Imaging and diagnostic accuracy of outpatient and inpatient hysteroscopy

Aim. To compare the results of visualisation and diagnostic accuracy during outpatient and inpatient hysteroscopy in women with endometrial disease.Materials and Methods. We performed a retrospective analysis of patients with uterine diseases who underwent outpatient hysteroscopy at Kemerovo City Clinical Hospital №4 (n = 300) or inpatient hysteroscopy within the hospitals (n = 300) in Kemerovo from 2018 to 2020. Confirmation of endometrial disease was carried out by manual vacuum aspiration.Results. Indications, imaging, and diagnostic accuracy did not differ for most endometrial diseases in outpatient and inpatient hysteroscopy, yet inpatient hysteroscopy was the option of choice in women with infertility (p = 0.035). Diagnostic accuracy of outpatient and inpatient hysteroscopy was highly concordant, albeit outpatient hysteroscopy more often revealed adenomyosis and uterine malformation and less often identified endometrial polyps.Conclusion. Outpatient and inpatient hysteroscopy are equally efficient, although outpatient hysteroscopy has its benefits in detecting adenomyosis and uterine malformation and be less informative in diagnosing endometrial polyps.

Heterotropic pregnancy: a common masquerade than ever thought?

Heterotopic pregnancy, coexistence of living or dead intrauterine pregnancy, single or multiple, with extra-uterine pregnancy located in the oviduct, ovary, uterine cornua, cervix or rarely peritoneal cavity. Heterotropic pregnancy is relatively uncommon in spontaneous conception with 1 in 30,000 cases reported, the incidence of heterotopic pregnancy increases to 1 in 3900 when conception is enhanced with various assisted reproduction techniques (ART). It is an ectopic pregnancy coexisting with intrauterine pregnancy. But is the incidence of heterotropic pregnancy rising? A case was reported from our centre in 2018 by Ejikeme et al, and we have recorded another two cases in the period of one year. Ectopic pregnancy has been described as a great masquerader, which makes diagnosis and management of heterotropic pregnancy a dilemma to attending physician. We present a case of an unbooked 26 years old G4P3+0 who has no family history of multiple gestation and presented at gestational age of 8 weeks and 5 days with 2 days history of abdominal pain and vaginal bleeding and 2 hours history of loss of consciousness. She later had exploratory laparotomy with left salpingectomy and manual vacuum aspiration of Retained Products of Conception with good outcome. In conclusion, spontaneous heterotropic pregnancy is a rare occurrence, however with advent of artificial reproductive technology and increase incidence of pelvic inflammatory disease, the incidence could be higher than earlier suspected.

Endovascular Treatment of Right Heart Masses Utilizing the AngioVac System: A 6-Year Single-Center Observational Study

Objective. To describe our institution’s experience with the AngioVac system. Background. Intracardiac and intravascular masses previously required surgical excision, but now, there are a number of minimally invasive options. With the advent of vacuum aspiration, more specifically the AngioVac System (AngioDynamics, NY, USA), there exists a system with both low mortality and minor complications. However, the number of retrospective studies remains limited. Outcome data for high-risk patients are also limited. Methods. Data were collected and analyzed in patients who underwent AngioVac therapy at our tertiary care center from January 2014 to December 2020. Results. Our results demonstrated a 93.3% intraoperative success rate and a 100% intraoperative survival rate. However, a number of complications, including but not limited to hematomas, anemia, and hypotension, occurred, as described below. Conclusions. Our experiences demonstrated good outcomes and continue to support the usefulness of the AngioVac System. The data also support the use of AngioVac as a treatment option for the debulking or removal of right heart masses in critically ill patients.

Promoting evidence-based clinical practice for women in abortion situations after the implementation of a surveillance network: a situational analysis in a Brazilian university hospital

Background Manual vacuum aspiration (MVA) and medical abortion (MA) can be used to treat women with abortion complications and the choice of the evacuation method is essential for the safe management of abortion. Objective to evaluate the frequency of use of MVA and MA and investigate the associated factors after the installation of a surveillance network of good practices (MUSA Network) in a university hospital in Brazil. Methods A cross-sectional study of women admitted for abortion at UNICAMP Women’s Hospital, Brazil, between July 2017 and November 2020. The dependent variables were the rates of MVA and MA. The independent variables were clinical and sociodemographic data. The Cochran-Armitage test, chi-square test, Mann–Whitney test and multiple logistic regression were used for statistical analysis. Results 474 women were included. Most women (91.35%) had undergone uterine evacuation: uterine curettage (78.75%), MVA (9.46%) and MA (11.54%). We observed a significant tendency toward an increase in the use of MVA (Z = 9.85; P <0.001). Factors independently associated with performance of MVA were admission in 2020 (OR 64.22; 95% CI 3.79–1086.69) and lower gestational age (OR 0.837; 95% CI 0.724–0.967). The only factor independently associated with MA was a higher level of education (OR 2.66; 95% CI 1.30-5.46). Conclusion the use of MVA increased after the installation of a surveillance network for good clinical practices. Being part of networks that encourage the use of evidence-based practices is an opportunity for health facilities to increase access to safe abortions.

Manual Vacuum Aspiration and Dilatation & Curettage in First Trimester Miscarriages; Comparison of Efficacy

Objective: To compare the efficacy of manual vacuum aspiration with dilatation and curettage in first trimester miscarriages. Study Design: Randomized control trial. Place and Duration of Study: Department of Obstetrics and Gynecology Unit “A”, Lady Reading Hospital, Peshawar. Patients were received through OPD and Emergency during the six months i.e from 1st Jan, 2015 till 30th June, 2015. Methodology: Women admitted in the department of Obstetrics and Gynecology Unit “A”, Lady Reading Hospital, Peshawar, who meet the inclusion and exclusion criteria, were included in the study by consecutive non probability sampling with random allocation by dividing them into two groups through lottery method. Patients in group A were treated by dilatation and curettage while the patients in group B were evacuated by manual vacuum aspiration. After the randomly allocated method of evacuation, the efficacy of the procedure was determined in terms of need for the evacuation by presence of retained products of conception on ultrasound done by specialist. Results: No substantial difference was found between patients subjected to D&C and to those subjected to MVA. Conclusion: MVA is as effective as D&C for the treatment of miscarriage. Keywords: Miscarriage, Abortion, Dilatation & Curettage, Manual Vacuum Aspiration, Retained products of conception.

Lesions of the breast with uncertain malignant potential

The article deals with a peculiar group of breast diseases, which belongs to the B3 category according to the BI-RADS classification, the so-called lesions with undefined malignant potential. The basic information concerning their biological behavior and modern tactical approaches to the management of patients with similar changes in the mammary gland are presented. The possibility of conservative management, as well as the minimization of surgical aid, in cases of indications for it, up to vacuum aspiration biopsy is being considered. In addition, the significance of these diseases for the subsequent development of pre-invasive and infiltrative cancer is discussed.

Manual Vacuum Aspiration (M.V.A) Versus Conventional Evacuation and Curettage in Early Pregnancy Loss

Objective: The aim of this study is to compare the efficacy of manual vacuum aspiration and conventional evacuation and curettage in early pregnancy loss Study Design: Randomized control trial Place and Duration: Study was conducted at department of obstetrics and gynecology Lady Reading Hospital Peshawar from 1st January 2019 to 31st August 2020. Methods Patients were early pregnancy loss (12 weeks or lesser gestational age) were enrolled. Patients were divided into two groups by lottery method. Group A were the patients who had conventional evacuation and curettage treatment. Group B were patient in which MVA was used. Patients’ demographics were recorded after taking written consent. Gestational age was calculated from first day of last menstrual cycle and by ultrasound. Cervical ripening was done by (misoprostol 400mcg) two hours before procedure. Procedure was carried out under aseptic measures. Complete uterine evacuation by either procedure was assessed by ultrasound after procedure and complications were noted. Data was analyzed by SPSS 24.0. Results: mean age in Group A was 29 years with SD ± 8.65 while mean age in Group B mean age was 30 years with SD ±7.62. Group B (Manual Vacuum Aspiration) was effective in 96% patients while Group A(Conventional Evacuation and Curettage) was effective in 89% patients. Complications were fewer in MVA as compared to conventional evacuation and curettage Keywords: MVA, Evacuation and curettage , Early pregnancy loss.

A comparative study between manual vacuum aspiration and electronic suction for surgical treatment of abortion

Background: Present study is done to study the safety, efficacy and complications of using manual vacuum aspiration (MVA) for surgical management of first trimester abortion in comparison to electronic suction.Methods: It is a retrospective observational study conducted in department of obstetrics and gynecology at tertiary care hospital. Out of 100 cases taken, 50 abortions were terminated by MVA and 50 were terminated by electric suction/vacuum aspiration (EVA).Results: In this study, majority of the patients were primigravida (60%). Most of the patients had period of gestation between 7 to 9 weeks (40%) followed by up to 6 weeks (33%) in both groups. Time taken for the procedure was less in MVA (5-9 min.) than electronic suction (7-11 min.). In terms of complications, blood loss ≥100 ml was more with EVA (18%) compared to MVA (6%). Uterine perforation was seen with EVA (4%) and none with MVA. As far as success rate is concerned, EVA got 98% while MVA got 90%. Post-operative hospital stay was less with MVA (≤12 hours) than EVA (up to 24 hours). Post-operative pain perception was less with MVA (18% severe pain) while with EVA, 36% with severe pain.Conclusions: Both the evacuation techniques are almost equally effective and safe, still duration; post-operative pain and hospital stay are less with MVA. Success rate is better with EVA.