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Register a new userIntraoperative and Postoperative Complications of Dilation and Curettage
اختلاطات تجريف الرحم أثناء وبعد العمل الجراحي
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University of Aleppo رسالة ماجستير
Publication date
2016
fields
Medicine
and research's language is
العربية
Authors
نسرين خالد كنجو( باحث )
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إن التوسيع والتجريف D&C هو عبارة عن توسيع لعنق الرحم باستخدام الموسعات بشكل يسمح للمجرفة بالوصول لجوف الرحم لتجريف البطانة الرحمية والحصول على مجروفات للفحص النسيجي. رغم توفر تقنيات جديدة لتقييم جوف الرحم والبطانة الرحمية لايزال للتوسيع والتجريف دور مهم في المراكز التي لا تتوفر فيها التقنيات المتطورة او عندما تكون الوسائل التشخيصية الأخرى غير مفيدة. أن التوسيع والتوجيف التشخيصي معد بشكل أساسي لتحري الشذوذات بالبطانة الرحمية ولتقييم وعلاج النزف الرحمي الشاذ. يعتبر التوسيع والتجريف عمل جراحي أعمى حيث لا يمكن للطبيب الذي يجريه رؤية مابداخل جوف الرحم عند المريضة مما يؤدي للتجريف بشكل سطحي وبقاء مناطق لاتصل إليها المجرفة وبالتالي الحاجة لإجراء أخر.
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
-
ما هي نسبة الاختلاطات التي تحدث أثناء تجريف الرحم وفقًا للدراسة؟
بلغت نسبة الاختلاطات أثناء تجريف الرحم 7.7% وفقًا للدراسة.
-
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%).
-
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.
-
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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Objectives: This was a prospective study, conducted to analyze the intraoperative
and postoperative complications between abdominal and vaginal hysterectomy.
METHODS: This study was carried out on 120 patients (85 cases abdominal and 35 cases
vagi
nal hysterectomy),in the department of gynecology at Al-Assad university hospital in
Lattakia in the period between 1/7/2013-1/7/2014.
Results: the mean duration of surgery of abdominal hysterectomy was 103 min and
that of vaginal was 91 min (p=0.0192). Wound infection was the main cause for febrile
morbidity in abdominal hysterectomy group where as urinary tract infection was the main
cause for febrile morbidity in vaginal hysterectomy. There was 3)3,5%(case of bladder
injury and 2(2,8%) case of ureteric injury in abdominal hysterectomy group while none in
vaginal hysterectomy group Postoperatively there was 3 (3,5%) cases of secondary
haemorrage in TAH group while 1(2,8%) case in vaginal hysterectomy .there were 8
(9,4%) cases of paralytic ileus in abdominal hysterectomy while none in vaginal
hysterectomy . Overall 45 (52.9%) cases of abdominal hysterectomy and 12 (34.2%) case
of vaginal hysterectomy had complications (p=0.029). Conclusions: This study showed
that vaginal hysterectomy was associated with less intraoperative complications and
postoperative complications as compared to abdominal hysterectomy.
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.
chronic pain after inguinal hernia repair is an adverse outcome that affects
about 12 % to 54 % of patients. Ilioinguinal and iliohypogastric ( IG – IH ) nerve block has been widely
used in patients undergoing inguinal hernia repair.
Ketorolac is
indicated for the short term (less than 5 days)management of pain and appears to be
particularly useful in the immediate postoperative period. A standard dose of Ketorolac provides
analgesia equivalent to 6 – 12 mg of morphine administered by the same route. The interval to onset is
also similar to morphine, but Ketorolac has a longer duration of action (6 – 8 h).
what is the best method for pain management after inguinal procedures? Is there any difference between
(IG – IH) nerve block, and Ketorolac IV postoperatively (pain scores, early movement, nausea, vomiting
...)?
Introduction: Ileus commonly occurs after abdominal surgery, and is associated
with complications and increased length of hospital stay (LOHS). Traditionally, preoperative
practice has been to fast the patient for up to 12 h prior to surgery. The r
ationale
for this is to reduce gastric acidity and volume with a consequent decrease in the risk of
gastric content aspiration during surgery. However, A Cochrane review found no increased
risk of aspiration in patients who were allowed fluids 2–3 h prior to surgery compared to
patients having undergone a traditional fasting period .. A carbohydrate-rich beverage
given before anaesthesia and surgery alters metabolism from the overnight fasted to the fed
state. This reduces the catabolic response (insulin resistance) after operation, which may
have implications for postoperative recovery. Aim : to investigates the effect of
preoperative carbohydrate treatment on postoperative ileus in adult patients undergoing
abdominal surgery. Material and methods: fifty abdominal surgery patients were
randomly assigned to preparation with a 12.5% carbohydrate drink (CHO) (25), or
overnight fasting group (25). The CHO group were given 600 mL to drink on the evening
before and 400 mL on the morning of surgery. The patients' complains of nausea and
vomiting was noted, the length hospital stay and the duration of postoperative ileus (POI),
was measured in tow groups. Conclusions: This study showed that pre-operative
carbohydrate drink may be used safely and also improves patient's comfort as decrease rate
of nausea and vomiting and reduce the length of hospital stay in patients undergoing
abdominal surgery.
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