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NSIDRC Journal Article Alert — May 29, 2009
Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University.
Past issues of Resource Center journal alerts are
available at http://www.sidscenter.org.
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Miscarriage/Stillbirth/Prenatal Issues
1. Milingos DS, Mathur M, Smith NC, Ashok PW
Manual vacuum aspiration: a safe alternative for the surgical management of early pregnancy loss
BJOG. 2009 May 12. [Epub ahead of print]
Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Foresterhill, Aberdeen, UK.
Manual vacuum aspiration (MVA) is an alternative to the standard surgical curettage, performed under local anaesthetic in the setting of a treatment room. The aim of our study was to assess the efficacy of MVA in the management of first trimester early fetal demise and first- and mid-trimester incomplete miscarriage. This was a retrospective study of 246 patients who were scheduled to undergo MVA for first trimester early fetal demise and first- and mid-trimester incomplete miscarriage. One woman was excluded in the analysis because of the procedure being abandoned prior to MVA. Efficacy of the procedure was 94.7% (232/245). Incomplete uterine evacuation was seen in 5.3% (13/245) patients. Although not widely used in the UK, MVA could be considered routinely, thus avoiding general anaesthesia and the need for access to theatre.
2. Burbank F
History of uterine artery occlusion and subsequent pregnancy
AJR Am J Roentgenol. 2009 Jun;192(6):1593-600
* AJR Am J Roentgenol. 2009 Jun;192(6):1588-92
Laguna Niguel, CA 92677, USA. fburbank@cox.net
OBJECTIVE: During mature placenta formation, select fetal trophoblasts invade maternal decidual arterioles and junctional zone arteries and change them into low-resistance uteroplacental arteries. Consequently, physicians performing vascular procedures that occlude the uterine arteries should understand their effects on miscarriage rates, the various toxemias of pregnancy, gross and microscopic placental anatomy, and invasive placentation. Thus, the objective of this article is to review the effects of vascular occlusion on pregnancy. CONCLUSION: In the long run, placental abnormalities may be the canary in the mine shaft to globally judge the effect of uterine artery embolization on pregnancy.
3. Roy KK, Baruah J, Sharma JB, Kumar S, Kachawa G, Singh N
Reproductive outcome following hysteroscopic adhesiolysis in patients with infertility due to Asherman's syndrome
Arch Gynecol Obstet. 2009 May 20. [Epub ahead of print]
Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Room No. 3085, Teaching Block, 3rd Floor, New Delhi, India, drkkroy2003@yahoo.co.in.
OBJECTIVES: To evaluate the outcome of hysteroscopic adhesiolysis in patients with infertility due to Asherman's syndrome. MATERIALS AND METHODS: This was a retrospective clinical analysis of 89 patients who underwent hysteroscopic adhesiolysis by monopolar electrode knife. A second-look office hysteroscopy was performed in all cases after 2 months. On second-look hysteroscopy, 12 patients showed reformation of adhesions and needed a repeat procedure. RESULTS: The mean age of the patient was 28.4 years. In the majority (64%) of patients, the possible cause of Asherman's syndrome was previous curettage on gravid uterus. The overall conception rate was 40.4% after hysteroscopic adhesiolysis. The mean conception time after surgery was 12.8 months. There was no conception in patients who needed repeat adhesiolysis. The conception rate was higher (58%) in mild Asherman's syndrome compared to 30% conception rate in moderate and 33.3% conception rate in severe cases. There was no significant association between conception rate and preoperative menstrual pattern. There was significant higher likelihood of conception rate (44.3%) in those who continued to have improved menstrual pattern compared to only 10% likelihood of conception in those who continued to have amenorrhea after adhesiolysis. The live birth rate was 86.1% and miscarriage rate was 11.1%. Cumulative pregnancy rate showed that 97.2% patients conceived within 24 months. There was increased incidence (43.8%) of cesarean section. Four (12.5%) patients had postpartum hemorrhage for adherent placenta. CONCLUSION: Hysteroscopic adhesiolysis for Asherman's syndrome is a safe and effective method of choice for restoring menstrual function and fertility.
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