Surgical procedures for evacuating incomplete miscarriage

  • Review
  • Intervention

Authors

  • Özge Tunçalp,

    Corresponding author
    1. Johns Hopkins Bloomberg School of Public Health, Population, Family and Reproductive Health, Baltimore, MD, USA
    • Özge Tunçalp, Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA. otuncalp@jhsph.edu.

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  • A Metin Gülmezoglu,

    1. World Health Organization, UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, Geneva, Switzerland
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  • João Paulo Souza

    1. World Health Organization, Department of Reproductive Health and Research, Geneva, Switzerland
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Abstract

Background

Incomplete miscarriage is a major problem that should be effectively managed with safe and appropriate procedures. Surgical evacuation of the uterus for management of incomplete miscarriage usually involves vacuum aspiration or sharp curettage.

Objectives

To compare the safety and effectiveness of surgical uterine evacuation methods for management of incomplete miscarriage.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (July 2010).

Selection criteria

Randomized trials where different surgical methods were used to manage incomplete miscarriage were eligible for inclusion.

Data collection and analysis

We extracted population characteristics, settings, and exclusion criteria, in addition to outcomes such as complications of the procedure, duration, need for re-evacuation, blood transfusion, and analgesia/anesthesia.

Main results

Two trials (involving 550 women) were included. Vacuum aspiration was associated with statistically significantly decreased blood loss (mean difference (MD) -17.10 ml, 95% confidence interval (CI) -24.05 to -10.15 ml), less pain during the procedure (risk ratio (RR) 0.74, 95% CI 0.61 to 0.90), and shorter duration of the procedure (MD -1.20 minutes, 95% CI -1.53 to -0.87 minutes), than sharp metal curettage, in the single study that evaluated these outcomes in 357 women. Serious complications such as uterine perforation and other morbidity were rare and the sample sizes of the trials were not large enough to evaluate small or moderate differences.

Authors' conclusions

Although the review indicates that vacuum aspiration is safe, quick to perform, and less painful than sharp curettage, and should be recommended for use in the management of incomplete miscarriage, the results are based on data from only one study. Analgesia and sedation should be provided as necessary for the procedure.

Résumé scientifique

Recueil et analyse des données

Nous avons extrait les caractéristiques démographiques, les paramètres et les critères d'exclusion, en plus des résultats tels que les complications de la procédure, la durée, le besoin d'une nouvelle évacuation, la transfusion sanguine et l'analgésie/anesthésie.

Notes de traduction

Plain language summary

Surgical procedures to evacuate incomplete miscarriage

Vacuum aspiration is a safe and quick treatment for incomplete miscarriages.

Bleeding and infection generally result if the uterus is not emptied after incomplete miscarriage (where parts of the products of conception are left in the uterus). The review of two trials, involving 550 women, found that vacuum aspiration (a procedure that empties the uterus by using a vacuum source with or without electricity) was safe, quick and easy to perform. It was also less painful than dilatation and curettage, which is often done under general anesthesia in an operating room.

Résumé simplifié

Procédures chirurgicales utilisées pour évacuer une fausse couche incomplète

Notes de traduction

Laički sažetak

Kirurški zahvati za uklanjanje nepotpunog spontanog pobačaja

Aspiracija (usisavanje) pomoću vakuuma je sigurna i brza terapija za uklanjanje nepotpunog pobačaja.

Kod nepotpunog pobačaja u maternici zaostanu dijelovi fetusa i posteljice iako je veći dio sadržaja izbačen. U tom slučaju veća je mogućnost nastanka krvarenja i infekcije. Ovaj Cochrane sustavni pregled uključio je dvije studije u kojima je sudjelovalo ukupno 550 žena. Rezultati pokazuju da je aspiracija pomoću vakuuma siguran, brz i jednostavan postupak. Također je takav postupak bio manje bolan nego dilatacija (širenje vrata maternice) i kiretaža, koji se često provode u općoj anesteziji u kirurškoj dvorani.

Bilješke prijevoda

Hrvatski Cochrane
Prevela: Livia Puljak
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr

Ancillary