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      Safety and efficacy of manual vacuum aspiration under local anesthesia compared to general anesthesia in the surgical management of miscarriage: a retrospective cohort study

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          Abstract

          Background

          In Japan, dilatation & curettage (D&C) has been performed under general anesthesia as a surgery for an early pregnancy miscarriage for a long time. In 2016, manual vacuum aspiration (MVA) under general anesthesia was introduced at our hospital and has been used as a surgical treatment for first-trimester pregnancy miscarriage, with its utility to date being reported here. In July 2018, our hospital introduced the MVA procedure under local anesthesia. In this study, we evaluated the efficacy and safety of MVA under general and local anesthesia in first-trimester pregnancy miscarriage surgery in Japanese women.

          Methods

          In this retrospective observational cohort study, we enrolled 322 pregnant women at less than 12 weeks of gestation, who underwent MVA surgery under local anesthesia ( n = 166) or conventional general anesthesia ( n = 156). The duration of surgery, blood loss volume, quantity of anesthesia, presence or absence of retained products of conception, and clinical complications were evaluated. In addition, the intraoperative pain and treatment satisfaction were assessed using the visual analog scale (VAS).

          Results

          The duration of surgery was significantly shorter in the local anesthesia group. No significant differences were observed between both groups in terms of the blood loss volume and incidence of retained products of conception. In addition, no serious complications were observed in either group. No significant differences were noted between the two groups in the VAS scores for pain and treatment satisfaction.

          Conclusions

          In this retrospective study, the use of MVA under local anesthesia for early pregnancy miscarriage surgery was found to be equally safe and effective when performed under conventional general anesthesia. This technique allowed the achievement of appropriate pain control with excellent patient satisfaction.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s13037-022-00328-7.

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          The impact of a thin endometrial lining on fresh and frozen–thaw IVF outcomes: an analysis of over 40 000 embryo transfers

          K. Liu, M. Hartman, A. Hartman … (2018)
          Abstract STUDY QUESTION Does each millimeter decrease in endometrial thickness lead to lower pregnancy and live birth rates in fresh and frozen IVF cycles? SUMMARY ANSWER Clinical pregnancy and live birth rates decline as the endometrial thickness decreases below 8 mm in fresh IVF-ET and below 7 mm in frozen–thaw embryo transfer (ET) cycles. WHAT IS KNOWN ALREADY Previous studies have been heterogenous and have shown conflicting results on the impact of endometrial thickness on IVF outcomes. Most studies do not include many patients with an endometrial thickness below 6 mm, and there are few studies of frozen–thaw ET cycles. STUDY DESIGN, SIZE, DURATION This study is a retrospective cohort analysis of all Canadian IVF fresh and frozen–thaw ET cycles from the CARTR-BORN database for autologous and donor fresh and frozen–thaw IVF-ET cycles from 1 January 2013 to 31 December 2015. A total of 24 363 fresh and 20 114 frozen–thaw IVF-ET cycles were reported during this timeframe. PARTICIPANTS/MATERIALS, SETTING, METHODS 33 Canadians clinics participated in voluntary reporting of IVF and pregnancy outcomes to the CARTR-BORN database. The impact of endometrial thickness on pregnancy, live birth and pregnancy loss rates were analyzed for fresh IVF-ET and frozen–thaw cycles. MAIN RESULTS AND THE ROLE OF CHANCE In fresh IVF-ET cycles, clinical pregnancy and live birth rates decreased (P < 0.0001) and pregnancy loss rates increased (P = 0.01) with each millimeter decline in endometrial thickness below 8 mm. Live birth rates were 33.7, 25.5, 24.6 and 18.1% for endometrial thickness ≥8, 7–7.9, 6–6.9 and 5–5.9 mm, respectively. In frozen–thaw ET cycles, clinical pregnancy (P = 0.007) and live birth rates decreased (P = 0.002) with each millimeter decline in endometrial thickness below 7 mm, with no significant difference in pregnancy loss rates. Live birth rates were 28.4, 27.4, 23.7, 15 and 21.2% for endometrial thickness ≥8, 7–7.9, 6–6.9, 5–5.9 and 4–4.9 mm, respectively. The likelihood of achieving an endometrial thickness ≥8 mm decreased with age (89.7, 87.8 and 83.9% in women <35, 35–39 and ≥40, respectively) (P < 0.0001). LIMITATIONS, REASONS FOR CAUTION This study only included cycles which proceeded to ET, which may overestimate pregnancy outcomes. Approximately 8% of cycles could not be included in the analysis due to data irregularity related to data entry. Demographic data aside from age were unavailable but may be important as lower endometrial thickness may be associated with poor ovarian response. WIDER IMPLICATIONS OF THE FINDINGS Although pregnancy and live birth rates decrease with endometrial thickness, reasonable outcomes were obtained even with lower endometrial thickness measurements. These data provide valuable guidance for both physicians and patients when confronted with decisions related to a persistently thin endometrium. STUDY FUNDING/COMPETING INTEREST(S) This study was not funded. The authors do not have any conflicts of interests to declare. TRIAL REGISTRATION NUMBER N/A.
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            The association between menstrual cycle pattern and hysteroscopic march classification with endometrial thickness among infertile women with Asherman syndrome

            Saeed Baradwan, Afnan Baradwan, Dania Al-Jaroudi (2018)
            Abstract Women with Asherman syndrome (AS) have intrauterine adhesions obliterating the uterine cavity. Hysteroscopic March classification describes the adhesions which graded in terms of severity. This study has been designed to assess the prevalence and association between of clinical presentations, potential causes, and hysteroscopic March classification of AS among infertile women with endometrial thickness. A retrospective descriptive study was carried out that included 41 women diagnosed with AS. All of the patients underwent evaluation and detailed history. All cases classified according to March classification of AS were recorded. Patients were divided into 2 groups based on measurement of endometrial thickness. Group A consisted of 26 patients with endometrial thickness ≤5 mm, and group B included 15 patients with endometrial thickness >5 mm. The prevalence of AS was 4.6%. Hypomenorrhea was identified in about 46.3%, and secondary infertility 70.7%. History of induced abortion, curettage, and postpartum hemorrhage were reported among 56.1%, 51.2%, and 31.7%, respectively. AS cases were classified as minimal in 34.1%, moderate 41.5%, and severe among 24.4% as per March classification. Amenorrhea was reported by 23.1% of women in group A, compared to 0% in group B (P = .002). Ten of 26 patients (38.5%) from group A had a severe form of March classification, compared with 0 of 15 patients (0%) in group B. This was statistically significant (P < .001). The thin endometrium associated with amenorrhea and severe form of March classification among patients with AS.
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              Intrauterine Adhesions Following Miscarriage: Look and Learn

              Margo Fluker, Stephanie Rhone, Ashley Gilman … (2016)
              Article 0 comments Cited 15 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Toshiyuki Kakinuma:
                ORCID: http://orcid.org/0000-0001-7853-4860
                tokakinuma@gmail.com
                Journal
                Journal ID (nlm-ta): Patient Saf Surg
                Journal ID (iso-abbrev): Patient Saf Surg
                Title: Patient Safety in Surgery
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1754-9493
                Publication date (Electronic): 25 May 2022
                Publication date PMC-release: 25 May 2022
                Publication date Collection: 2022
                Volume: 16
                Electronic Location Identifier: 16
                Affiliations
                GRID grid.411731.1, ISNI 0000 0004 0531 3030, Department of Obstetrics and Gynecology, , International University of Health and Welfare Hospital, ; 537-3 Iguchi, Nasushiobara, Tochigi 329-2763 Japan
                Author information
                http://orcid.org/0000-0001-7853-4860
                Article
                Publisher ID: 328
                DOI: 10.1186/s13037-022-00328-7
                PMC ID: 9131636
                SO-VID: eafcf310-4497-4617-bd8f-38a4a06b80e0
                Copyright © © The Author(s) 2022
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 22 March 2022
                Date accepted : 15 May 2022
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2022

                ScienceOpen disciplines: Surgery
                Keywords: miscarriage,local anesthesia,missed abortion,obstetrical anesthesia,pain,vacuum aspiration
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: miscarriage, local anesthesia, missed abortion, obstetrical anesthesia, pain, vacuum aspiration

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