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PubMed2000

[Value of fractional curettage of prehysterectomy in endometrial neoplasms].

OBJECTIVE: To evaluate the value of fractional curettage in the histologic type, histologic grade and cervical involvement of the endometrial carcinoma. METHODS: A total of 691 cases of endometrial carcinoma in fractional curettage specimen were analyzed retrospectively, patients with no carcinoma postoperatively in the removed uterus were excluded from the study. Those endocervical curettages with adenocarcinoma according the histologic relationship between tumor tissue and endocervical tissue were divided into 4 main groups. RESULTS: (1) The inaccurate rate of histologic type in prehysterectomy curettage was 8.83% (61/691). About a half poorly differentiated adenocarcinomas were undergraded in the prehysterectomy curettage. (2) In 691 cases of endometrial carcinomas, 159 (23.01%) cases were determinated cervical involvement by tumor in the hysterectomy specimen, of which 88 cases had tumor tissue in the prehysterectomic curettage. In a variety of histologic appearances of endocervical curettage, the ratio of cervical involvement by tumor in hysterectomy was respectively group I 30.30% (10/33), group II 9 cases (9/9), group III 100.00% (40/40), group IV 46.88% (29/63), those without tumor tissue in the endocervical curettage 12.68% (71/560). CONCLUSIONS: (1) The reliability of histologic type of endometrial carcinoma based on the findings of the fractional curettage specimen in related to the tumor type. The diagnosis of poorly differentiated adenocarcinomas in the prehysterectomy specimen is limited. (2) Determinating the presence or absence of cervical involvement can't only depend upon the endocervical curettage with or without tumor tissue. It is suggested that those endocervical curettage with tumor tissue be divided into 4 main groups according the histologic relationship between tumor tissue and endocervical tissue, group II and group III are good predictors of cervical involvement by tumor.

Cervix Uteri↗
PubMed2004

Economic evaluation of misoprostol in the treatment of early pregnancy failure compared to curettage after an expectant management.

BACKGROUND: The increased pressure on health care expenses implies that physicians should consider economic aspects as part of the clinical decision-making process. Direct and indirect costs of a strategy starting with misoprostol in treatment of early pregnancy failure as compared to curettage is therefore performed. METHODS: We performed a cost-minimization analysis alongside a multicentre randomized trial. Clinical data and data on the use of medical resources were obtained from a randomized trial comparing misoprostol and curettage, which had shown that misoprostol reduced the need for curettage in 53%. In a sensitivity analysis the percentage of women who needed curettage after misoprostol varied between 25 and 90%. RESULTS: Direct costs per case were significantly lower in the misoprostol group (mean 433) than in the curettage group (mean 683) (mean difference 250, 95% CI 184 to 316, P < 0.001). These significant differences existed under a wide range of alternative assumptions about unit costs. The differences in direct cost in favour of misoprostol were large for women who had complete evacuation after initial misoprostol treatment as compared to those who needed additional curettage after failed misoprostol. Mean indirect costs were equal for both groups (misoprostol mean 486; curettage mean 428; mean difference 60, 95% CI -61 to 179, P = 0.51). The mean total costs for a strategy starting with misoprostol was 915 versus 1107 for curettage, with a mean difference between both groups of 192 (95% CI 33 to 351, P = 0.04). An increase of the complete evacuation rates for initial misoprostol therapy to 90% in the sensitivity analysis increased the cost difference between misoprostol and curettage to 550. CONCLUSION: The use of misoprostol for early pregnancy failure after failed expectant management is less costly than curettage.

Abortifacient Agents, Nonsteroidal↗
PubMed1987

A critical evaluation of the endocervical curettage.

A prospective study was undertaken to critically evaluate the endocervical curettage. The study group consisted of 261 patients with colposcopically identifiable cervical lesions that had not been previously biopsied and were not macroscopically suspicious for invasive cancer. In 210 patients, the entire lesion, transformation zone, and squamocolumnar junction were visible (satisfactory colposcopy), and in 51 patients, the full extent of the lesion was not visualized colposcopically (unsatisfactory colposcopy). We used a method of examination not previously described. Colposcopy was performed before and after the endocervical curettage, but before the ectocervical biopsy. This method of examination allowed us to identify potentially contaminated endocervical curettages and to test the null hypothesis that a positive endocervical curettage in patients with satisfactory colposcopy is not the result of contamination. Twenty of 210 endocervical curettages in patients with satisfactory colposcopy were potentially contaminated, as suggested by an ectocervical lesion disrupted by the endocervical curettage. No patient with a positive endocervical curettage had an intact ectocervical lesion. Therefore, the null hypothesis was rejected (P less than .005). Of the 51 patients with unsatisfactory colposcopy, 39 (76%) underwent cone biopsy. Invasive cancer was diagnosed by cone biopsy in two patients when both ectocervical biopsy and endocervical curettage demonstrated only dysplasia. We also confirmed that patients with unsatisfactory colposcopy occasionally benefit from having an endocervical curettage. However, basing the treatment plan for any lesion short of invasive cancer solely on the results of colposcopy, ectocervical biopsy, and/or endocervical curettage could lead to significant undertreatment of some patients.

Biopsy↗
PubMed1998

Treatment of giant cell tumor of bone: a comparison of local curettage and wide resection.

BACKGROUND: Giant cell tumor of bone is benign but locally aggressive neoplasm with a tendency for local recurrence. Although various treatment options have been utilized and reported, it remains a difficult therapeutic problem for the orthopedic surgeon. METHODS: We reviewed the results of the treatment of giant cell tumor of bone in 27 patients. Eleven patients were treated with extended curettage and burring then packing with cement, while 16 patients had wide resection and reconstruction. RESULTS: At an average of 50 months after surgery, the recurrence rate of curettage was 27% and that of wide resection was 6.25%. Two of the three patients who had a recurrence after curettage were treated by a secondary curettage procedure and were later free of disease. Overall, the local control rate after second curettage and packing with cement was 90.9%. There was no infection in the curettage group but infection occurred in 3 patients of the resection group. Eight patients in the curettage group (80%) had an excellent functional result but only 2 patients in the resection group (13%) achieved an excellent result. CONCLUSION: This study demonstrates that either curettage and packing with cement or wide resection are effective in treatment of giant cell tumor of bone. There is, however, a better functional result after curettage and packing with cement than following wide resection. We recommend curettage and cement packing for giant cell tumor of bone whenever it is technically feasible.

Adolescent↗
PubMed1979

[Experiences using the suction curettage system of Hamann and Pockrand (author's transl)].

All curettages of a 8-week-period were done using the suction system of Hamann and Pockrandt. This test-collective includes 66 patients, their age was between 20 and 78 years; 6 of them had to be excluded: the surgical intervention was begun without general anaesthesia but continued with general anaesthesia is required by the patient. The test-collective was divided into 2 groups: in group A (30 patients) all suction-curettages were done in general anaesthesia, in the first 20 patients a conventional curettage with dilation of the cervix were performed additionally, in order to proof the effectiveness of the suction curettage. The histological findings of the materials of the conventional curettages had shown no more informations than that of the materials of the suction curettages. -- In group B (30 patients) the suction curettage were done in diazepampentazocin-analgesia; a third of them had specified no sensations, the others had stated a feeling of pressure or spasms. -- In each group the histological examinations were possible without any problems. The advantages of the suction curettage system are the rare necessity of cervix dilatation (7 of 60 cases), the possibility of the operation without general anaesthesia and the possibility of a quick performance of the curettage.

Abortion, Incomplete↗
PubMed2003

The efficacy of curettage in delineating margins of basal cell carcinoma before Mohs micrographic surgery.

BACKGROUND: Curettage may be helpful as a preliminary step to outline the gross subclinical extensions of high-risk basal cell carcinomas (BCCs) before the first stage of Mohs micrographic surgery. Although many Mohs surgeons use curettage in the Mohs surgical setting, no prospective studies have as yet been performed that demonstrate the efficacy of curettage in delineating tumor margins before Mohs surgery. OBJECTIVE: To document the efficacy of curettage in delineating BCC margins before Mohs micrographic surgery. METHODS: This was a prospective evaluation of 599 patients with biopsy-proven BCCs treated with Mohs surgery. The preoperative dimensions of each tumor, the curetted dimensions before the first surgical stage, the proposed excisional margins before each surgical stage, and the final defect dimensions after each surgical stage were measured. The maximum curetted margin around each tumor was calculated and compared with typical Mohs excisional margins of 1, 2, 3, and 4 mm. A hypothetical 1-, 2-, 3-, or 4-mm excisional margin was added to the preoperative X and Y dimensions of each tumor, and the actual final defect sizes were compared with the hypothetical final defect sizes to determine whether an additional surgical stage would have been needed had curettage not been performed. The amount of tissue stretch occurring after specimen removal was calculated to determine whether tissue stretch falsely elevated the number of instances in which an additional surgical stage would have been needed had curettage not been performed. RESULTS: The curetted margin around the observed extent of each tumor exceeded 1 mm in 87.6% of cases, 2 mm in 47.1% of cases, 3 mm in 19.7% of cases, and 4 mm in 5.7% of cases. The mean curetted margin was 1.7 mm. Taking a 1-mm margin in the first stage of Mohs surgery without first performing curettage would have necessitated an extra surgical stage in 99.2% of cases, whereas taking a 2-, 3-, or 4-mm margin would have necessitated an extra surgical stage in 93.0%, 88.1%, and 49.4% of cases, respectively. After calculating and eliminating the effects of tissue stretch, it was found that a 1-mm excisional margin taken in the first stage of Mohs surgery without first performing curettage would have necessitated an extra surgical stage in 99.0% of the cases. Taking a 2-, 3-, or 4-mm margin would have necessitated an extra surgical stage in 87.5%, 57.9%, and 29.5% of cases, respectively. CONCLUSION: Careful debulking and palpation with the curette significantly reduce the number of Mohs surgical stages required for BCC clearance. Even after taking the effects of tissue stretch into consideration, a significant proportion of tumors would still require an additional stage for tumor clearance without aggressive presurgical curettage.

Adult↗
PubMed2006

Effects of postpartum uterine curettage on maternal well-being in severe preeclamptic patients.

PURPOSE: We assessed the effect of postpartum uterine curettage on maternal recovery time in severe preeclamptic patients. METHOD: Fifty-six pregnant women with the diagnosis of severe preeclampsia in their third trimester were enrolled in the study. Uterine curettage was performed in the early postpartum period on 31 randomly selected patients and curettage was not performed in the remaining 25 patients. Prepartum mean arterial pressure (MAP) values, quantitative platelet counts, presence of proteinuria tested semiquantatitively, lactic dehydrogenase (LDH), aspartate transferase (AST), alanine transferase (ALT), and uric acid levels were determined. FINDINGS: In the group that underwent curettage, we observed a faster drop in the mean arterial pressures monitored at two-hour intervals, especially after the sixth postpartum hour (p < 0.05). Average urine output recorded at four-hour intervals in the postpartum period was significantly higher in the curettage group compared to the non-curettage group (p < 0.05). The difference in the platelet counts of both groups was not significant at the 12th postpartum hour, however, at 24 hours, platelet counts in the curettage group were higher. In the postpartum period at the 12th and 24th hours there was no difference between the two groups with regard to LDH, AST, and ALT values (p > 0.05). RESULTS: In our study we have observed that uterine curettage performed in the postpartum period had favorable effects on blood pressure, platelet count, and urinary output and also helped in faster recovery from severe preeclampsia. We, therefore, consider that postpartum uterine curettage is useful for patients with severe preeclampsia that require faster recovery.

Adult↗
PubMed1999

Outcomes of suction curettage and mifepristone abortion in the United States. A prospective comparison study.

A prospective, nonconcurrent cohort analysis of 178 mifepristone/misoprostol and 199 suction curettage abortion subjects, ages > or = 18 years, with intrauterine pregnancies < or = 63 days estimated gestational age, was conducted to compare the outcomes of suction curettage abortion to those of medical abortion. The medical abortion subjects received 600 mg of mifeprisone orally, followed by 400 micrograms of oral misoprostol 2 days later. Surgical abortion subjects underwent electronic vacuum aspiration. All subjects were followed for 2 weeks or until the absence of clinical bleeding. Outcome measures included a successful abortion (complete abortion without a surgical intervention), duration of bleeding, and morbidity. Overall, 18.3% medical and 4.7% surgical patients failed their primary procedure and received an unanticipated suction curettage (RR 3.93, 95% CI 1.87, 8.29). Four mifepristone subjects required curettage for acute bleeding, nine to manage ongoing pregnancy, and five for incomplete abortion. Fourteen mifepristone and eight surgical subjects required curettage for persistent bleeding. The median time delay for therapeutic curettage was significantly longer in the medical abortion group (35 versus 8 days; Mann-Whitney U = 17.0, p = 0.008). Medical subjects experienced significantly longer bleeding (mean difference = 9.6 days, 95% CI 6.8, 12.4). No significant change in hemoglobin occurred in either group. Mifepristone patients reported significantly greater pain (77.1% vs 10.5%; RR 7.4, 95% CI 4.7, 11.5), and nausea or vomiting (68.6% vs 0.6%; RR 117.9, 95% CI 16.7, 834.7). Women receiving mifepristone/misoprostol are more likely to require an unplanned surgical intervention than women who undergo suction curettage. They experience more discomfort with their procedure and in the follow-up interval, bleed for a longer period, and remain at risk for surgical completion curettage for several weeks.

Abortifacient Agents, Steroidal↗
PubMed2004

Randomized, controlled surgical trial of preoperative tumor curettage of basal cell carcinoma in Mohs micrographic surgery.

BACKGROUND: The use of preoperative tumor curettage in Mohs micrographic surgery has never been prospectively systematically assessed. OBJECTIVE: To assess the utility of preoperative tumor curettage in Mohs micrographic surgery for primary or recurrent, well-defined basal cell carcinoma less than 2 cm in diameter located on the head or neck. METHODS: Patients were randomized to either preoperative tumor curettage or control group and were compared in terms of percent surface area increase from tumor surface area to wound surface area, absolute surface area increase, number of tissue layers removed, types of repairs performed, and postoperative complications. Multivariate analysis was performed to see if tumor location, appearance (exophytic or flat), or histology affected any of the above. RESULTS: The preoperative tumor curettage group had a 399% (95% confidence interval [CI] 346-452) mean surface area increase from tumor to wound surface area versus 263% (95% CI 216-311) for control group (P=.0002). The preoperative tumor curettage group had a mean absolute surface area increase of 1.78 cm2 (95% CI 1.57-1.99) versus 1.40 cm2 (95% CI 1.15-1.65) for control group (P=.02). The preoperative tumor curettage group had fewer tissue layers removed (P=.3). Preoperative tumor curettage had no effect on types of repairs performed or number or type of postoperative complications. Tumor appearance and histology had no effect on any of the above end points. CONCLUSION: Preoperative tumor curettage was associated with significantly greater percent surface area increase and absolute surface area increase from tumor surface area to wound surface area. This difference did not affect type of repair performed or postoperative complications.

Basal Cell Carcinoma↗
PubMed2005

The curative effect of a second curettage in persistent trophoblastic disease: a retrospective cohort survey.

OBJECTIVE: To assess the curative effect of a second curettage in patients with low-risk Persistent Trophoblastic Disease (PTD) after molar pregnancy. METHODS: A retrospective cohort survey was performed on 2122 patients registered with the Dutch Central Registry for Hydatidiform Moles between 1987 and 2003. Of these, 422 patients developed PTD. For various reasons, 128 patients were excluded. The study group comprised 85 patients with, according to the Dutch guidelines, low-risk PTD who underwent a second therapeutic curettage as a part of the treatment for PTD. The control group consisted of 209 patients with low-risk PTD who did not undergo a second curettage. Patients in the study and control group were classified for high/low-risk PTD according to the internationally accepted FIGO 2000 guidelines. Primary outcome measures were the need for chemotherapy and if applicable, the number of chemotherapy courses. RESULTS: After second curettage, eight out of 85 patients (9.4%) did not need additional chemotherapy which significantly differs from the 209 patients in the control group who all needed chemotherapy (P < 0.001). A debulking effect of the second curettage was observed: a median of 6 courses (interquartile range 3 courses) in the control group versus 5 courses (interquartile range 3 courses) in the study group (P = 0.036). Four out of the 85 (4.8%) patients with a second curettage had a major complication (uterine perforation or hemorrhage), which was managed conservatively. CONCLUSION: A second curettage cured 9.4% of patients with PTD in this historical cohort and reduces the number of courses of chemotherapy. A second curettage seems to benefit only a limited number of patients with PTD. A randomized controlled prospective trial is needed to confirm this observation.

Adult↗
PubMed2006

Comparison of cryotherapy and curettage for the treatment of pyogenic granuloma: a randomized trial.

BACKGROUND: Pyogenic granuloma is a benign vascular lesion of the skin and mucous membranes. Many different treatments have been used, with variable success rates. OBJECTIVES: To evaluate and compare the effects of cryotherapy and curettage in the treatment of pyogenic granuloma. METHODS: Eighty-nine patients with pyogenic granuloma were randomized to receive cryotherapy with liquid nitrogen or curettage and electrodesiccation. Forty patients in the cryotherapy group and 36 patients in the curettage group completed the study period. RESULTS: Among the patients who completed the study, treatment resulted in complete resolution of all lesions after one to three sessions (mean 1.42) in the cryotherapy group and after one to two sessions (mean 1.03) in the curettage group. The difference between the two groups was statistically significant (P < 0.001). Twenty-three patients (57.5%) in the cryotherapy group and 25 patients (69%) in the curettage group had no scar or pigmentation abnormality. Except for cosmetic problems, no other side-effect or complication was recorded in the study. CONCLUSIONS: This study showed that both cryotherapy and curettage are safe and effective. Curettage had the advantage of fewer treatment sessions required to achieve resolution and better cosmetic results. We suggest that curettage could be the first-line treatment for pyogenic granuloma.

Adolescent↗
PubMed1993

Immediate postpartum curettage: accelerated recovery from severe preeclampsia.

OBJECTIVE: To investigate the ability of immediate postpartum curettage to accelerate maternal recovery from severe preeclampsia. METHODS: Thirty-two parturients with severe preeclampsia were randomly assigned to either undergo ultrasound-directed curettage following delivery or to have no curettage. RESULTS: Subjects who underwent immediate postpartum curettage had a significantly decreased mean arterial pressure at each 2-hour point for the first 24 hours compared with those who were not curetted (P < .0002). The mean urine output after uterine curettage was significantly greater during each 4-hour interval of the first 24 hours postpartum compared with controls (P < .0002). The platelet count increased in the curettage group from 12 to 24 hours following curettage, whereas controls exhibited a decrease in the platelet count from 12 to 24 hours (P < .0003). CONCLUSION: Immediate puerperal uterine curettage of the parturient with severe preeclampsia appears to accelerate disease recovery with no apparent adverse sequelae.

Adolescent↗
PubMed1993

Suction v. conventional curettage in incomplete abortion. A randomised controlled trial.

This randomised controlled trial of 357 patients who had had an incomplete abortion compared suction curettage with conventional curettage for evacuation of the uterus. The 179 patients undergoing suction curettage had a significantly lower intra-operative blood loss (P < 0.0001) and a significantly higher mean haemoglobin level at follow-up compared with the 178 patients who had conventional curettage. Suction curettage was a faster procedure and less painful. No difference was found between the two groups with regard to the incidence of post-abortal sepsis, or the re-evacuation rate. No problems were encountered with the use of suction curettage in the presence of uterine sepsis. In an era where blood transfusions should be kept to an absolute minimum, suction curettage will help to save blood in several ways.

Abortion, Incomplete↗
PubMed2002

The value of curettage in diagnosis of endometrial hyperplasia.

OBJECTIVES: The aim of this study was to assess the value of diagnosis of endometrial hyperplasia by curettage and to determine the results of proliferating cell nuclear antigen (PCNA) immunostaining in differentiating endometrial carcinoma from endometrial hyperplasia. METHODS: According to Kurman's criteria, we treated 150 patients with endometrial hyperplasia detected by curettage and compared retrospectively the diagnosis by curettage with that by hysterectomy. PCNA expression was examined using immunohistochemostaining on 60 patients with complex atypical hyperplasia detected by curettage. RESULTS: Simple hyperplasia was found by curettage in 53 patients, complex hyperplasia in 11, simple atypical hyperplasia in 26, and complex atypical hyperplasia in 60. All patients were rediagnosed after hysterectomy. As a result, 65 were found to have simple hyperplasia, 7 complex hyperplasia, 15 simple atypical hyperplasia, 29 complex atypical hyperplasia, and 34 endometrial carcinoma. The accuracy of histological diagnosis by curettage was 76.7-92.0% and was dependent on different types of hyperplasia. Simple atypical hyperplasia and complex atypical hyperplasia were more likely to coexist with endometrial carcinoma than both simple hyperplasia and complex hyperplasia (chi2 = 26.3, P < 0.001), and complex atypical hyperplasia was more likely to coexist with endometrial carcinoma than simple atypical hyperplasia (chi2 = 9.78, P < 0.005). In complex atypical hyperplasia patients, coexistence with endometrial carcinoma was more common after menopause than before menopause (chi2 = 3.93, P < 0.05). In complex atypical hyperplasia patients, the expression of PCNA in cases associated with endometrial carcinoma was higher or stronger than in cases associated without endometrial carcinoma (chi2 = 7.68, P < 0.01, or U = 252.00, P < 0.01). Conclusions. Curettage tends to be more highly accurate in diagnosing simple hyperplasia than complex atypical hyperplasia, which is often found by hysterectomy to be associated with endometrial carcinoma. The expression of PCNA may be helpful in differentiating complex atypical hyperplasia from endometrial carcinoma.

Adult↗
PubMed1983

Cervical conization: when is uterine dilatation and curettage also indicated?

Although the primary goal of cervical cone biopsy is treatment of cervical intraepithelial neoplasia, conization plus uterine dilatation and curettage is usually considered as a single, standard procedure. We reviewed 128 cone biopsies (114 of these procedures included dilatation and curettage) over a 3-year period to see whether dilatation and curettage was necessary as an accompaniment to conization. The mean age for all patients was 32.8 years, and 6.25% (eight patients) had a history of abnormal uterine bleeding. There was no evidence of endometrial abnormality in any of the 114 dilatation and curettage specimens. These findings suggest that dilatation and curettage is not warranted as a routine adjunct to cone biopsy. We believe more precise criteria for combining dilatation and curettage with conization are required, and these include: patients in the peri- or postmenopausal period, suspected intrauterine abnormalities, and the presence of abnormal glandular cells in a cytologic sample. With the use of these guidelines, only 18 patients (14%) would have required dilatation and curettage.

Adolescent↗
PubMed2004

Morbidity that is associated with curettage for the management of spontaneous and induced abortion in women who are infected with HIV.

OBJECTIVE: The purpose of this study was to determine the morbidity that is associated with curettage for the management of abortions in women who were infected with human immunodeficiency virus compared with women who were not infected with human immunodeficiency virus. STUDY DESIGN: Women who were infected with human immunodeficiency virus (cases) and who underwent curettage for the management of scheduled and unscheduled abortions in the first half of pregnancy between January 1, 1993, and December 31, 2002, were identified. Women who were not infected with human immunodeficiency virus (control subjects) were matched 3:1 to cases for gestational age, type of abortion, and year of procedure. Medical records were reviewed to obtain demographic characteristics, gestational age, abortion characteristics, and procedure-related complications. Chi-squared test, Student t test, and Wilcoxon rank-sum test were used to determine statistical significance. RESULTS: Seventy-one women who were infected with human immunodeficiency virus (cases) and 213 women who were not infected with human immunodeficiency virus (control subjects) who underwent curettage during the study period were evaluated. Forty-eight cases (68%) and 146 control subjects (69%) underwent a scheduled curettage. Twenty-three cases (32%) and 66 control subjects (31%) underwent an unscheduled curettage for spontaneous or incomplete abortion. No significant differences were seen in age, gravidity, or parity. There were significantly more black women in the HIV-infected cohort (P < .001), which was representative of our human immunodeficiency virus population. The mean gestational age in the cases was greater than in the control subjects (10.9 +/- 4.2 weeks of gestation vs 9.2 +/- 3.1 weeks of gestation; P = .004). Procedure-related complications occurred in 10 of the women (14%) who were infected with human immunodeficiency virus who underwent curettage, compared with 9 of the women (4%) who were not infected with human immunodeficiency virus (P = .004). With the use of logistic regression, complication rates were unaffected by the difference in gestational age. Infectious complications did not differ between the 2 groups (P = .435). CONCLUSION: There was a higher rate of procedure-related complications among women who were infected with human immunodeficiency virus and who underwent curettage for management of spontaneous and induced abortions. There was no increase in infectious morbidity in the women who were infected with human immunodeficiency virus.

Abortion, Induced↗
PubMed1990

[The value of curettage in the assessment of abnormal uterine bleeding].

Current practice of investigating abnormal uterine bleeding via dilatation and curettage is sometimes open to question, and outpatient procedures are emphasised. The therapeutic effect of curettage in normalising menstrual patterns is being discussed. In a prospective study we answered the question of diagnostic and therapeutic effects of curettage. Over a period of 6 months, all patients with curettage treated in our department were investigated (history, risk factors, previous hormonal treatment, preoperative haemoglobin value, type of anaesthesia, complications, histology). Curettages performed for the purpose of abortion, as well as in combination with conisation of the uterine cervix, were not included in the study. 234 curettages were carried out. Clinical indications were as follows: in 29% of the cases recurrent preclimacteric metrorrhagia, in 27% climacteric metrorrhagia, in 24% PMB (postmenopausal bleeding). In 19 cases we found an Hb value lower than 10.5 g%. Risk factors (obesity, hypertension, diabetes mellitus) for endometrial cancer were found in 38% of MB and in 20% of climacteric metrorrhagia. In 9 cases, the histological diagnosis was endometrial cancer (clinical indications: 5 PMB, 3 climacteric metrorrhagia, 1 recurrent preclimacteric metrorrhagia). Our study shows, that the indication for curettage should be applied generously, especially in cases of abnormal postmenopausal and perimenopausal bleeding.

Adult↗
PubMed2004

Misoprostol versus curettage in women with early pregnancy failure after initial expectant management: a randomized trial.

BACKGROUND: Little is known about the effectiveness of misoprostol treatment in women with early pregnancy failure who have been managed expectantly. We therefore performed a randomized trial on this subject. METHODS: Women with early pregnancy failure, who had been managed expectantly for at least 1 week, were assigned randomly (using a computer-generated list) to receive either vaginal misoprostol 800 microg or curettage. If, after 24 h, there had not been complete evacuation, a further 800 microg of misoprostol was administered. In the absence of complete evacuation after > days, curettage was performed. The primary end-point was the complete evacuation of the products of conception, with secondary end-points being the occurrence of side effects, pain intensity, need for analgesics, and intensity and duration of bleeding. RESULTS: In the misoprostol group, 47% (37/79) required curettage due to incomplete evacuation. After 1 week, evacuation was complete in 85% (67 out of 79) of the misoprostol group and 93% (70 out of 75) of the curettage group. Severity of pain, bleeding and emergency evacuation was higher in the misoprostol group. The complication rate was 0% for misoprostol and 4% for curettage. CONCLUSIONS: Curettage is superior to misoprostol in the evacuation of early pregnancy failure after failed expectant management. However, misoprostol could be clinically useful since it reduces the need for curettage by half and has a lower complication rate, at the expense of increased pain, vaginal bleeding and emergency evacuation.

Abortifacient Agents, Nonsteroidal↗