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Abstract 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

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]

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. Abstract 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.

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 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 D&C 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 (D&C).

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]

Post-abortion complications are a significant cause of maternal morbidity and mortality when conducted by untrained persons in sub-standard settings, which are commonly seen in Low and Middle-Income Countries (LMICs). The presentation depends on the type and extent of the injury but at times may be misleading and delayed recognition resulting in fatal complications. Uterine perforation is one of the uncommon complications of unsafe abortion. The authors report a case of 26-year-old female patient, Gravida 2, para 1 admitted with a history of bleeding per vaginum for the past five days. A detailed Ultrasonography (USG) was done by an ultrasonologist who confirmed the presence of a small rent in the uterine wall and the intrauterine product as a continuation of the omentum. An emergency laparotomy was performed and intraoperative findings showed uterine perforation located at the scar line of the previous uterine incision, through which omentum has entered the uterine cavity and traversed through the cervical canal into the vagina. That part of the omentum which had come into the uterine cavity was removed after ligating all feeding vessels, and the rest of the omentum was placed back into the peritoneal cavity. The uterus was preserved and the patient was discharged in stable condition. Uterine perforation sometimes may present with minimal symptoms and a thorough history and physical examination is key in diagnosing it. Unsafe abortions in hands of quacks and unqualified practitioners leading to life-threatening complications still remain a major problem in developing countries like India and require the immediate attention of policymakers.

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]

We hypothesized that patients at our hospital who received general anesthesia as the initial anesthetic technique for dilation and curettage for loss of pregnancy during the first or second trimesters would have a higher estimated blood loss compared to patients who had sedation. We searched our electronic medical record system for patients who had a dilation and curettage for the indication of loss of pregnancy during the first or second trimesters from July 1, 2018, to June 30, 2021. A total of 165 (72%) and 64 (28%) patients had general anesthesia and sedation, respectively, as the initial anesthetic technique. Patients who had general anesthesia and sedation had estimated blood loss interquartile ranges of 50 to 500 mL and 30 to 100 mL, respectively (P < 0.01). A multivariate model that controlled for gestational age and location of procedure found that the odds ratio of patients receiving sedation for dilation and curettage in the labor and delivery suite was 7.24 (95% confidence interval 2.92, 17.94; P < 0.01) compared to the main operating room. Dilation and curettage that used sedation was associated with a lower estimated blood loss and was more likely to be performed in the labor and delivery suite. [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.

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.

Objective:In this study, we aimed to compare the endometrial suction biopsy with Pipelle® and endometrial curettage (D&C) findings from patients with abnormal uterine bleeding and/or endometrial thickness to observe the possible influencing factors on ESB’s diagnostic value.Method:In Tekirdağ Community Hospital and Gynecology Clinic, data were retrospectively collected from hospital registry. 122 patients who had abnormal uterine bleeding and/or endometrial thickness were selected and from all cases, endometrial biopsies were taken with Pipelle® and D&C methods at the same time. In conclusion, pathologic results of two methods were compared.Results:Pathology results were as follows: By Pipelle®, 44 patients (36.1%) were found with endometrial polyp, 26 patients (21.3%) with endometrial atrophy, 31 patients (25.4%) with proliferative endometrium, 11 patients (9%) with secretory endometrium, 4 patients (3.3%) with endometrial carcinoma, 1 patient (0.8%) with hyperplasia without atypia, 2 patients (1.6%) with inflammation; by D&C, 55 patients (45.1%) were found with polyp, 20 patients (16.4%) with endometrial atrophy, 34 patients (27.9%) with proliferative endometrium, 9 patients (7.4%) with secretory endometrium, 4 patients (3.3%) with endometrial carcinoma, 1 patient (0.8%) with hyperplasia without atypia, 2 patients (1.6%) with inflammation. Correlations between two methods were found as 97.6%, 95.3%, 91.7%, 98.3%, 100%, 100%, and 100% for proliferative endometrium, atrophy, polyp, secretory endometrium, endometrial cancer, hyperplasia without atypia and inflammation, respectively. Discorrelations between two diagnostic methods were more commonly seen in endometrial polyp pathology.Conclusion:Our study findings revealed very high correlations between the pathology results of Pipelle® and D&C procedures. Pipelle®, with the advantages of being a simple outpatient procedure and having less complication rates, can be preferred over D&C reliably in most clinic situations. On the other hand, D&C method should be preferred in cases of endometrial polyp pathologies due to increased discorrelation rates and biopsy failures in Pipelle® biopsy.

Background: Cesarean scar pregnancy (CSP), a distinct form of ectopic pregnancy, presents challenges in effective management. It is categorized into three subtypes according to the location of placental implantation and the thickness of the myometrium at the uterine scar. Nevertheless, the optimal choice of treatment modalities for these subtypes remains largely unexamined., Methods: In this retrospective analysis, we investigated the cases of 130 patients diagnosed with CSP who underwent diverse treatment approaches, namely ultrasound-guided dilation and curettage (D&C), hysteroscopic surgery alone or in combination with laparoscopic surgery (HCoLC), or uterine artery embolization (UAE) followed by curettage. Clinical data were meticulously retrieved from medical records and follow-up data, and a comparative analysis of relevant indicators was carried out across the different CSP subtypes., Results: From January 2017 to December 2021, 35 patients underwent D&C, 85 underwent HCoLC, and 10 received UAE as a pretreatment. In the D&C group, the success rates for Type I and Type II CSP were 64.29% (18/28) and 14.28% (1/7), respectively. Significant differences were observed between the success and failure groups in terms of gestational sac size and clinical classification. Compared to Type I CSP, Type II CSP exhibited significantly longer surgical durations and higher hospitalization costs (P < 0.05). Three patients classified as Type III underwent simultaneous hysteroscopic evacuation of cesarean scar pregnancy and laparoscopic repair of the cesarean scar defect, achieving a 100% success rate in their initial treatment. HCoLC showed no significant differences in surgical duration and hospitalization costs but had higher success rates and shorter hospital stays compared to the D&C and UAE groups (P < 0.05). The UAE group had significantly longer surgical durations, higher hospitalization costs, and a higher incidence of postoperative complications (P < 0.05). However, these factors did not result in improved surgical success rates., Conclusion: The classification of CSP and the measurement of gestational sac are of crucial importance in determining the most appropriate surgical intervention strategy. For patients diagnosed with Type I CSP, D&C and hysteroscopy are reliable treatment choices. In cases with larger gestational sacs or Type II CSP, hysteroscopy, either alone or in combination with laparoscopy, is regarded as a reliable and effective treatment approach. In patients with type III CSP, lesion excision with uterine repair is the recommended treatment., (© 2024. The Author(s).)

Objective: A pregnancy at the utero-tubal junction is a rare type of ectopic pregnancy and is associated with high maternal morbidity if it remains undetected. In the present study we discuss four cases of ectopic pregnancies at the utero-tubal junction which caused diagnostic and management dilemmas., Methods: Four cases of early pregnancies with the gestational sac (G-sac) implanted near the utero-tubal junction are described. In case 1 this was suspected after a failed attempt at dilatation and curettage at our hospital, cases 2 and 3 presented with amenorrhea and pain abdomen and case 4 was diagnosed on first pregnancy documentation scan after frozen embryo transfer., Results: As initial two-dimensional (2D) transvaginal scan (TVS) failed to diagnose the exact location of the G-sac, three-dimensional (3D) TVS helped to localize the exact location of pregnancy and subsequent individualized management. Case 1 had a partial intramural ectopic pregnancy managed by laparotomy and removal of the ectopic sac. The second and third cases were eccentric uterine pregnancies. The fourth was an interstitial ectopic pregnancy managed by a laparoscopic loop and stitch technique., Conclusion: This case series describes the role of 3D TVS for the evaluation of pregnancies implanted at the utero-tubal junction and individual management of eccentric intrauterine, interstitial ectopic and intramural ectopic pregnancies. A diagnostic algorithm for such types of cases and management options is discussed., (© 2024 International Federation of Gynecology and Obstetrics.)

Uterine perforation represents an uncommon yet potentially significant complication that may arise during the process of dilation and curettage (D&C), a frequently conducted procedure employed for a variety of gynaecological indications, including missed abortion. This report delineates an atypical case of uterine perforation in a 30-year-old female patient who underwent D&C subsequent to a missed abortion at 10 weeks of gestation and subsequently experienced acute abdominal discomfort accompanied by clinical features of internal haemorrhage shortly after the intervention. Diagnostic imaging corroborated the occurrence of uterine perforation, prompting the execution of emergency surgery to rectify the perforation and address concomitant complications. Following the surgical intervention, the patient achieved a complete recovery. This case report underscores the necessity for heightened vigilance during D&C procedures. The early identification and swift surgical management of this condition are imperative to avert severe morbidity or mortality associated with this infrequent complication. Furthermore, it accentuates the importance of pre-operative counselling and post-operative surveillance to ensure the timely identification and management of potential complications., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Dudhe et al.)

Background Cervical polyps are benign growths from the cervical epithelium, found in 2% to 5% of the population. They usually appear as small, stalk-attached lesions ranging from pea to cherry size. Contributing factors include cervical infections, congestion, and elevated estrogen levels. During pregnancy, these polyps may increase the risk of late abortion and preterm birth. While malignancy is rare, histopathological examination after removal is advised to rule out cancer. Materials and methods This current study, the first of its kind in Afghanistan, aimed to assess the scope of cervical polyps among Afghan women presenting to Rabia Balkhi National Hospital in 2018. We conducted a descriptive study of cervical polyps, exploring the prevalence, symptoms, complications, and procedures used to remove them. Data were collected from 3730 cases admitted to the hospital. Results Out of 3730 cases, 50 patients (1.34%) were diagnosed with cervical polyps. The polyps varied in size and were typically attached to the cervix by a slender stalk. Symptoms reported included inter-menstrual, post-coital, and post-menopausal bleeding. Histopathological examinations were performed following polyp removal to rule out malignancy. Conclusion This study provides a comprehensive overview of the prevalence and clinical presentation of cervical polyps among Afghan women. The findings highlight the importance of recognizing and managing cervical polyps to prevent potential complications, especially during pregnancy. Further research is needed to understand this population's epidemiology, pathogenesis, and optimal management strategies for cervical polyps., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Review Board (IRB) of the Ministry of Public Health of Afghanistan issued approval Al.0457.2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Yousofzai et al.)

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]

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Background: This case describes the youngest patient documented in the literature who presented with a giant hydatidiform mole, effectively addressed through conservative treatment., Case Presentation: Our department received a 20-year-old Caucasian patient who was admitted due to significant metrorrhagia in an undisclosed pregnancy. During examination, we identified a massive, highly vascularized hydatidiform mole measuring 22 cm (cm). We performed a surgical dilatation and curettage. The anatomopathological findings confirmed the presence of a complete hydatidiform mole (CHM). Following the established guidelines, we conducted weekly monitoring of human chorionic gonadotropin (hCG). Unfortunately, the patient discontinued the follow-up and became pregnant again before achieving hCG negativation., Conclusion: This case suggests that conservative treatment is a viable option regardless of the size of gestational trophoblastic disease (GTD), especially when the preservation of fertility is a crucial consideration, as effectively demonstrated in our case., (© 2024. The Author(s).)

Hysteroscopy dilatation and curettage is a common minor gynaecological procedure utilised for diagnostic or therapeutic purposes. A 62-year-old woman underwent a hysteroscopy, dilatation and curettage for investigation of prolonged post-menopausal bleeding. Unexpected uterine haemorrhage was encountered without evidence of uterine perforation causing haemodynamic instability. A thrombotic microangiopathy was triggered, leading to microangiopathic haemolytic anaemia, thrombocytopaenia and evidence of micro-thrombosis causing stroke and end-organ dysfunction, including acute renal failure. The histopathology confirmed stage 1 endometrioid adenocarcinoma. This is the first case report of a thrombotic microangiopathy leading to microangiopathic haemolytic anaemia in a patient with endometrioid adenocarcinoma FIGO grade 1, stage 1B following a minor gynaecological procedure.

Background: Abnormal uterine bleeding (AUB) refers to any symptomatic deviation from normal menstruation. AUB is a common gynecological disorder in non-pregnant women of reproductive age, accounting for approximately 33% of gynecological outpatient visits. The early diagnosis and management cause of AUB is important because of increased incidence of endometrial carcinoma with rapid growth. Transvaginal ultrasound is non-invasive imaging technique used to find endometrial carcinoma before referring patients for invasive techniques. Dilatation and curettage (D&C) and endometrial biopsy are surgical procedures that scrape the endometrial lining of the uterus for diagnosis and treatment. The aim of this study is to describe the clinicopathologic pattern of endometrial specimens in women with AUB and ultrasonographic correlation., Methods: Tissues from endometrial biopsy and curettage of 411 patients with AUB who referred to Shahid Mohammadi hospital were prospectively selected from 2021 to 2023. Patients were divided into three groups based on age and menstrual status including: premenopausal (18-39 years), perimenopausal (40-49 years) and postmenopausal (≥50 years). The results were correlated to patient's age and other data and evaluated with statistical analysis., Results: During the two-year study period, a total of 411 endometrial specimens with clinical diagnosis of AUB were submitted and the results were analyzed. The youngest patient presenting with AUB was 21 years old, while the oldest was 77 years old. The most common complaint was menorrhagia in 201 (48.0%) out of 411 patients. The most common pathology finding in three groups was polyp in 100 (24.3%) cases. Hormonal effect was the next commonly observed pattern seen in 70 (17.0%) cases. P value was calculated as 0.003 which was significant using chi-square for the trend seen in age., Conclusion: Endometrial sampling is a useful tool for evaluation of women with AUB and referring patients for treatment. Histopathological evaluation of the endometrium is very useful in detecting the etiology of AUB. Transvaginal sonography has high sensitivity in detecting polyps., (© 2024 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

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]

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]

Introduction: Manual vacuum aspiration is increasingly accepted as an alternative to medical or surgical evacuation of the uterus after first-trimester miscarriage. This study aimed to assess the efficacy of ultrasound-guided manual vacuum aspiration (USG-MVA) in the management of first-trimester miscarriage., Methods: This retrospective analysis included adult women with first-trimester miscarriage who underwent USG-MVA in Hong Kong between July 2015 and February 2021. The primary outcome was the efficacy of USG-MVA in terms of complete evacuation of the uterus, without the need for further medical or surgical intervention. Secondary outcomes included tolerance of the entire procedure, the success rate of karyotyping using chorionic villi, and procedural safety (ie, any clinically significant complications)., Results: In total, 331 patients were scheduled to undergo USG-MVA for first-trimester miscarriage or incomplete miscarriage. The procedure was completed in 314 patients and well-tolerated in all of those patients. The complete evacuation rate was 94.6% (297/314), which is similar to the rate (98.1%) achieved by conventional surgical evacuation in a previous randomised controlled trial in our unit. There were no major complications. Samples from 95.2% of patients were suitable for karyotyping, which is considerably higher than the rate of suitable samples (82.9%) obtained via conventional surgical evacuation in our previous randomised controlled trial., Conclusion: Ultrasound-guided manual vacuum aspiration is a safe and effective method to manage first-trimester miscarriage. Although it currently is not extensively used in Hong Kong, its broader clinical application could avoid general anaesthesia and shorten hospital stay., Competing Interests: As an editor of the journal, JPW Chung was not involved in the peer review process. Other authors have disclosed no conflicts of interest.