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Intraoperative and Postoperative Complications of Dilation and Curettage

اختلاطات تجريف الرحم أثناء وبعد العمل الجراحي

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 Publication date 2016
  fields Medicine
and research's language is العربية
 Created by Shamra Editor




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Uterine curettage is considered the fundamental procedure in the treatment of abortions especially in complete and missed abortions in many counties despite the availability of many alternative methods to treat these cases. It is also widely used as a diagnostic means to diagnoses the endometrial abnormalities which cause abnormal uterine bleeding. This research aims to figure out complications rate which occur during uterine curettage and the subsequent complications rate and to identify the most important causes of them for the purpose of knowing the efficiency and the safety of the diagnostic and therapeutic uterine curettage.


Artificial intelligence review:
Research summary
تناولت هذه الدراسة اختلاطات تجريف الرحم أثناء وبعد العمل الجراحي، وقد أعدت كبحث علمي لنيل شهادة الماجستير في التوليد وأمراض النساء وجراحتها من جامعة حلب. هدفت الدراسة إلى معرفة نسبة الاختلاطات التي تحدث أثناء وبعد تجريف الرحم، وتحديد أهم أسبابها، وذلك لتقييم مدى فعالية وأمان هذا الإجراء التشخيصي والعلاجي. شملت الدراسة 324 مريضة، حيث كان التجريف علاجيًا في 230 حالة واستقصائيًا في 94 حالة. بلغت نسبة الاختلاطات أثناء الجراحة 7.7%، وكانت أبرزها النزف (3.1%)، بقاء أجزاء من محصول الحمل (1.9%)، انثقاب الرحم (1.2%)، وتمزق العنق (1.2%). أما نسبة الاختلاطات التالية للجراحة فكانت 0.9%، وشملت النزف بعد الجراحة (0.5%) والانتان (0.5%). أظهرت الدراسة ارتباطًا هامًا بين حدوث الاختلاطات وكبر حجم الرحم ووجود الرحى العدارية. أوصت الدراسة بإجراء إيكو للرحم قبل الانتهاء من التجريف، وتطبيق الصادات في حالات التجريف العلاجي المترافق مع الإنتان، واستخدام الملقط متعدد الأسنان لتقليل تمزقات العنق.
Critical review
دراسة نقدية: تعتبر هذه الدراسة شاملة ومفصلة في تناولها لموضوع اختلاطات تجريف الرحم، وقدمت معلومات قيمة حول نسبة حدوث الاختلاطات وأسبابها. ومع ذلك، يمكن الإشارة إلى بعض النقاط التي قد تعزز من قوة الدراسة. أولاً، كان من الممكن توسيع حجم العينة لتشمل عددًا أكبر من المريضات، مما يزيد من قوة النتائج الإحصائية. ثانيًا، لم تتناول الدراسة تأثير العوامل النفسية والاجتماعية على حدوث الاختلاطات، وهو جانب مهم يمكن أن يؤثر على النتائج. ثالثًا، كان من الممكن تضمين مقارنة مع دراسات أخرى في مناطق جغرافية مختلفة لتقديم صورة أكثر شمولية. على الرغم من هذه النقاط، فإن الدراسة تظل مرجعًا هامًا في مجال التوليد وأمراض النساء.
Questions related to the research
  1. ما هي نسبة الاختلاطات التي تحدث أثناء تجريف الرحم وفقًا للدراسة؟

    بلغت نسبة الاختلاطات أثناء تجريف الرحم 7.7% وفقًا للدراسة.

  2. ما هي أبرز الاختلاطات التي تحدث أثناء تجريف الرحم؟

    أبرز الاختلاطات التي تحدث أثناء تجريف الرحم هي النزف (3.1%)، بقاء أجزاء من محصول الحمل (1.9%)، انثقاب الرحم (1.2%)، وتمزق العنق (1.2%).

  3. ما هي التوصيات التي قدمتها الدراسة لتقليل نسبة الاختلاطات؟

    أوصت الدراسة بإجراء إيكو للرحم قبل الانتهاء من التجريف، وتطبيق الصادات في حالات التجريف العلاجي المترافق مع الإنتان، واستخدام الملقط متعدد الأسنان لتقليل تمزقات العنق.

  4. ما هو الهدف الرئيسي من هذه الدراسة؟

    الهدف الرئيسي من الدراسة هو معرفة نسبة الاختلاطات التي تحدث أثناء وبعد تجريف الرحم، وتحديد أهم أسبابها لتقييم مدى فعالية وأمان هذا الإجراء التشخيصي والعلاجي.


References used
) Kalish RB , Chasen ST , Rosenzweig LB, Rashbaum WK , Chervenak FK . impact of midtrimester dilation and evacuation on subsequent pregnancy outcome . Am J Obstet Gynecol . 2002;187:613-614
Jackson JE, Grobman WA , Haney E, Castel H . Mid-trimester dilation and evacuation with laminaria does not increase the risk for severe subsequent pregnancy complications . Int J Gynaecol Obstet.2007;96:12-15.
Turok DK , Curtcheff SE , Esplin MS , et al . Second trimester termination of pregnancy: a review by site and procedure type . contraception . 2008;77:155-161.
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Abortion is the most common complication of early pregnancy, so that should be effectively managed with safe and appropriate procedures. Surgical evacuation of the uterus for management of first trimester abortions usually involves vacuum aspiration or sharp curettage. Objective:To compare the complications of electric vacuum aspiration (EVA) and sharp curettage (D&C) for first trimester abortions, and detect the method that ensure more safety and efficacy. Subjects and methods: The study included one hundred women with incomplete abortion, missed abortion or blighted ovum, gestational age less than 12 weeks whom come to the department of obstetrics and gynecology at Al-Assad university hospital in Lattakia , Syria between 1 July 2013 and 1 July 2014. They were allocated into two groups, group A (n = 50) underwent EVA and group B (n=50) underwent D&C. The procedures were performed using the general anesthesia. We excluded: febrile state, clotting disorders, sever medical and surgical complications, unstable hemodynamic state. Results: Clinical characteristics were similar in the two groups. There were no reports of maternal deaths, cervical laceration, uterine perforation or blood transfusion recorded in the two groups. Blood loss was greater with D&C group than with EVA group (0.001). need an analgesic was greater with D&C group than with EVA group (0.002). Duration of operation and hospitalization was significantly shorter with EVA group than with D&C group. The two groups were similar in success procedure. Conclusion: The efficacy of EVA was the same as that of D&C in successful the procedure, but pain and blood loss were experienced more in the D&C group.
Introduction: Ileus commonly occurs after abdominal surgery, and is associated with complications and increased length of hospital stay. Post-operative ileus (POI) is an important reason for remaining patients not permit oral (NPO) in post-operativ e period. The tradition was that when patients passed flatus, they were ready to consume a liquid diet, and then a solid food diet was gradually introduced. This approach was taken to avoid aspiration, gastric and intestinal distension, and anastomotic dehiscence. Although studies demonstrated that the conventional strict feeding regimens were not necessary, many surgeons still hesitated to allow early oral feeding. There has been concern that early oral intake would result in vomiting and severe paralytic ileus with subsequent aspiration pneumonia, wound dehiscence and anastomotic leakage. This belief has become surgical dogma, unsupported by scientific evidence. Aim: to investigates the effect of early oral postoperative carbohydrates feeding on postoperative outcome. Material and methods: forty abdominal surgery patients were randomly assigned to early oral postoperative feeding group (20) or traditional feeding group (20). In the early feeding group (study group), patients were initially started on clear fluid only 16 h after surgery and progressed to liquids (after 24 h) and then soft and regular diet in next day (after 48 h). In the post-operative period, the patients were visited each 12 h and clinical signs and symptoms such as, time of passed flatus and moved their bowels, nausea and vomiting, and the length hospital stay were assessed. Conclusions: This study showed that early oral postoperative carbohydrates feeding group passed flatus and moved their bowels much sooner than the control group thus reducing the duration of POI and hospital stay, but there is no increase in occurrence of of nausea and vomiting between tow groups.
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