operation, with no secondary processing such as laparoscopic surgery. There was no case of bladder injury, uterus perforation and hysterectomy. The three groups in operation time, intraoperative blood loss, β-hCG to normal time, lesion absorption time, the success rate and the incidence of complications had no statistical significance (both P＞0.05). The hospitalization time and expenses in group B compared with the other two groups were decreased significantly (both P＜0.05). The maximum diameter of gestational sac or mass in Logistic regression model was statistically significant (OR=1.094, 95%CI: 1.012-1.183, P=0.024). Conclusions：Suction curettage under transabdominal ultrasound guidance after MTX treatment combined uterine artery embolization is safe and effect. It can be widely used in the treatment of endogenous and exogenous CSP. UACE is recommended as the preferred method for preoperative pretreatment. It is more security for patients whose lesions biggest diameter is less than 4.3 cm. [ABSTRACT FROM AUTHOR]

Background Tricuspid valve endocarditis caused by Group B streptococcus is a rare clinical entity with poor prognosis and has been previously reported following gynecologic procedures. Case summary We report a case of an 18-year-old female diagnosed with Group B streptococcus tricuspid valve endocarditis with septic emboli following an elective therapeutic abortion. After six weeks of treatment with ceftriaxone, she returned with recurrent symptoms and was found to have embolized a sizable vegetation to the pulmonary artery with probable lung infarction. She underwent surgical embolectomy and was treated with antibiotics and anticoagulation and was subsequently discharged in stable condition. Conclusion Group B streptococcus endocarditis is a serious complication of gynecologic procedures. The role of preoperative antibiotics, postoperative clinical suspicion of endocarditis based on respiratory symptoms and a multidisciplinary approach may lead to enhanced patient outcomes. [ABSTRACT FROM AUTHOR]

Endometrial evaluation is generally indicated in cases presenting with abnormal uterine bleeding (AUB), especially in women more than 35 years of age. AUB encompasses a variety of presentation, for example, heavy menstrual bleeding, frequent bleeding, irregular vaginal bleeding, postcoital and postmenopausal bleeding to name a few. Many methods are used for the evaluation of such cases, with most common being sonography and endometrial biopsy with very few cases requiring more invasive approach like hysteroscopy. Endometrial aspiration is a simple and safe office procedure used for this purpose. Materials and Methods: We retrospectively analyzed cases of AUB where endometrial aspiration with Pipette (Medgyn) was done in outpatient department between January 2015 and April 2016. Case records (both paper and electronic) were used to retrieve data. Results: One hundred and fifteen cases were included in the study after applying inclusion and exclusion criteria. Most cases were between 46 and 50 years of age followed by 41-45 years. No cases were below 25 or more than 65 years of age. Heavy menstrual bleeding was the most common presentation of AUB. Adequate samples were obtained in 86% of cases while 13.9% of cases' sample was inadequate for opinion, many of which were later underwent hysteroscopy and/or dilatation and curettage (D and C) in operation theater; atrophic endometrium was the most common cause for inadequate sample. Uterine malignancy was diagnosed in three cases. Discussion: Endometrial aspiration has been compared with traditional D and C as well as postoperative histopathology in various studies with good results. Many such studies are done in India as well as in western countries confirming good correlation with histopathology and adequate tissue sample for the pathologist to give a confident diagnosis. No complication or side effect was noted with the use of this device. Conclusion: Endometrial aspiration is a simple, safe, and effective method to sample endometrium in cases of AUB avoiding risk of anesthesia and is less time-consuming. Many similar devices are also available in the market and need to be popularized in all parts of the country. [ABSTRACT FROM AUTHOR]

Background: Every year around 50 million unintended pregnancies worldwide are terminated by induced abortion. Even in countries, where it is legalized and performed in a safe environment, abortion carries some risk of complications for women. Findings of researchers on the factors that influence the sequelae of abortion are controversial and inconsistent. This study evaluates the effects of gestational age and the method of surgical abortion (i.e., dilatation and curettage and vacuum aspiration) on the most common abortion complications: postabortion hemorrhage and fever.Methods: We performed a secondary analysis of the data from the population-based Georgian Reproductive Health Survey 2010. Information on 1974 surgical abortions performed >30 days prior to the survey interview were analyzed during the study. Logistic regression statistical analysis was applied to compare the abortion sequelae that followed vacuum aspiration and dilatation and curettage at different gestational ages (<10 weeks and ≥10 weeks). We examined two major early abortion-related complications: postabortion hemorrhage and febrile morbidity (fever ≥38 °C).Results: Postabortion hemorrhage was reported in 43 cases (1.9%), and febrile morbidity occurred in 44 cases (2%) among all of the surgical abortions. The abortions performed by dilatation and curettage were associated with an estimated fourfold increased risk of developing hemorrhage (OR 4.4, 95% CI 2.2-8.6) and a twofold increased risk of developing fever (OR 2.37, 95% CI 1.17-4.79) compared with the abortions that were performed via vacuum aspiration. The risk of postabortion hemorrhage (OR 1.9, 95% CI 0.8-4.4) or fever (OR 0.9, 95% CI 0.4-2.1) did not significantly differ at gestational age < 10 weeks and ≥10 weeks.Conclusion: Vacuum aspiration was associated with reduced risks of postabortion hemorrhage and fever compared to dilatation and curettage. Gestational age ≥ 10 weeks was not found to be a predictive factor of immediate postabortion complications: hemorrhage and fever. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy and prognostic factors of uterine artery chemoembolization (UACE) for the treatment of cesarean scar pregnancy (CSP). Methods Clinical and follow up data of 240 women with CSP treated with UACE were analyzed retrospectively. Basic characteristics and complications were summarized. Results Pregnancy was terminated successfully in all women without hysterectomy, hemorrhagic shock, blood transfusion, or death. After UACE, 231 women underwent ultrasound-guided dilation and curettage (D&C) whereas 9 required laparoscopic or open surgical excision of the gestational tissues with uterine reconstruction. The average amount of blood loss was 29 土 55 ml. After D&C or excision, the drop in median values of red blood cells (0.5 T/ L), hemoglobin (17 g/L) and hematocrit (53) was significant lower (P<0.001) compared to that before UACE. The median value of serum β-HCG (1616.7 U/ml) was also significantly lower (P<0.001) than that before UACE (28285.1 U/ml). Lower abdominal pain and mild-moderate fever were the most common complications of UACE. Conclusion UACE is effective and safe treatment for CSP. [ABSTRACT FROM AUTHOR]

A 35-year-old woman, gravida 3, para 2, spontaneously delivered an infant without any major complications. On the 38th day after delivery, she returned to the hospital due to irregular bleeding. Transvaginal ultrasound showed a mass in the cervix; therefore, dilatation and curettage was performed, using placental forceps, to remove the retained placenta. During the procedure, a uterine perforation was suspected. Sonohysterography was performed in order to confirm the uterine perforation. The sonohysterogram revealed that the high echogenic mass that was suspected to be retained placenta was adhered on the posterior uterine myometrium. Saline that had been injected into the uterine cavity escaped into the Douglas pouch via a small hole in the posterior uterine wall. An emergency laparotomy was performed. Pathological examination of the removed uterus revealed placenta increta in the posterior wall, as well as an adjacent perforated fistula. Sonohysterographic diagnosis of uterine perforation in the present case was not only validated with diagnosis, but also the residual placenta was clearly visible. The use of sonohysterography for detection of a suspected case of uterine perforation after dilatation and curettage was accurate and provided a safe procedure for fast evaluation. [ABSTRACT FROM AUTHOR]