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Background: We describe variation in postpartum opioid prescribing across a statewide quality collaborative and assess the proportion due to practitioner and hospital characteristics. Methods: We assessed postpartum prescribing data from nulliparous, term, singleton, vertex births between January 2020 and June 2021 included in the clinical registry of a statewide obstetric quality collaborative funded by Blue Cross Blue Shield of Michigan. Data were summarized using descriptive statistics. Mixed effect logistic regression and linear models adjusted for patient characteristics and assessed practitioner‐ and hospital‐level predictors of receiving a postpartum opioid prescription and prescription size. Relative contributions of practitioner and hospital characteristics were assessed using the intraclass correlation coefficient. Results: Of 40,589 patients birthing at 68 hospitals, 3.0% (872/29,412) received an opioid prescription after vaginal birth and 87.8% (9812/11,177) received one after cesarean birth, with high variation across hospitals. In adjusted models, the strongest patient‐level predictors of receiving a prescription were cesarean birth (aOR 899.1, 95% CI 752.8–1066.7) and third−/fourth‐degree perineal laceration (aOR 25.7, 95% CI 17.4–37.9). Receiving care from a certified nurse‐midwife (aOR 0.63, 95% CI 0.48–0.82) or family medicine physician (aOR 0.60, 95%CI 0.39–0.91) was associated with lower prescribing rates. Hospital‐level predictors included receiving care at hospitals with <500 annual births (aOR 4.07, 95% CI 1.61–15.0). A positive safety culture was associated with lower prescribing rates (aOR 0.37, 95% CI 0.15–0.88). Much of the variation in postpartum prescribing was attributable to practitioners and hospitals (prescription receipt: practitioners 25.1%, hospitals 12.1%; prescription size: practitioners 5.4%, hospitals: 52.2%). Discussion: Variation in postpartum opioid prescribing after birth is high and driven largely by practitioner‐ and hospital‐level factors. Opioid stewardship efforts targeted at both the practitioner and hospital level may be effective for reducing opioid prescribing harms. [ABSTRACT FROM AUTHOR]

Objective: Cesarean scar pregnancy (CSP) is an ectopic pregnancy that implants in the scar of a previous cesarean section and is a pathological condition that requires maternal management, as the implantation site may rupture and cause massive bleeding. Therefore, diagnosis should be made early in the first trimester, and consideration should be given for terminating the pregnancy before heavy bleeding occurs. As there is no consensus regarding the method of abortion for CSP, we aimed to examine the best methods safely managing CSP. Subject and Methods: We retrospectively reviewed four cases diagnosed with CSP during early pregnancy that occurred at our hospital from January 2016 to December 2021. Results: Two cases in which the gestation period was < 7 weeks, the fetal heart rate was negative, and no intra-abdominal hemorrhage were able to be treated with dilation and curettage (dilation and evacuation) alone. Conversely, two patients who had uterine rupture and were brought to the hospital by emergency underwent simple abdominal hysterectomy. Conclusion: As a response to CSP, good outcomes may be achieved by diagnosing the disease as early as possible in the gestational week and taking prompt action before clinical symptoms develop. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Swift and precise identification of heterotopic cesarean scar pregnancy, coupled with standardized treatment approaches for handling possible serious complications, form an essential component in reaching favorable outcomes for patients experiencing this rare type of pregnancy. Heterotopic pregnancy (HP) denotes a form of multiple gestation where intrauterine and ectopic pregnancies coexist. Cesarean scar ectopic pregnancy, on the other hand, involves the implantation of a fetus over the previous cesarean scar. This condition poses a significant risk of uterine rupture, which may lead to serious health complications, and even death. We report a case of a fit 37‐year‐old woman with two previous cesarean deliveries who was diagnosed with a heterotopic cesarean scar pregnancy at 8 weeks gestation following symptoms of lower abdominal pain and delayed menstruation. Both pregnancies demonstrated cardiac activity and the portion of the myometrium located between the bladder wall and the gestational sac was noted to exhibit considerable thinness. The patient underwent an exploratory laparotomy coupled with dilation and curettage and recovered uneventfully. The proper management of a HCSP requires timely diagnosis through ultrasonography. Early diagnosis allows for immediate intervention to prevent complications such as uterine rupture or potentially lethal bleeding. [ABSTRACT FROM AUTHOR]

ObjectivesTo describe treatment and outcomes of patients with confirmed cesarean scar ectopic pregnancy (CSEP) at a tertiary referral center.Study designWe reviewed a deidentified family planning clinical database for patients seen by our subspecialty service for CSEP from January 2017 through December 2021 in this case series. We extracted referral information, final diagnosis, management, and outcome measures including estimated blood loss, secondary procedures, and treatment complications.ResultsOf 57 cases referred for suspected CSEPs, 23 (40%) had confirmed diagnoses; one additional case was diagnosed during clinic evaluation for early pregnancy loss. Most (n = 50 [88%]) referrals occurred in the last 2 years of the 5-year study period. Of 24 confirmed CSEP cases, eight were pregnancy losses at the time of diagnosis. Fourteen cases were ≤50 days gestation or gestational size (7 [50%] pregnancy losses) and 10 >50 days gestation (range 39-66 days). We treated all 14 patients ≤50 days primarily with suction aspiration under ultrasound guidance in an operating room with no complications and estimated blood loss of 14 ± 10 mL. Of the 10 patients>50 days (maximum 66 days), seven were managed with primary aspiration of which five were uncomplicated. We treated one patient (57 days) had primary intrauterine double-catheter balloon with immediate hemorrhage requiring uterine artery embolization followed by an uncomplicated suction aspiration.ConclusionsPatients with confirmed CSEPs at 50 days or less gestation or gestational size can likely be primarily treated with suction aspiration with low risk for significant adverse outcomes. Treatment success and complications are directly related to gestational age at treatment.ImplicationsUltrasound-guided suction aspiration monotherapy should be considered for primary CSEP treatment up to 50 days and, with continued experience, may be reasonable beyond 50 days gestation. Invasive treatments or those that require multiple days and visits, such as methotrexate or balloon catheters, are not necessary for early CSEPs.

Objective: To investigate the impact of preoperative hysteroscopy on progression‐free survival (PFS) and disease‐specific survival (DFS), and to explore the factors which contribute to poor clinical outcomes between hysteroscopy and dilation and curettage (D&C) in endometrial cancer (EC). Methods: A retrospective study was designed by collecting data from women diagnosed with EC through hysteroscopy or D&C from January 2010 to December 2019 in a tertiary hospital in China. A propensity score was used for 1:1 matching of advanced stage patients. Univariate and multivariate analysis were conducted to determine whether hysteroscopy was a prognostic factor in EC and to identify factors associated with its impact on PFS and DFS in different subgroups. Results: Overall, 543 and 272 women who underwent D&C and hysteroscopy, respectively were included. Compared to D&C, preoperative hysteroscopy was related to reduced PFS and DFS, with a hazard ratio (HR) of 1.904 and 3.905, respectively. Hysteroscopy contributed to an increased risk of positive wash cytology (48.27% vs 24.13%), recurrence (48.28% vs 20.69%) and shorter PFS after matching in FIGO Stage I–IV EC, while there was no significance in positive ascites cytology (14.04% vs 13.45%), PFS and DFS in FIGO Stage I EC. Conclusions: Hysteroscopy was an independent predictive factor for poor prognosis in EC. Hysteroscopy appeared to be a safe diagnostic method as D&C in FIGO Stage I EC but was a risk factor for increased recurrence and reduced PFS in advanced stage disease. Its impact on DFS is uncertain. Synopsis: Preoperative hysteroscopy procedure was associated with increased risk of recurrence and shorter PFS in advanced endometrial cancer. [ABSTRACT FROM AUTHOR]

Key Clinical Message Swift and precise identification of heterotopic cesarean scar pregnancy, coupled with standardized treatment approaches for handling possible serious complications, form an essential component in reaching favorable outcomes for patients experiencing this rare type of pregnancy. Abstract Heterotopic pregnancy (HP) denotes a form of multiple gestation where intrauterine and ectopic pregnancies coexist. Cesarean scar ectopic pregnancy, on the other hand, involves the implantation of a fetus over the previous cesarean scar. This condition poses a significant risk of uterine rupture, which may lead to serious health complications, and even death. We report a case of a fit 37‐year‐old woman with two previous cesarean deliveries who was diagnosed with a heterotopic cesarean scar pregnancy at 8 weeks gestation following symptoms of lower abdominal pain and delayed menstruation. Both pregnancies demonstrated cardiac activity and the portion of the myometrium located between the bladder wall and the gestational sac was noted to exhibit considerable thinness. The patient underwent an exploratory laparotomy coupled with dilation and curettage and recovered uneventfully. The proper management of a HCSP requires timely diagnosis through ultrasonography. Early diagnosis allows for immediate intervention to prevent complications such as uterine rupture or potentially lethal bleeding.

To study the comparison between hysteroscopic morcellation (HM) of retained products of conception (RPOC) with ultrasound (US)-guided electric vacuum aspiration in terms of intrauterine adhesion (IUA) formation, efficacy, and complications. A randomized controlled, nonblinded trial. Three teaching hospitals and one university hospital from April 2015 to June 2022. A total of 133 women with RPOC on US, ranging from 1–4 cm, were randomized to receive either HM or electric vacuum aspiration. Hysteroscopic morcellation was performed with the TruClear System (Medtronic, Minneapolis, MN, USA). Electric vacuum aspiration was performed using an 8- or 10-mm flexible plastic Karman cannula under US guidance. Women allocated to vacuum aspiration underwent the procedure as soon as possible. In the HM group, an office diagnostic hysteroscopy was planned a minimum of 6 weeks after the end of pregnancy, followed by retained product of conception removal at least 8 weeks after the end of the pregnancy. Postoperatively, an office second-look hysteroscopy was scheduled to assess the primary outcome of IUAs. Postoperative IUAs were seen in 14.3% (9/63) of patients in the HM group and 20.6% (13/64) of patients in the vacuum aspiration group (−6% [−19.1% to 7.1%]). Significantly more RPOC were removed completely by HM compared with vacuum aspiration (95.2% vs. 82.5% (−14% [−24.9% to −3.1%]), and additional operative hysteroscopy was less frequently necessary in the HM group (12.5%) compared with the vacuum aspiration group (31.3%) (−20.1% [−34.3% to −6%]). The median operating time was shorter for vacuum aspiration compared with HM (5.80 minutes vs. 7.15 minutes). No differences were observed between HM and vacuum aspiration for the occurrence of intraoperative or postoperative complications (5.5% vs. 5.0% and 2.7% vs. 1.3%, respectively). In our randomized controlled trial, no significant differences were found in the occurrence of IUAs and complications. However, the RPOC were more often completely removed by HM than vacuum aspiration, and the HM group required fewer additional hysteroscopic treatments. NTR4923 (https://trialsearch.who.int/Trial2.aspx?TrialID=NTR4923). Date of registration: November 23, 2014, date of initial participant enrollment: January 1, 2015 [ABSTRACT FROM AUTHOR]

Suction curettage is preferred over sharp curettage in obstetric settings. We compare the quality of operative tissue sampling between sharp curettage and suction curettage using electric vacuum aspiration for nonobstetric abnormal uterine bleeding in reproductive-aged women. A retrospective cohort study. Community hospital in Long Island, New York. Women ages 21 to 45 years (n = 257) who underwent operative curettage procedure for nonobstetric abnormal uterine bleeding. Independent ratings of specimens from suction curettage using electric vacuum aspiration and sharp curettage by 2 pathologists blinded to method of tissue collection. The primary outcome was percentage of organized tissue, indicative of a higher-quality pathology specimen. Specimens obtained by electric suction curettage (p <.001) had a significantly higher percentage of organized tissue (M = 66.28, SD = 20.33) than sharp curettage (M = 55.51, SD = 24.17). There were no differences between the curettage groups for operative time, blood loss, intraoperative complications, or pathology diagnosis. Specimens obtained with suction curettage contained more organized tissue with similar pathologist satisfaction and confidence scores than sharp curettage. We suggest clinicians consider electric suction curettage in the diagnostic workup of abnormal uterine bleeding in reproductive-aged women. In addition, patient-centered benefits include no increase in operative time, blood loss, or complication rate compared with sharp curettage. [ABSTRACT FROM AUTHOR]

Abstract Purpose We aimed to evaluate whether hysteroscopy increases the risk of intraperitoneal dissemination or worsens the prognosis of endometrial carcinoma (EC) patients and whether radical hysterectomy (RH) improves overall survival (OS) or disease‐free survival (DFS) in patients with stage II to III EC and to investigate the effects of different procedures for identifying EC and the effects of different surgical methods on the OS and DFS of endometrial cancer patients. Methods Four hundred sixty‐five women with EC were included in this retrospective study. Log‐rank tests and Kaplan–Meier analysis were used for the outcome comparisons of the effects of the EC diagnostic method and different hysterectomy procedures. A Cox proportional hazards model was used for univariate regression analysis. Results Among the three procedures for diagnosing EC (diagnostic curettage, hysteroscopy, and hysterectomy), the incidences of fallopian tube and ovarian invasion were not significantly different (p = 0.506 and 0.066, respectively). The diagnostic methods for EC had no significant effect on OS (p = 0.577) or DFS (p = 0.294). In addition, type II RH and type III RH did not improve the prognosis of patients with FIGO stage II and III disease (log‐rank p = 0.914 and 0.810 for OS; log‐rank p = 0.707 and 0.771 for DFS, respectively). Conclusion Based on the current study evidence, the use of diagnostic hysteroscopy procedures is safe and does not increase the risk of fallopian tube and ovarian invasion of intraperitoneal dissemination or worsen the prognosis of EC patients. Type II and type III RH did not demonstrate a benefit for stage II‐III EC patients.

Objectives: To compare intrauterine adhesion (IUA) formation after hysteroscopic removal (HR) of retained products of conception (RPOC) with IUA formation after ultrasound-guided electric vacuum aspiration (EVA) and externally validate the outcomes of an RCT. Study design: This prospective cohort study was conducted from April 2015 until June 2022 in 2 Dutch teaching hospitals and one Belgian university hospital. Women opting for EVA underwent the procedure as soon as possible. In the HR group, the therapeutic hysteroscopy was performed at least eight weeks after the end of pregnancy. Postoperatively, an office second-look hysteroscopy was offered to all patients. Women were included if they had been diagnosed with RPOC ranging from 1 to 4 cm on ultrasound and did not want to participate in the RCT. EVA was performed using a Karman cannula. Operative hysteroscopy consisted either of hysteroscopic morcellation with the TruClear™ System or the Intrauterine BIGATTI Shaver or cold loop resection with a bipolar resectoscope. Results: Of 178 included women, 124 were treated with HR and 28 with EVA. Outcomes of HR and EVA did not differ significantly in terms of complications (5.6 % vs 3.6 %; p = 1.00). Second-look hysteroscopy showed IUAs in 14 of 91 women (15.4 %) after HR and in 1 of 16 (6.3 %) after EVA (p = .461). Completeness of removal was significantly higher (90.1 %) after HR than after EVA (68.8 %) (p = .035). Additional operative hysteroscopy was required in 14.3 % of the HR group versus 37.5 % in the EVA group (p = .036). Conclusion: In our cohort study, no significant differences in IUAs or complications were found. RPOC removal with HR was more often complete than removal with EVA, and additional therapeutic hysteroscopy was less frequently required after HR. These findings need to be correlated with those of RCTs. Clinical trial registration: The study was registered in de Dutch Trial Register (NTR4923). Date of registration 23-11-2014. Date of first enrollment 01-01-2015. https://trialsearch.who.int/Trial2.aspx?TrialID=NTR4923

Purpose: We aimed to evaluate whether hysteroscopy increases the risk of intraperitoneal dissemination or worsens the prognosis of endometrial carcinoma (EC) patients and whether radical hysterectomy (RH) improves overall survival (OS) or disease‐free survival (DFS) in patients with stage II to III EC and to investigate the effects of different procedures for identifying EC and the effects of different surgical methods on the OS and DFS of endometrial cancer patients. Methods: Four hundred sixty‐five women with EC were included in this retrospective study. Log‐rank tests and Kaplan–Meier analysis were used for the outcome comparisons of the effects of the EC diagnostic method and different hysterectomy procedures. A Cox proportional hazards model was used for univariate regression analysis. Results: Among the three procedures for diagnosing EC (diagnostic curettage, hysteroscopy, and hysterectomy), the incidences of fallopian tube and ovarian invasion were not significantly different (p = 0.506 and 0.066, respectively). The diagnostic methods for EC had no significant effect on OS (p = 0.577) or DFS (p = 0.294). In addition, type II RH and type III RH did not improve the prognosis of patients with FIGO stage II and III disease (log‐rank p = 0.914 and 0.810 for OS; log‐rank p = 0.707 and 0.771 for DFS, respectively). Conclusion: Based on the current study evidence, the use of diagnostic hysteroscopy procedures is safe and does not increase the risk of fallopian tube and ovarian invasion of intraperitoneal dissemination or worsen the prognosis of EC patients. Type II and type III RH did not demonstrate a benefit for stage II‐III EC patients. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the efficacy and safety of evening primrose oil (EPO) for cervical ripening before gynecologic procedures and compare it to misoprostol. In this study, 40 hysteroscopy and dilation and curettage candidates were enrolled. Patients were randomly assigned to receive either 2000 mg of vaginal EPO (n = 20) or 200 μg of vaginal misoprostol (n = 20) 2 hours before the expected procedure. The measured outcomes were the size of the Hegar dilator that passed through the cervix effortlessly, uterine cervicovaginal complications, and drug‐related side effects. The two groups were not significantly different in age, number of gravity, parity, type of delivery, and menopausal status (P >.05). The mean ± SD size of the first dilator was 5.25 ± 1.55 in the misoprostol group and 7.30 ± 1.08 in the EPO group (P <.001). The pain complaint in the EPO group was significantly lower (P =.027), but the two groups were not significantly different in terms of other complications. No cases of uterine or cervical rupture were seen in either group. The present study showed that 2000 mg of vaginal EPO was significantly more effective for cervical ripening than 200 μg of vaginal misoprostol before gynecological surgery. Therefore, it is recommended to use EPO as an alternative to misoprostol. [ABSTRACT FROM AUTHOR]

This report documents the case of a patient with a previously diagnosed partial molar pregnancy evacuated by dilation and suction curettage with appropriately declining post-operative levels of beta-human chorionic gonadotropin (beta-hCG), who, one month later, underwent uterine artery embolization in the setting of acute bleeding and imaging concerning for arteriovenous malformation. After embolization, beta-hCG levels increased, prompting concern for gestational trophoblastic neoplasia and referral to gynecologic oncology. With further workup, the elevation was found to be transient and benign – a phenomenon not previously described.

Latent female genital tuberculosis (FGTB) has been gaining attention in the world of assisted reproductive technology due to its adverse effect on the female reproductive system, which is becoming a cause of concern in the pathway of fulfilling the dream of children in infertile couples. It has been known to severely affect the ovarian reserve, which is one of the prime causes of infertility in females nowadays. Intraovarian plasma-rich platelet therapy (IOPRP) has been known to improve diminished ovarian reserve (DOR); however, its effect on DOR caused due to latent FGTB is not known. A 34-year-old middle-aged South Asian woman was unable to get pregnant due to being a victim of latent female genital tuberculosis. The patient also had a history of four failed IUI (intra-uterine insemination) cycles prior to their visit to Wardha Test Tube Baby Centre, Sawangi, Maharashtra, in January 2021. The patient had reported having improved ovarian reserve, thereby having positive clinical pregnancy upon the administration of IOPRP at our centre. This case report throws light on the aspect that the use of IOPRP on patient suffering from DOR caused due to latent FGTB may lead to significant positive pregnancy outcomes.

Objective: The aim of this study was to review the reproductive outcomes of women with a cesarean scar pregnancy (CSP) treated with dilation and curettage (D&C) after uterine artery embolization (UAE). Materials and methods: This was a retrospective study to review women who received UAE followed by D&C for CSP between January 2010 and December 2019 at the Changhua Christian Hospital, Changhua in Taiwan. Data were collected from both electronic and paper medical records. Patients were contact via phone call to follow up reproductive outcomes between January 2021 and March 2021. These subsequent reproductive outcomes (including pregnancy rate, secondary infertility rate, miscarriage rate, live birth rate, and recurrent CSP rate) were recorded and analyzed. Results: A total of 53 cases of women who received UAE followed by D&C for CSP were identified. The women's average age was 34.8 ± 5.1 years. The mean gestational age at diagnosis was 6.2 ± 1.1 weeks. The mean level for human chorionic gonadotropin was 23,407.7 ± 29,105.5 mIU/ml. The average of blood loss during D&C was 19.2 ± 43.6 ml. The average hospitalization time after D&C was 3.5 ± 1.1 days. Of the 53 cases, 10 patients were lost to follow-up and 43 patients agreed to follow-up on reproductive outcomes in 2021. Twenty-three patients who desired to conceive were analyzed. Nineteen out of these 23 women (82.6%) succeeded in conceiving again and gave birth to 15 healthy babies (78.9%). Only one woman (1/19, 5.3%) experienced recurrence of CSP. The average time interval between previous CSP treatment and subsequent conception was 10.4 ± 6.7 months. Conclusion: UAE combined with curettage treatment in CSP patients results in a positive rate of subsequent pregnancy outcomes. This minimally invasive procedure may be considered as one of the treatment options for CSP, as it enables preservation of fertility after treatment.

Cesarean scar pregnancy (CSP) is a long-term complication after cesarean section that can cause severe maternal morbidity and mortality. Although a variety of treatments have been described, there is no consensus as to the optimal management approach. Many grading systems for CSP have been proposed, among which the classification made by the consensus of Chinese experts in 2016 was shown to provide improved treatment guidance for clinical practice. The purpose of the present study was to analyze the success rate of different treatments for each type of CSP as classified according to the Chinese Expert's Consensus (2016), and to develop a management strategy for CSP. A retrospective study was performed among patients diagnosed with CSP at Shandong Provincial Hospital between January 2009 and December 2019. We reviewed clinical characteristics, treatment methods, and subsequent outcomes; and analyzed these endpoints using the statistical software package SPSS 22.0 (SPSS, Inc., Chicago, IL). For type I CSP, systemic methotrexate (MTX) administration exhibited a success rate of 79.2% for type Ia and 14.3% for type Ib. Local and systemic MTX administration success rates were 88.9% for type Ia and 66.7% for type Ib. Dilation and curettage (D&C), curettage after uterine artery embolization (UAE + C), and hysteroscopic curettage (H + C) were 100% successful. For type II, UAE + C, H + C, and laparoscopy combined with hysteroscopic curettage (L + H+C) were 100% successful. D&C had a success rate of 97.0% for type IIa and 88.9% for type IIb. The success rate of systemic MTX administration was 52.0% for type IIa and 62.5% for type IIb. Both UAE + C and L + H+C had 100% success rates for type IIIa CSPs, while for type IIIb, the success rate was 87.9% for UAE + C vs. 96.6% for L + H+C. For type I CSPs, D&C was quick, easy, and safe; for type II, H + C was more suitable. For type III and some type II patients who wished to undergo simultaneous repair of the cesarean defect, L + H+C was the optimal method. UAE can be used as a complementary option instead of a prophylactic measure, and when difficulties with endoscopic surgeries were encountered, conversion to laparotomy was the ultimate treatment. [ABSTRACT FROM AUTHOR]

Objectives: To explore the effect of cesarean scar pregnancy (CSP) treatment by comparing uterine artery chemotherapy embolization (UACE) combined with dilation and curettage (D&C) with or without ultrasound guidance. Methods: CSP patients treated with UACE combined with D&C from January 2013 to December 2020 at Shuguang Hospital, affiliated to Shanghai University of Traditional Chinese Medicine were included in this retrospective study. The patients were divided into groups A and B according to whether D&C was guided by ultrasound. Results: Forty‐eight patients with CSP diagnosed by transvaginal ultrasound were included in this study, whose gestational age was <8 weeks. There were no significant differences in the basic clinical characteristics of the two groups. The success rates of the 2 groups were no significant difference, 100% (27/27) in group A and 85.7% (18/21) in group B. The maximal intraoperative blood loss of group A was 100 mL and that of group B was 150 mL. There was no uterine perforation during the operation. Ultrasound guidance can shorten the D&C operation time, reduce intraoperative bleeding during D&C, and decrease the residual rate of trophoblastic tissue after D&C. Conclusions: Ultrasound guidance can improve the safety and efficiency of UACE combined with D&C in the treatment of CSP and reduce its complications. We believe it is an optimal treatment for CSP patients who do not plan to have children in the future. [ABSTRACT FROM AUTHOR]

Purpose: To assess the role of Uterine Artery Embolization (UAE) to treat cesarean scar pregnancy (CSP) using different embolic materials, focusing on its clinical and technical success rates; the association of UAE with methotrexate (MTX) and/or dilatation & curettage (D&C) was evaluated also. Materials and methods: A retrospective analysis 33 patients (mean age 35 years) affected by CSP and treated with UAE from March 2012 to 2020 was performed. Dynamic levels of serum β-HCG have been collected until they decreased to normal values after procedures. For the statistical analysis the sample was divided into 2 groups: UAE versus UAE + MTX. Results: The gestational sac age ranged between 5 and 13 weeks (mean 7 weeks). According to operator's preference, 11 patients (33.33%) were treated with sponge injection, 2 patients (6.06%) with a combination of sponge and microsphere the remaining 20 patients (60.60%) with microspheres alone. No major complications occurred after UAE and D&C, neither side effects related to the MTX administration. Technical and clinical success rates were 97% and 85%, respectively. Mean percentage of β-HCG reduction was 90% (range − 99.92 to + 7.98%). Statistical analysis with linear regression shows a R2 value of 0.9624 in UAE group while a R2 value of 0.9440 in UAE + MTX group with statistical significance (p < 0.0001). No significative differences were found between the two groups about clinical success rate and embolic material adopted. Conclusion: In this series UAE has been found to be safe and effective for the treatment of CSP. [ABSTRACT FROM AUTHOR]

Traditionally, curettage has been the most widely performed surgical intervention for removing retained products of conception. However, hysteroscopic removal is increasingly performed as an alternative because of the potentially lower risk of intrauterine adhesions and higher rates of complete removal. Until recently, studies comparing curettage with hysteroscopic removal regarding reproductive and obstetrical outcomes were limited, and data conflicting. This study aimed to assess reproductive and obstetrical outcomes in women wishing to conceive after removal of retained products of conception by hysteroscopy or ultrasound-guided electric vacuum aspiration. This was a prospective long-term follow-up study, conducted in 3 teaching hospitals and 1 university hospital. Patients were included from April 2015 until June 2022 for follow-up, either in a randomized controlled, nonblinded trial on the risk of intrauterine adhesions after removal of retained products of conception, or in a cohort alongside the randomized trial. Women with an ultrasonographic image suggestive of retained products of conception ranging from 1 to 4 cm were eligible. Surgical procedures in the randomized controlled trial were hysteroscopic morcellation or ultrasound-guided electric vacuum aspiration. In the cohort study, hysteroscopic treatment included hysteroscopic morcellation or cold loop resection compared with ultrasound-guided electric vacuum aspiration. A total of 261 out of 305 patients (85.6%) were available for follow-up after removal of retained products of conception, resulting in a cohort of 171 women after hysteroscopic removal and 90 women after removal by ultrasound-guided vacuum aspiration. Respectively, 92 of 171 women (53.8%) in the hysteroscopic removal group and 56 of 90 (62.2%) in the electric vacuum aspiration group wished to conceive (P =.192). Subsequent pregnancy rates were 88 of 91 (96.7%) after hysteroscopic removal and 52 of 56 (92.9%) after electric vacuum aspiration (P =.428). The live birth rates were 61 of 80 (76.3%) and 37 of 48 (77.1%) after hysteroscopic removal and electric vacuum aspiration, respectively (P =.914), with 8 of 88 pregnancies (9.1%) in the hysteroscopic removal group and 4 of 52 (7.7%) in the electric vacuum aspiration group still ongoing at follow-up (P= 1.00). The median time to conception was 8.2 weeks (interquartile range, 5.0–17.2) in the hysteroscopic removal group and 6.9 weeks (interquartile range, 5.0–12.1) in the electric vacuum aspiration group (P =.262). The overall placental complication rate was 13 of 80 (16.3%) in the hysteroscopic removal group and 11 of 48 (22.9%) in the electric vacuum aspiration group (P =.350). Hysteroscopic removal and ultrasound-guided electric vacuum aspiration of retained products of conception seem to have no significantly different effects on subsequent live birth rate, pregnancy rate, time to conception, or pregnancy complications. Reproductive and obstetrical outcomes after removal of retained products of conception are reassuring, albeit with a high risk of placental complications. [ABSTRACT FROM AUTHOR]

Abstract Background Cesarean scar pregnancy (CSP) remains a sporadic and special form of ectopic pregnancy in which the fertilized ovum is implanted on a previous cesarean scar within 12 weeks. This study aims to evaluate the optimal time interval between uterine artery embolization (UAE) and curettage modalities in order to provide the best clinical outcomes. Methods From January 2018 to December 2020, we recruited 61 patients with CSP. They were randomly divided into two groups depending on whether the time interval between UAE and dilatation and curettage (D&C) requires additional hospitalization: 31 patients received prophylactic UAE followed by D&C on the same day (0–12 h; group A) and 30 patients need hospitalization (12–72 h; group B). The clinical characteristics, diagnostic data, and outcomes of the two groups were compared and analyzed. Results A total of 59 (96.72%) cases had responded well to the first treatment. One patient in each arm undergone retreatment, but none of the 61 patients needed additional hysterectomy. There was no considerable relationship between the two groups with respect to the intraoperative hemorrhage during D&C, serum index (containing β-hCG, hemoglobin, CRP, and D-dimer) on the first day after D&C, side effects (containing fever and abdominal pain), renal, hepatic, and coagulation function, time of CSP residual mass disappearance, and hospitalization cost. The time of serum β-hCG resolution after surgery was 41.22 ± 14.97 days in group A and 66.67 ± 36.64 days in group B (P = 0.027), and group A treatment resulted in a shorten hospital stay as compared with group B (4.81 ± 2.74 days vs. 6.80 ± 2.14 days, P

Abstract Background Endometrial thickness (ET) has previously been shown to positively correlate with implantation and clinical pregnancy rates. Pregnancies achieved using in-vitro fertilization (IVF) technique are prone to higher rates of early miscarriage. The aim of this study was to compare the effects of expectant management, medical treatment (Misoprostol) and dilation and curettage (D&C) for early miscarriage following IVF cycles on the subsequent cycle outcomes - endometrial thickness and reproductive outcomes. Methods A retrospective cohort study of women who underwent embryo transfer, conceived and had first trimester miscarriage with at least one subsequent embryo transfer. ET measurements during fresh or frozen-thawed IVF cycles were assessed for each patient. Comparisons of ET differences between the miscarriage and the subsequent cycles, as well as reproductive outcomes, were performed according to the initial miscarriage management approach. Results A total of 223 women were included in the study. Seventy-eight women were managed conservatively, 61 were treated with Misoprostol and 84 women underwent D&C. Management by D&C, compared to conservative management and Misoprostol treatment was associated with higher prevalence of a significant (> 2 mm) ET decrease (29.8%% vs. 14.1and 6.6%, respectively; p

Objective To determine the risk factors for occult endometrial atypia and malignancy in patients diagnosed with non-atypical endometrial hyperplasia (NEH) on endometrial biopsy. Methods All new cases of NEH diagnosed between April 2015 and March 2016 at KK Women’s and Children’s Hospital, who underwent hysterectomy as first-line treatment, were included in the study. Patients with a history of endometrial hyperplasia or malignancy were excluded from the study. Patient demographics (e.g., age, parity, body mass index [BMI]), medical history, and clinical presentation were obtained for analysis. Results In total, 262 patients were diagnosed with NEH, of which 18.3% (n=48) underwent hysterectomy as first-line management. The average time to surgery was 77.0±35.7 days. All cases were diagnosed by dilation and curettage, and hysteroscopy. The mean age was 51 years, and the mean BMI was 26.9±5.8 kg/m2. Histology from the hysterectomy specimen showed 9 (18.8%) patients with atypical hyperplasia and 2 (4.2%) with grade 1, stage 1A endometrioid adenocarcinoma. Patients with higher grade final pathology had significantly lower median parity (1 vs. 2, P=0.039), higher mean BMI (30.1±6.5 vs. 25.9±5.3 kg/m2, P=0.033), and BMI ≥30 kg/m2 (54.5% vs. 13.5%, P=0.008, odds ratio 7.68), compared to patients whose final histology showed NEH or no residual hyperplasia. Conclusion Occult endometrial atypia and malignancy were found in 18.8% and 4.2% of patients with an initial diagnosis of NEH, respectively. High BMI and low parity were identified as significant risk factors for high-grade endometrial lesions in patients with NEH.

Objective: The aim of this systematic review and meta-analysis was to estimate the incidence and time to diagnosis of postmolar gestational trophoblastic neoplasia (GTN) following uterine evacuation and normalization of human chorionic gonadotropin (hCG). Materials and Methods: Databases, including PubMed Medline,® Ovid Medline,® Cumulative Index to Nursing and Allied Health Literature, and Embase, were searched from inception to July 23, 2019, for studies of patients with molar pregnancies who were surveilled until normalization of hCG with at least 6 months of intended follow-up data. Meta-analyses were performed on subgroups of hCG normalization before and after 56 days as well as partial versus complete molar pregnancies. Results: Of 816 studies screened, 25 cohort studies encompassing 40,513 cases of hCG normalization following molar pregnancy were identified. The overall incidence of postmolar gestational trophoblastic neoplasia (pGTN) after spontaneous normalization of hCG was 0%–1.5%. Sixty-one percent of pGTN cases following hCG normalization were diagnosed beyond 6 months from normalization. The risk of neoplasia in women who had normalization before 56 days was significantly lower than women who had normalization after 56 days with a pooled odds ratio of 0.28 (95% confidence interval: 0.12, 0.66; p < 0.001). Conclusions: pGTN has a low incidence after spontaneous normalization of hCG When this neoplasia does occur, it often presents well beyond the standard recommended surveillance timeperiods. (J GYNECOL SURG 38:86) [ABSTRACT FROM AUTHOR]

Background: The management of retained products of conception (RPOC) is not well standardised due to a lack of evidence‐based guidelines. Hysteroscopic resection has been proven to be safe and is hypothesised to have lower risk than dilation and curettage, but data comparing the two directly are limited. Aim: The aim of this study is to evaluate the outcomes for hysteroscopic resection for the management of RPOC in comparison to current standard management techniques. Methods: A literature search was conducted in September 2019 using MEDLINE, Scopus, The Cochrane Library and Web of Science. The key search terms were 'hysteroscopy'/'hysteroscopic resection' and 'retained products of conception'/'RPOC'. Both prospective and retrospective studies were included. A total of 19 studies were included (n = 2314). Due to a critical risk of bias in all studies with a comparison arm, a meta‐analysis was not performed. Meta‐analysis techniques were still used to provide summary estimates for primary and secondary outcomes, including conception rate, time to conception, live birth rate, intrauterine adhesions (IUAs), surgical complications and future pregnancy complications. Results: The overall conception rate for hysteroscopic resection was 81.1% (live birth rate 87.3%) compared to 65.4% for non‐hysteroscopic management (live birth rate 93.8%). After hysteroscopic resection the overall complication rate was 1.9% and the IUA rate was 6.8%. Conclusions: Due to the poor quality and overall scarcity of comparative data, the question whether hysteroscopic resection is superior to traditional curettage for the management of RPOC remains unanswered. This review provides summary data, which will enable the design of adequately powered future studies. [ABSTRACT FROM AUTHOR]

Abstract Background The World Health Organization does not recommend dilatation and sharp curettage (D&C) for the surgical treatment of miscarriage during the first trimester because this may cause Asherman’s syndrome due to endometrial damage; therefore, suction remains the primary treatment option. While manual vacuum aspiration (MVA) has been widely used since the 1990s outside Japan, the use of an MVA device (Women’s MVA system) was approved in Japan in October 2015. Here, we examined the efficacy of the MVA kit in women surgically treated for miscarriage. Methods This retrospective cohort study was conducted between 2014 and 2018 at the International University of Health and Welfare Hospital in Japan. Women who underwent surgical treatment for miscarriage within 12 weeks of pregnancy were identified and enrolled in the study. A total of 404 women were included who underwent the following procedures: 121 D&C, 123 electric vacuum aspiration (EVA), and 160 MVA. For each participant, the duration of surgery, amount of bleeding, amount of anesthetic used, incomplete abortion requiring repeat procedures, and intraoperative/postoperative complications were evaluated. Results The duration of surgery was 13.7 ± 7.2, 11.2 ± 4.2, and 6.9 ± 4.3 min in the D&C, EVA, and MVA groups, respectively (p = 1.00). The amount of anesthetic used was not significantly different among all groups. Bleeding of ≥ 100 mL was confirmed in three (2.4%), one (0.8%), and one (0.6%) patient(s) in the D&C, EVA, and MVA groups, respectively (p = 0.50). Incomplete abortion was identified in three (2.4%), two (1.6%), and one (0.6%) patient(s) in the D&C, EVA, and MVA groups, respectively (p = 0.61). However, severe intraoperative/postoperative complications were not observed in any group. Conclusions Surgical treatment for miscarriage performed using the MVA kit has safety and efficacy similar to those of conventional methods, such as D&C and EVA.

Aim:To assess the risk factors associated with high rate of insufficient endometrial sampling on endometrial biopsy in postmenopausal women.Methods:Data were retrieved from the records of 522 consecutive patients who underwent endometrial sampling. Logistic regression analyses were performed to determine various factors associated with scanty endometrial biopsy. The exclusion criteria included patient refusal, uncertain menopausal status, cervical carcinoma detected after sampling and unavailable records.Results:The sample was insufficient for a definitive diagnosis in 143 (25.9%) patients. Out of these, 53 cases were investigated with invasive procedures. Further histopathological examination revealed that five (9.4%) patients had uterine malignancy. Based on the multivariate analysis, time since the onset of menopause [Odds ratio (OR)=1.044, 95% confidence interval (CI)=1.000-1.090, p=0.049] was significantly associated with insufficient endometrial biopsy in cases with a endometrial thickness of >12 mm on ultrasonography (OR=0.624, 95% CI=0.472-0.824, p=0.001). The use of dilation and curettage technique (OR=0.662, 95% CI=0.522-0.841, p=0.001) decreased the risk of insufficient sampling on endometrial biopsy.Conclusion:Time since the onset of menopause and the thickness of endometrium were significant independent factors associated with insufficient sample. Using Karman cannula for endometrial aspiration may not be a reliable method in the evaluation of postmenopausal women. An insufficient endometrial sample does not rule out endometrial carcinoma, therefore, a further histopathological examination is recommended.

PurposeTo evaluate the clinical effects and outcomes of local intra-gestational sac methotrexate injection followed by dilation and curettage for treatment of cesarean scar pregnancies (CSP).MethodThis prospective non-randomized study was conducted on patients diagnosed with CSP between 2018 and 2020 at the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region. Patients were categorized into two groups according to the treatments, i.e., local intra-gestational sac methotrexate injection followed by dilation and curettage (group A), and uterine artery embolization in combination with dilation and curettage (group B). The choices of treatment reflect the patients' decision after they thoroughly understood the benefits and risks of the two therapies. Clinical data were then collected and compared between these two alternatives.ResultsSeventy-seven patients with CSP were enrolled in the study. Of this total, 41 vs. 36 were respectively categorized into group A and group B. Similar success rates were observed between these two groups (92.7 vs. 97.2%; RR = 27.362, 95% CI: 0.496–1.51E3, p = 0.106). However, the overall occurrence of complications in group A was significant lower when compared with group B (17.1 vs. 52.8%; RR = 0.236, 95% CI: 0.077–0.728, p = 0.012). Lower abdominal pain (unrelated to infection) and intrauterine adhesions were the two primary complications exhibited in group B of the present study, with rates of 38.9 and 22.2% respectively.ConclusionsLocal intra-gestational sac methotrexate injection followed by dilation and curettage is an effective and safe treatment for CSP that also drastically reduces the risks of complications. Further multiple center randomized trials with large series are warranted to confirm these findings.

Objective: To investigate the therapeutic efficacy and prognostic factors of combined administration of estriol valerate tablets and progesterone for the prevention of intrauterine adhesions (IUA) in patients with early missed abortion (EMA) after dilation and curettage., Methods: Clinical data of 120 EMA patients undergoing dilation and curettage at Ganzhou People's Hospital from July 2021 to June 2023 were collected for this retrospective study. The 120 enrolled patients were divided into two groups, with 70 patients in the study group receiving both estriol valerate tablets and progesterone for the prevention of IUA, and 50 in the control group undergoing no such treatments at all. The therapeutic efficacy of IUA prevention in patients was compared between the two groups. Subsequently, patients who developed IUA were categorized into the adhesion group (n = 23) and those who did not into the non-adhesion group (n = 97). The clinical data of patients were compared between the adhesion group and the non-adhesion group. Both univariate and multivariate logistic regression analyses were performed to identify the risk factors of IUA in patients with EMA after dilation and curettage. Receiver Operating Characteristic (ROC) curves were drawn to analyze the predictive value of independent risk factors for IUA in patients with EMA after dilation and curettage., Results: The study group showed a notably higher excellent and good response rate than the control group in IUA prevention (92.00% vs. 82.00%, P = 0.035). Logistic regression analysis revealed that a history of multiple previous miscarriages (P: 0.018; OR: 0.120; 95% CI: 0.02-2.119), relatively small endometrial volume (P: 0.001; OR: 0.026; 95% CI: 0.003-0.210), relatively thin endometrial thickness (P: 0.001; OR: 32.123; 95% CI: 4.339-237.807) and lack of preventive treatment (P: 0.051; OR: 0.211; 95% CI: 0.048-0.935) were independent risk factors for the occurrence of IUA in patients with EMA after dilation and curettage. ROC curve-based analysis showed that these risk factors; encompassing, the number of previous miscarriages, endometrial volume, endometrial thickness and preventive treatment, had a notably higher efficacy in jointly predicting the occurrence of IUA in EMA patients following dilation and curettage in comparison to an individual risk factor alone., Conclusion: The occurrence of IUA in patients with EMA following dilation and curettage is influenced by several factors, including the number of previous miscarriages, the volume and thickness of the endometrium, and preventive treatments. To minimize the risk of IUA, it is crucial to implement proactive interventions prior to uterine surgeries. It was found that a combination therapy involving estriol valerate tablets and progesterone could effectively prevent the development of IUA in patients with EMA after dilation and curettage., Competing Interests: None., (AJTR Copyright © 2024.)

We herein report a rare case of simultaneous intrauterine molar pregnancy and tubal pregnancy. A woman of childbearing age who had never been pregnant underwent an ultrasound examination 70 days after the onset of menopause. She had a history of ovulation induction. The ultrasound findings suggested a partial hydatidiform mole. She was then pathologically confirmed to have a complete hydatidiform mole after uterine suction dilation and curettage. On postoperative day 4, an ultrasound examination before discharge showed an inhomogeneous mass in the left adnexal region with mild lower abdominal pain. On postoperative day 17, the blood human chorionic gonadotropin level did not drop as expected, and a follow-up examination still indicated a mass in the left adnexal region. We were unable to rule out an ectopic hydatidiform mole. Hysteroscopy with laparoscopic exploration of the left adnexal mass and salpingotomy suggested a diagnosis of intrauterine hydatidiform mole combined with left tubal pregnancy., Competing Interests: Declaration of conflicting interestThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Subcapsular hematoma of the liver is a potentially fatal complication of pregnancy-related hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. In turn, HELLP syndrome is one of the most critical complications of preeclampsia. We present a case of a 31-year-old woman who developed a subcapsular liver hematoma in the postpartum period secondary to HELLP syndrome. The diagnosis was made based on the clinical features, radiological investigation, and laboratory values. She was managed with fluids, intravenous steroids, and rigorous monitoring in the intensive care unit before being moved to a tertiary care center with hepatic surgery and interventional radiology capabilities. [ABSTRACT FROM AUTHOR]

Background: Cesarean scar pregnancy (CSP) remains a sporadic and special form of ectopic pregnancy in which the fertilized ovum is implanted on a previous cesarean scar within 12 weeks. This study aims to evaluate the optimal time interval between uterine artery embolization (UAE) and curettage modalities in order to provide the best clinical outcomes.Methods: From January 2018 to December 2020, we recruited 61 patients with CSP. They were randomly divided into two groups depending on whether the time interval between UAE and dilatation and curettage (D&C) requires additional hospitalization: 31 patients received prophylactic UAE followed by D&C on the same day (0-12 h; group A) and 30 patients need hospitalization (12-72 h; group B). The clinical characteristics, diagnostic data, and outcomes of the two groups were compared and analyzed.Results: A total of 59 (96.72%) cases had responded well to the first treatment. One patient in each arm undergone retreatment, but none of the 61 patients needed additional hysterectomy. There was no considerable relationship between the two groups with respect to the intraoperative hemorrhage during D&C, serum index (containing β-hCG, hemoglobin, CRP, and D-dimer) on the first day after D&C, side effects (containing fever and abdominal pain), renal, hepatic, and coagulation function, time of CSP residual mass disappearance, and hospitalization cost. The time of serum β-hCG resolution after surgery was 41.22 ± 14.97 days in group A and 66.67 ± 36.64 days in group B (P = 0.027), and group A treatment resulted in a shorten hospital stay as compared with group B (4.81 ± 2.74 days vs. 6.80 ± 2.14 days, P <  0.001). However, the average hourly serum β-hCG decrease rate within 24 h and the leukocytes on the first day after D&C in group B were superior than in group A (P <  0.050).Conclusion: For patients with CSP, UAE followed by D&C on the same day (0-12 h) appears to have more advantages in hospitalization and recovery time, while the long time interval (12-72 h) may have a lower risk of inflammation and a more rapid decrease in serum β-hCG level within 24 h after D&C surgery. The treatment of CSP should be individualized based on the conditions of patients. [ABSTRACT FROM AUTHOR]

Study Objective: Operative hysteroscopy requires elevated intrauterine pressures, which could lead to the spread of malignant cells into the peritoneal cavity. Currently, there is a paucity of data analyzing clinical outcomes in endometrial cancer after hysteroscopic morcellation with newer equipment. In this study, we sought to determine whether there are increased rates of positive peritoneal cytology, lymphovascular space invasion, or surgical upstaging in patients undergoing hysteroscopic morcellation compared with alternative endometrial biopsy methods.Design: A retrospective chart review of patients from 2013-2018 was performed. The exclusion criteria included biopsy at outside institution, stage IV endometrial cancer known before biopsy, and missing data regarding biopsy method and histology. Peritoneal cytology results, lymphovascular space invasion, and surgical staging were compared by method of biopsy and histology using chi-square and Kruskal-Wallis tests.Setting: The patients included in this study were accrued from the Karmanos Cancer Insittute in Detroit, Michigan.Patients: A total of 289 patients met the inclusion criteria: 184 patients were classified as low-grade (Fédération Internationale de Gynécologie et d'Obstétrique grades 1 and 2) and 105 as high-grade (Fédération Internationale de Gynécologie et d'Obstétrique grade 3, serous, clear cell, and carcinosarcoma) endometrial cancer.Interventions: Fifty-three patients (18%) underwent hysteroscopy with morcellation. Alternative biopsy methods included hysteroscopy without morcellation, n = 81 (28%); endometrial biopsy, n = 112 (38.7%); and dilation and curettage, n = 43 (15%).Measurements and Main Results: Positive peritoneal cytology was noted in 34 cases (12%) and negative cytology in 165 (57%). Cytology was not performed in 90 cases (31%). When comparing outcomes by histologic subtypes, no difference was seen in peritoneal cytology (p = .704 and .727 for low grade and high grade, respectively), stage (p = .773 and .053 for low grade and high grade, respectively) or lymphovascular space invasion (p = .400 and .142 for low grade and high grade, respectively).Conclusion: Our study demonstrates that hysteroscopy with morcellation is a safe diagnostic method for low- and high-grade endometrial pathologic conditions and does not lead to increased dissemination of malignant cells, lymphovascular space invasion, or upstaging of patients. [ABSTRACT FROM AUTHOR]

Background: Endometrial thickness (ET) has previously been shown to positively correlate with implantation and clinical pregnancy rates. Pregnancies achieved using in-vitro fertilization (IVF) technique are prone to higher rates of early miscarriage. The aim of this study was to compare the effects of expectant management, medical treatment (Misoprostol) and dilation and curettage (D&C) for early miscarriage following IVF cycles on the subsequent cycle outcomes - endometrial thickness and reproductive outcomes. Methods: A retrospective cohort study of women who underwent embryo transfer, conceived and had first trimester miscarriage with at least one subsequent embryo transfer. ET measurements during fresh or frozen-thawed IVF cycles were assessed for each patient. Comparisons of ET differences between the miscarriage and the subsequent cycles, as well as reproductive outcomes, were performed according to the initial miscarriage management approach. Results: A total of 223 women were included in the study. Seventy-eight women were managed conservatively, 61 were treated with Misoprostol and 84 women underwent D&C. Management by D&C, compared to conservative management and Misoprostol treatment was associated with higher prevalence of a significant (> 2 mm) ET decrease (29.8%% vs. 14.1and 6.6%, respectively; p <.001) and was the only approach associated with a significant increase in the rates of ET under 7 and 8 mm in the following cycle (p = 0.006 and 0.035; respectively). Clinical pregnancy rates were significantly lower following D&C compared with conservative management and Misoprostol (16.7% vs. 38.5 and 27.9%, respectively; p = 0.008) as well as implantation rate (11.1% vs. 30.5.% and 17.7, respectively; p < 0.001). Conclusion: Our data suggest that D&C management of a miscarriage is associated with decreased ET and higher rates of thin endometrium in the subsequent IVF cycle, compared with conservative management and Misoprostol treatment. In addition, implantation and pregnancy rates were significantly lower after D&C. [ABSTRACT FROM AUTHOR]

Aim: To investigate the clinical characteristics and risk factors of uterine rupture without preceding Cesarean section. Methods: The medical records of all deliveries at the Women's Hospital, Zhejiang University School of Medicine between 1992 and 2017 were reviewed. All cases of uterine rupture without previous Cesarean delivery were included. Two types of uterine rupture, incomplete and complete, were distinguished. The clinical characteristics of each patient were collected and analyzed, including demographic information, clinical manifestation, operative records, site of rupture, pregnancy and labor complication, obstetrics risk factors, and birth outcome. Results: There were 222 418 deliveries in total during the study period. Nineteen cases of uterine rupture without previous Cesarean section were identified. As a result, the incomplete rupture group had significant advanced gestational age, decreased maternal gravidity, lower incidence of dilation and curettage, and lower perinatal mortality rate. In aspect of the rupture site, the involvement of the lower segment of the uterus was significantly more common in the incomplete rupture group. In the complete rupture group, the participants with a gestation age less than 28 weeks were more likely to have a history of dilation and curettage than those with a gestation age over 28 weeks. Conclusions: The history of dilation and curettage is the major risk factor of uterine rupture without Cesarean section. Our findings imply that obstetricians should be cautious of spontaneous uterine rupture in pregnant women who has a history of dilation and curettage. [ABSTRACT FROM AUTHOR]

Jian Qiu,1,2 Yunfeng Fu,1 Jiewei Xu,3 Xiaohong Huang,2 Guorong Yao,2 Weiguo Lu1 1Department of Gynecologic Oncology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, China; 2Department of Obstetrics and Gynaecology, Huzhou Central Hospital, Huzhou, Zhejiang 313000, China; 3Department of General Surgery, Huzhou Central Hospital, Huzhou, Zhejiang 313000, China Purpose: The purpose of this study was to investigate the efficiency, complications, and subsequent fertility outcomes of two methods in treating patients with cesarean scar pregnancy (CSP) after receiving uterine artery embolization (UAE) treatment.Patients and methods: A total of 62 CSP patients who visited our hospital and underwent UAE from January 2013 to January 2018 were retrospectively analyzed. Patients were either treated by dilation and curettage (D&C) guided by ultrasonography or hysteroscopy. The differences of related clinical indicators, clinical efficacy, complications, and subsequent fertility outcomes between the two groups were analyzed.Results: The rates of therapeutic success of the ultrasonography group and hysteroscopy group were 84.6% and 95.7%, respectively, the difference was not statistically significant (P=0.243). However, the intraoperative blood loss, duration of hospitalization, and overall complications were significantly lower in hysteroscopy group compared with D&C guided by ultrasonography group (P

Objective: To demonstrate the efficacy of management for cesarean scar ectopic pregnancies up to 8 weeks' gestation using ultrasound-guided Foley balloon catheter placement combined with dilation and curettage (D and C) at TuDu Hospital. Subjects and Methods: A quasi-experimental study was conducted from March 2015 to March 2016. Patients with imaging-confirmed cesarean ectopic pregnancies were admitted to an inpatient unit at Tu Du Hospital. A Foley balloon catheter was placed inside the uterus under ultrasound guidance and was left in place for 24 h. Afterward, the patient underwent ultrasound-guided D and C. Follow-up to confirm success included serial blood draws to measure beta-human chorionic gonadotropin (β-hCG) levels until a value of 0, and routine ultrasounds to confirm absence of a gestational sac and no evidence of vascularity at the site of the cesarean section scar. Results: A total of 311 patients were enrolled over 3 months. Overall, 90.7% (95% confidence interval [CI]: 86.8%–93.9%) patients were successfully treated with this regimen. Several factors that were significantly associated with successful management included gestational age

Objectives: To determine the feasibility and safety of resectoscopic treatment for uterine evacuation of first-trimester miscarriage., Methods: A single-centre prospective study performed between April 2021 and October 2021 at a university-affiliated tertiary medical centre. Patients diagnosed with early miscarriage of up to 12 weeks from the last menstrual period were eligible for participation. Recruited patients underwent hysteroscopic uterine evacuation under general anaesthesia by a Versapoint 2 bipolar resectoscope 24Fr (Johnson and Johnson, Germany)., Results: A total of 15 patients were recruited for the study. The procedural characteristics as well as intra- and postoperative adverse events were recorded. The mean duration of the procedure was 14.3 ± 3.7 minutes. The achievement of complete evacuation was recorded in all cases, and no adverse events occurred during any procedure. Post-procedure follow-up 6 weeks after treatment was conducted by office hysteroscopy in 10 women and by ultrasonography in 4 women. One woman had conceived prior to her scheduled follow-up visit. In total, 2 (13.3%) cases of retained products of conception were diagnosed during office hysteroscopy and they were removed by the "see-and-treat" technique without anaesthesia. The diagnosis was confirmed pathologically. No intrauterine adhesions were detected and none of the women required a second hysteroscopy under anaesthesia due to retained products of conception., Conclusions: Hysteroscopic evacuation of first-trimester miscarriage by a standard resectoscope is a safe and feasible technique., (Copyright © 2023 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.)

Introduction There is no clear guidance for the optimal setting for dilation and curettage (D&C) for the management of first-trimester pregnancy failure. Identifying patients at risk of clinically significant blood loss at the time of D&C may inform a provider's decision regarding the setting for the procedure. We aimed to identify risk factors predictive for blood loss of 200mL or greater at the time of D&C. Methods  This is a retrospective cohort study of patients diagnosed with first-trimester pregnancy failure at gestational age less than 11 weeks who underwent surgical management with D&C at a single safety net academic institution between 4/2016 and 4/2021. Patient characteristics and procedural outcomes were abstracted. Women with less than 200mL versus greater than or equal to 200mL blood loss were compared using descriptive statistics, chi-square for categorical variables, and Satterthwaite t-tests for continuous variables. Results A total of 350 patients were identified; 233 met inclusion criteria, and 228 had non-missing outcome data. Mean gestational age was 55 days (SD 9.4). Thirty-one percent (n=70) had estimated blood loss (EBL) ≥200mL. Younger patients (mean 28.7 years vs. 30.9, p=0.038), Latina patients (67.1% vs. 51.9%, p=0.006), patients with higher body mass index (BMI, mean 30.6 vs. 27.3 kg/m2, p=0.006), and patients with pregnancies at greater gestational age (59.5 days vs. 53.6 days, p<0.001) were more likely to have EBL ≥200mL. Additionally, patients with pregnancies dated by ultrasound (34.3% vs. 18.4%, p=0.007), those who underwent D&C in the operating room (81.4% vs. 48.7%, p<0.001), and those who underwent general anesthesia (81.4% vs. 44.3%, p<0.001) were more likely to have EBL ≥200mL. Discussion In this study, patients with EBL ≥200mL at the time of D&C differed significantly from those with EBL<200mL. This information can assist providers in planning the best setting for their patients' procedures., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Novatt et al.)

Heterotopic caesarean scar pregnancy (HCSP) is very rare, with only 24 cases reported in the literature. Optimal management is yet to be determined. We describe a 38-year-old woman, G2P1, who presented with vaginal bleeding and haemodynamic instability at 9 weeks of gestation in a HCSP. She was managed with ultrasound-guided lower-segment curettage and bilateral uterine artery ligation. The patient's pregnancy was complicated by preterm rupture of membranes and shortened cervix at 27 weeks of gestation. This necessitated preterm delivery, with subsequent neonatal death attributed to extreme prematurity. The patient later had a spontaneously conceived pregnancy, which was complicated by placenta percreta requiring elective caesarean hysterectomy at 34 weeks of gestation. This is, to our knowledge, the first case report describing preservation of the intrauterine pregnancy and future fertility in a patient with a HCSP and significant first-trimester bleeding. We suggest that ultrasound-guided lower-segment curettage may be a suitable management option for carefully selected patients with HCSP in a tertiary centre. All patients with HCSP require judicious counselling regarding the risk of morbidly adherent placenta and need for tertiary-level obstetric management in future pregnancies.

Purpose: Cytopathology detecting for endometrial cancer is becoming accepted, and Tao Brush is the most widely used sampler for endometrial cells. This study aims to compare the effectiveness between Li brushes and Tao brushes for the diagnosis of endometrial lesions and to evaluate the diagnostic accuracy of endometrial cytology compared with histology. Methods: There were 109 patients needing dilation and curettage (D&C) and 21 patients needing hysterectomies included from November 2017 to April 2018. Every patient was sampled by Tao brush and Li brush before D&C or hysterectomy performed. The cytological results were compared based on the gold standard histological results of D&C or hysterectomy. Results: The sensitivity of Li brush cytology for detecting endometrial cancer and atypical hyperplasia was estimated at 83.33%, specificity at 100%, positive predictive value (PPV) at 100%, and negative predictive value (NPV) at 98.02%, respectively. While for the Tao brush, it was 91.67% of sensitivity, 96.04% of specificity, 73.33% of PPV, and 98.98% of NPV, respectively. The kappa value was 0.767, which indicated a substantial agreement. Cytology by both two brushes had a lower insufficient sample rate (2.75% of Tao brush, 4.59% of Li brush) than did D&C (11.93%). Discussion: Endometrial cytology is a reliable approach for evaluating endometrium with a lower insufficient sample rate. Cytology sampled by both Li brushes and Tao brushes has a high accuracy with histological diagnosis in detecting endometrial cancer and atypical hyperplasia. Combining social and economic benefits, the Li brush may be a better endometrial cell collector. [ABSTRACT FROM AUTHOR]

Objective: To study whether intrauterine application of auto-crosslinked polymers of hyaluronic acid (ACP) gel after dilation and curettage (D&C) improves reproductive outcomes.Design: Follow-up of a prospective randomized trial.Setting: University and university-affiliated teaching hospitals.Patient(s): Women with a miscarriage at <14 weeks' gestation with at least one previous D&C were randomized to D&C plus ACP gel (intervention) or D&C alone (control). A hysteroscopy was performed after 8-12 weeks, and if intrauterine adhesion (IUAs) were encountered, adhesiolysis was executed.Intervention(s): Participants received a questionnaire 30 months after treatment.Main Outcome Measure(s): Ongoing pregnancy and outcome of subsequent pregnancies.Result(s): Ongoing pregnancies were recorded in 74.6% (50/67) of the intervention group versus 67.2% (43/64) of the control group, and in, respectively, 94.3% (50/53) versus 71.7% (43/60) in the women wishing to conceive. The median times to conception leading to a live birth were, respectively, 21.9 versus 36.1 months. Reduced menstrual blood loss was reported in 7.5% (5/67) versus 20.3% (13/64) and dysmenorrhea in 14.9% (10/67) versus 34.4% (22/64), respectively.Conclusion(s): Application of ACP gel following D&C performed after miscarriage seems to have a favorable effect on subsequent reproductive outcomes in women with at least one previous D&C. Given the fact that the study was not powered for reproductive outcomes, the data should be interpreted with caution. The effect may be underestimated due to routine removal of IUAs.Dutch Clinical Trial Registry Number: NTR 3120. [ABSTRACT FROM AUTHOR]

Purpose: To assess the safety and efficacy of local intra-gestational sac methotrexate injection followed by dilation and curettage (D&C) in treating cesarean scar pregnancies (CSP).Method: Medical records of CSP patients treated with local intra-gestational sac methotrexate injection followed by dilation and curettage were analyzed at the Maternal and Child Hospital of Guangxi Zhuang Autonomous Region, China.Results: Thirty-one patients were included in this study. The mean gestational age, sac diameter and thickness of the uterine scar were 49.6 ± 7.7 days, 1.8 ± 0.6 cm and 0.30 ± 0.15 cm, respectively. The median pretreatment serum β-human chorionic gonadotropin (β-HCG) level was 40,887 mIU/mL, with the 25th and 75th percentiles at 19,852 and 74,552, respectively. The median blood loss during D&C was 20 mL with the 25th and 75th percentiles at 10 mL and 50 mL. Following D&C, a Foley's balloon catheter compression was implanted in 26 (83.9%) patients due to active uterine bleeding. All patients had a β-HCG regression time of ≤ 4 weeks after D&C. While 30 patients (96.8%) had a uterine recovery time of ≤ 4 weeks, and 29 patients (93.5%) had resumption of menstruation of less than 6 weeks. Three patients (9.7%) had complications. One of them suffered from massive vaginal bleeding and underwent s blood transfusion. There were no other complications, such as pelvic infection and uterine rupture during the procedures. And no patient was converted to surgical resection or uterine artery embolization. Overall, 30 patients (96.8%) were treated successfully.Conclusion: Local intra-gestational sac methotrexate injection followed by D&C with the aid of a Foley's balloon catheter compression appears to be a safe and effective treatment for CSP. Further randomized controlled trials are suggested to confirm these findings. [ABSTRACT FROM AUTHOR]

A diagnostic biopsy for endometrial cancer is performed via dilation and curettage (D&C). However, D&C may miss endometrial cancer lesions due to of its 'blind' approach. Hysteroscopy is a useful method that can be used to detect endometrial cancer lesions. In addition, office hysteroscopy is easy to be scheduled and does not require anesthesia. The patient was a 40-year-old woman with suspected endometrial cancer; however, it could not be diagnosed by D&C and biopsy using hysteroscopy during hospitalization. Office hysteroscopy during the proliferative phase indicated that the suspicious endometrial cancerous lesion was minimal at the isthmus of the uterus with atypical vessels and a white spot, for which biopsy was performed. Pathological diagnosis was endometrioid carcinoma with squamous differentiation, G1. Therefore, total laparoscopic hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy were performed. In this case, it was difficult to detect minimal lesion in the secretory phase because the endometrial thickness hid the endometrial cancer. It is easy to perform office hysteroscopy in the proliferative phase. This case indicated that office hysteroscopy is a useful method to diagnose and perform biopsy for minimal lesions. [ABSTRACT FROM AUTHOR]

Aim: To assess the risk factors associated with high rate of insufficient endometrial sampling on endometrial biopsy in postmenopausal women. Methods: Data were retrieved from the records of 522 consecutive patients who underwent endometrial sampling. Logistic regression analyses were performed to determine various factors associated with scanty endometrial biopsy. The exclusion criteria included patient refusal, uncertain menopausal status, cervical carcinoma detected after sampling and unavailable records. Results: The sample was insufficient for a definitive diagnosis in 143 (25.9%) patients. Out of these, 53 cases were investigated with invasive procedures. Further histopathological examination revealed that five (9.4%) patients had uterine malignancy. Based on the multivariate analysis, time since the onset of menopause [Odds ratio (OR)=1.044, 95% confidence interval (CI)=1.000-1.090, p=0.049] was significantly associated with insufficient endometrial biopsy in cases with a endometrial thickness of >12 mm on ultrasonography (OR=0.624, 95% CI=0.472-0.824, p=0.001). The use of dilation and curettage technique (OR=0.662, 95% CI=0.522-0.841, p=0.001) decreased the risk of insufficient sampling on endometrial biopsy. Conclusion: Time since the onset of menopause and the thickness of endometrium were significant independent factors associated with insufficient sample. Using Karman cannula for endometrial aspiration may not be a reliable method in the evaluation of postmenopausal women. An insufficient endometrial sample does not rule out endometrial carcinoma, therefore, a further histopathological examination is recommended. [ABSTRACT FROM AUTHOR]

Background and Purpose: Knee joint biomechanics requires an understanding of lower extremity (LE) segmental interactions. In some cases, knee pain may arise as a result of altered LE biomechanics; while in other cases, knee pain may stem from other causes, such as a peripheral nerve injury. Case Description: A 33-year-old woman presented via direct access for physical therapist (PT) examination with a chief complaint of left knee pain. The day after undergoing a dilation and curettage (D&C) procedure the patient had an acute onset of gait dysfunction. Over the next few days, the patient developed left anterior knee pain (7/10 at worst) in addition to a significant change in physical functioning (Lower Extremity Functional Scale [LEFS] 38/80). Physical examination revealed left LE weakness, altered sensation, and an absent Achilles deep tendon reflex. Outcomes: The patient's presentation was consistent with a lumbosacral plexus stretch injury, with S1 being most affected. A physiatrist was consulted and recommended initiating PT treatment with bi-weekly re-examination. The 6-week (14 visits) re-examination revealed abolished left knee pain and improved physical functioning (LEFS 66/80). Conclusion: Stretch injuries are a known complication of lithotomy positioning. Knowledge of this and the addition of a thorough examination allowed the PT to identify the possible cause of the patient's abrupt onset of left LE dysfunction. Regardless of mode of patient access, screening for referral is crucial and may include referral or, as in this case, consultation with other professionals. [ABSTRACT FROM AUTHOR]