A Comparative Study on the Effects of Ketofol, Dexmedetomidine, and Isofol in Anesthesia of Candidates for Dilatation and Curettage

Background: Dilatation and curettage (D & C) is one of the relatively common surgeries among women. Familiarity with the analgesics, along with their different uses and specific characteristics, can help to determine the best and most appropriate drug to control pain in the patients. Objectives: This study aimed to compare the effects of ketofol, dexmedetomidine, and isofol in anesthesia of candidates for D & C. Methods: In this double-blind clinical trial, 150 candidates for D & C surgeries with ASA class 1 and 2 were included. Patients were randomly divided into three groups. The first group received ketamine + propofol, the second group received dexmedetomidine, and the third group received isofol (isoflurane + propofol). Any hemodynamic changes or respiratory disorders, including apnea or hypoventilation, drop in the level of blood oxygen saturation, and the need for respiratory support, were recorded and compared. Results: Hypoventilation was observed in 47 patients in isofol group, 18 in the dexmedetomidine group, and 42 in ketofol group. Also, 48 patients in the isofol group, eight in the dexmedetomidine group, and 33 in the ketofol group experienced apnea. Moreover, 17 patients in the dexmedetomidine group, 35 in the ketofol group, and eight in the isofol group experienced bradycardia. The rate of bradycardia was significantly higher in the dexmedetomidine group (70%) compared to the other two groups, and the rate of hypotension was significantly higher in the isofol group (P = 0.001). Conclusions: According to the results, dexmedetomidine was associated with fewer complications during general anesthesia in D & C surgery.

Transvaginal ultrasonography versus hysteroscopy in endometrial pathology diagnosis among women with abnormal uterine bleeding

Objective: Abnormal uterine bleeding is any deviation from a normal menstrual pattern. Transvaginal ultrasonography is useful in determining endometrial thickness but cannot conclusively exclude sessile and pedunculated lesions. Hysteroscopy is an invasive procedure that detects discrete lesions. This study was aimed to evaluate the diagnostic accuracy of 2-dimensional transvaginal ultrasonography and hysteroscopy in evaluating endometrial lesions in women with abnormal uterine bleeding, by determining the sensitivity and specificity of the two methods in diagnosing the lesions. Methods: Eighty-four cases of abnormal uterine bleeding were chosen based on inclusion criteria. The patients were subjected to routine investigations. The findings of transvaginal ultrasonography, hysteroscopy, and dilatation and curettage were compared and analyzed. Results: Maximum incidence of abnormal uterine bleeding was observed in women between 41 and 50 years of age (73.8%). The most common presenting complaint was menorrhagia (76.1%). 76% of patients experienced symptoms for less than six months. The sensitivity and specificity of transvaginal ultrasonography were 60% and 96.3%, respectively. The sensitivity and specificity of hysteroscopy were 80.4% and 93.1%, respectively. The accuracy of transvaginal ultrasonography was 60.3%, and that of hysteroscopy was 83.3%. Conclusion: Transvaginal ultrasonography and hysteroscopy can be used as first-line diagnostic modalities to rule out and find the causes of abnormal uterine bleeding, which can aid in instituting prompt and appropriate medical treatment.

Clinical Usefulness of Endometrial Cytology in Determining the Therapeutic Effect of Fertility Preserving Therapy

<b><i>Introduction:</i></b> The significance of endometrial cytology in determining the therapeutic efficacy of medroxyprogesterone acetate (MPA) therapy is unclear. This study aimed to evaluate the clinical usefulness of endometrial cytology during MPA therapy. <b><i>Methods:</i></b> Overall, 77 patients who underwent dilatation and curettage (D&amp;C) to evaluate the therapeutic efficacy of MPA therapy at our hospital between January 2018 and December 2019 were retrospectively analyzed. The results of D&amp;C, cytological evaluation, and other clinicopathological factors were analyzed based on the patients’ medical records. <b><i>Results:</i></b> The sensitivity and specificity of cytology were 61% and 92%, respectively, with D&amp;C being the gold standard for diagnosis in 142 D&amp;C/cytological examinations. Among patients with no residual disease on D&amp;C, 5 (4%) had suspicious or positive cytology. Although MPA therapy was terminated in 3 of these patients, only 1 patient had early recurrence, and the frequency of recurrence was similar to that of patients who showed negative results in both D&amp;C and cytology. <b><i>Discussion/Conclusion:</i></b> The sensitivity of endometrial cytology in determining the therapeutic effect of MPA therapy is low, and we confirmed that the omission of D&amp;C is unacceptable. Our findings also suggested that the addition of cytological evaluation to D&amp;C during MPA therapy had a low clinical significance.

Diagnostic approach to Perimenopausal bleeding by Pipelle or Dilatation and Curettage

Perimenopausal bleeding, is a very common problem, which is an alarming symptom for both; women and their doctors because of the rising fears of cellular changes or tumor of endometrium. In our study we tried to prove that collecting endometrial samples using the outpatient method of Pipelle is as effective as collecting the endometrial samples in the traditional method of Dilation and Curettage (DandC) in operation theatre which necessitates general anesthesia. Ninety four patients more than 40 years old were included in the study, all of them were complaining of abnormal uterine bleeding (pregnant ladies and ladies using hormonal contraception were excluded from the study) and endometrial samples were collected first in outpatient clinic using the Pipelle and labelled as A samples and secondly in the theatre under general anesthesia by dilatation and curettage and labelled as B samples, all samples were sent for histopathology without informing the pathologist about the method of sample collection and patients past medical history. Then, the reports of histopathological examination were compared between Pipelle and DandC samples (group A and group B). From the results we can conclude that samples of endometrium using Pipelle could replace the traditional method of DandC, with high specificity and sensitivity in detecting endometrial carcinoma and endometrial hyperplasia.

Is there any role of antibiotic as a post procedure prophylaxis in dilatation and curettage? A comparative single centre study at tertiary care centre

Background: Dilatation and curettage (D and C) is one of commonest procedure in the gynaecology. There are still two schools of thoughts pertaining to whether to administer antibiotic as a pre and post procedure prophylaxis or not to administer and hence study planned to evaluate the incidence of infection in patients after dilation and curettage with and without prophylactic antibiotics.Methods: Adults (>18 years) (n=100) who underwent dilatation and curettage procedure for any indication were included and patients with prior history of infection were excluded from the study. Patients were divided into 2 groups; group 1 (n=50) received prophylactic antibiotics and group 2 (n=50) received no prophylactic antibiotics as per the discretion of treating doctor.Results: Infection in both the groups was 2% and there is no statistically significant difference between the groups (p>0.349).Conclusions: Appropriate use of antibiotics can be a cost-effective strategy which can minimize the chances of development of antibiotic resistance and other side effects. Antibiotic are not necessary for pre and post procedure prophylaxis in D and C.

Comparative Evaluation of Hemodynamic Stability and Recovery during Conscious Sedation by Dexmedetomidine-Fentanyl Versus Ketamine- Fentanyl in procedures outside the operating room

Background Conscious sedation is a technique of providing analgesia, sedation and anxiolysis while ensuring rapid recovery without side effects. Conscious sedation is administered with the dual goals of rapidly and safely establishing satisfactory procedural condition for the performance of therapeutic or diagnostic procedures while ensuring rapid, Email: predictable recovery with minimal post-operative sequels. Aim of the Work to study the effect of dexemdetomidine with fentanyl versus ketamine with fentanyl on hemodynamic stability and recovery during conscious sedation in dilatation and curettage procedure. Patients and Methods In our study, 50 patients were randomly divided into 2 equal groups. group DF received dexmedtomidine loading dose 1 μg/kg over 10 min and followed by 0.5 μg/kg/hr infusion till completion of surgery. And group KF received ketamine 0.5 mg/kg slow intravenous Bolus. Results Our study showed that dexmedetomidine is a safe drug with good hemodynamic and recovery time, also exerts sedative and analgesic effects without respiratory depression, unlike most analgesic/sedative drugs, such as ketamine, opioids, benzodiazepines, and propofol. Conclusion dexmedetomidine in combination with fentanyl is useful to provide conscious sedation for non operating room procedures in adults and it may be a valuable alternative to ketamine.

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.

High-Intensity Focused Ultrasound or Uterine Artery Embolization Combined With Ultrasound-Guided Dilatation and Curettage in Cesarean Scar Pregnancy: A Retrospective Cohort Study

BackgroundCesarean scar pregnancy (CSP) is a rare and new form of ectopic pregnancy. With increasing rate of cesarean delivery worldwide during the decades, the incidence of CSP increases as well. It may cause massive hemorrhage, uterine rupture, placenta percreta, hysterectomy or even maternal death. This study is to compare the efficacy of high-intensity focused ultrasound (HIFU) and uterine artery embolization (UAE) associated with ultrasound-guided dilatation and curettage (UGDC) in three types of CSP. Methods403 CSP patients were treated with UGDC after pretreatment. Among them, 288 patients chose HIFU before UGDC, while the others (n=115) chose UAE. The body mass index (BMI), gravidity, parity, the number of cesarean delivery, the interval of previous cesarean delivery (PCD), the length, thickness and width of uterus and gestational sac, fetal cardiac activity, the types of CSP, the baseline of beta-human chorionic gonadotropin (β-HCG), the value of β-HCG before and 24 hours after pretreatment, hospital expenditure, the value of hemoglobin before and 24 hours after dilatation and curettage (D&C) and severe complications were collected and compared between the two groups. ResultsAll patients were successfully treated without severe complications. There was no significant difference in maternal age, BMI, gravidity, parity, the number of cesarean delivery, the interval of PCD, the volume of uterus and gestational sac, fetal heart activity, types of CSP and baseline serum β-HCG level between the two groups. The median hospital expenditure and blood loss were less in HIFU group and the median decline rate of β-HCG was higher in HIFU group (p=0.000, p=0.000, p=0.006, respectively). 39 (13.54%) patients in HIFU group, while 21 (18.26%) cases in UAE group used Foley balloon to control the vaginal bleeding.ConclusionBoth HIFU and UAE combined with UGDC have high successful rate in the treatment of CSP. While, HIFU followed by UGDC might be better for less hospital expenditure, blood loss and higher decline rate of β-HCG.