Early surgical abortion: safe and effective

Does ultrasound guidance during dilation and curettage for first trimester missed abortion reduce complication rates?

BACKGROUND

Dilation and curettage (D&C) may be performed with or without transabdominal ultrasound guidance. The aim of this study was to evaluate the association between the use of ultrasound guidance during D&C for first trimester missed abortion (MA) and D&C related complication rates.

METHODS

A retrospective cohort study included women in the age of 20-45 years, who underwent D&C for first-trimester MA in a hospital-based setting between 2013-2019. The study population was divided into two groups: the study group which included women who underwent D&C with ultrasound guidance (US group) and the control group, which included women who underwent D&C without ultrasound guidance (N-US group). Gynecologic, obstetric, and operative related data were collected from electronic medical records.

RESULTS

Three-hundred and seventy-eight women were included in the study, 86 women in the US group and 292 women in N-US group. Baseline maternal characteristics and procedure-related characteristics did not differ between the groups. No significant difference between the US group and N-US group was shown when comparing D&C related complications, including retained products of conception rate (2.3% vs. 5.5%, respectively; P=0.385), uterine perforation rate (1.2% vs. 0.3%, respectively; P=0.404), and the total complication rate (8.1% vs. 12.3%, respectively; P=0.338). In a multivariate analysis, the use of ultrasound guidance during D&C was not found to be associated with lower complication rate (adjusted odds ratio [aOR] 95% confidence interval [CI] 1.468 [0.578-3.729], P=0.419).

CONCLUSIONS

Performance of D&C under ultrasound guidance for first-trimester MA, in a hospital-based setting, was not associated with lower complication rate, suggesting that the common practice of performing D&C without the use of ultrasound is an acceptable approach.

No. 360-Induced Abortion: Surgical Abortion and Second Trimester Medical Methods

OBJECTIVE

This guideline reviews evidence relating to the provision of surgical induced abortion (IA) and second trimester medical abortion, including pre- and post-procedural care.

INTENDED USERS

Gynaecologists, family physicians, nurses, midwives, residents, and other health care providers who currently or intend to provide and/or teach IAs.

TARGET POPULATION

Women with an unintended or abnormal first or second trimester pregnancy.

EVIDENCE

PubMed, Medline, and the Cochrane Database were searched using the key words: first-trimester surgical abortion, second-trimester surgical abortion, second-trimester medical abortion, dilation and evacuation, induction abortion, feticide, cervical preparation, cervical dilation, abortion complications. Results were restricted to English or French systematic reviews, randomized controlled trials, clinical trials, and observational studies published from 1979 to July 2017. National and international clinical practice guidelines were consulted for review. Grey literature was not searched.

VALUES

The quality of evidence in this document was rated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology framework. The summary of findings is available upon request.

BENEFITS, HARMS, AND/OR COSTS

IA is safe and effective. The benefits of IA outweigh the potential harms or costs. No new direct harms or costs identified with these guidelines.

Counselling before first trimester abortion and acceptability of the procedure: results from a Slovenian cross-sectional study

Objectives: In Slovenia, first-trimester abortion is performed at the woman's request, either surgically under general anaesthesia or medically with mifepristone and misoprostol, in a public hospital. Our study aimed to evaluate pre-abortion counselling and to reveal differences in acceptability and satisfaction with the two abortion methods.Methods: A cross-sectional study was carried out at Ljubljana University Medical Centre between January and June 2015. Women requesting termination of a pregnancy up to 10 weeks' gestation voluntarily completed an anonymous questionnaire after the procedure and were divided into a surgical and a medical abortion group.Results: Of the 266 women who were invited to take part, 229 accepted; 16.6% chose a surgical abortion, 83.4% a medical abortion. The most frequent reason cited for requesting an abortion was economic/housing problems. Most women who chose a surgical abortion did so because it was faster, whereas most women who chose a medical abortion did so on the advice of a primary care gynaecologist. Women choosing a surgical abortion had more previous pregnancies and presented with a higher gestational age pregnancy. The choice of method was not related to the woman's age. There were no differences in acceptability of the two procedures. Pain during the procedure was, however, more severe in the medical abortion group (p = .026), along with bleeding, nausea and chills; there were no differences in severity of vomiting, diarrhoea, dizziness or headache between the groups. Women in the surgical abortion group reported higher satisfaction with the method (p < .001). The study revealed a low frequency of pre-abortion contraceptive counselling.Conclusion: The most common reason given for choosing a surgical abortion was the speed of the procedure; for a medical abortion, it was on the advice of a primary care gynaecologist. Satisfaction was higher with the surgical abortion method. There were no differences in general acceptability of the methods.

Early Detection of Structural Anomalies in a Primary Care Setting in the Netherlands

OBJECTIVE

This study assessed the percentage and type of congenital anomalies diagnosed at first-trimester ultrasound (US) scan in a primary care setting without following a standardized protocol for fetal anatomical assessment.

MATERIALS AND METHODS

US scans performed between 11+0 and 13+6 weeks of gestation in pregnancies with estimated date of delivery between January 1, 2012 and January 1, 2016 were searched. Data were supplemented with results of 20-week scans and pregnancy outcome.

RESULTS

Of all scans, 38.6% were dating scans and 61.4% were part of first-trimester screening. Anomalies were diagnosed prenatally in 200 (1.8%) fetuses; 81 (0.7%) were chromosomal and 119 (1.1%) were structural. Of all prenatally detected anomalies, 27% (n = 32) were detected at first-trimester scan, with a false-positive rate of 0.04%. All cases of anencephaly (n = 4), encephalocele (n = 2), exomphalos (n = 9), megacystis (n = 4), and limb reduction (n = 1) were diagnosed. First-trimester detection of gastroschisis and congenital heart defects was 67 and 19%, respectively.

CONCLUSION

In a primary care setting, global fetal anatomical assessment at first-trimester scan without following a standardized protocol detects about 30% of all structural anomalies and most of the severe anomalies, with an extremely low false-positive rate. We hypothesize that additional training and use of a systematic protocol would improve early detection of structural anomalies.