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Results for “Abortion, Incomplete”

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PubMed1994

A time and cost analysis of the management of incomplete abortion with manual vacuum aspiration.

OBJECTIVES: Traditionally, management of incomplete abortion involves use of D&C or suction curettage in the operating room. Such management is costly and time-consuming. In order to potentially save time and money, we studied the use of manual vacuum aspiration curettage (MVAC) for the management of this problem. METHODS: Data on hospital charges and times (e.g. waiting time, procedure time) were obtained for all cases of incomplete abortion presenting to hospital between January 1990 and July 1992. Between January 1990 and July 1991, all cases were managed traditionally. After July 1991, all cases were managed using MVAC in either the emergency room or the labor ward. RESULTS: Compared to the use of electrical suction equipment in the operating theatre, MVAC procedures resulted in significant savings in terms of both waiting times and costs. Waiting time was reduced by 52% and procedure time was reduced from a mean of 33 min to 19 min (P < 0.01). Total hospital costs were reduced by 41% (P < 0.01). CONCLUSIONS: Use of manual vacuum aspiration curettage in the management of incomplete abortion can reduce hospital costs and save time for both patients and clinicians.

Abortion, Incomplete↗
PubMed1997

Methodological issues in the South African incomplete abortion study.

In 1994, a national hospital-based study was undertaken of cases of incomplete abortion presenting to public hospitals in South Africa. Data were collected for all women admitted to a random sample of hospitals with incomplete abortion during a two-week period. The WHO protocol for such studies was used as a basis for developing the methods to describe the epidemiology of incomplete abortion and hospital management of cases. Attempts were made to estimate the proportion of cases that might have been induced. This report focuses on methodological issues arising from the study that have implications for future research. The findings demonstrate that only a small proportion of the women acknowledged having had an induced abortion and that only a few of those who did showed evidence of interference with pregnancy. Clinical opinion of sepsis and the likelihood of induction were found to be highly unreliable. These findings considerably reduce the usefulness of the WHO-protocol method of estimating the likely origin of incomplete abortions. Results presented in terms of three partially overlapping descriptive categories are judged to better reflect the limitations of the data collected.

Abortion, Incomplete↗
PubMed1997

An analysis of the cost of incomplete abortion to the public health sector in South Africa--1994.

OBJECTIVE: To analyse the medical costs incurred in treating women for incomplete abortion. This study was performed in conjunction with a nationwide survey of women who presented to public hospitals with incomplete abortion in 1994. DESIGN: Cost analysis with two modified Delphi panels used to develop models of resource use reflecting three severity categories of symptoms and three hospital treatment settings. SETTING: Public hospitals in South Africa. PARTICIPANTS: A panel of 15 senior level obstetrician/ gynaecologists and a second panel of 11 patient care managers representing district, regional and tertiary level hospitals in 7 provinces. MAIN RESULTS: A conservative estimate of the total cost of treating women is R18.7 million +/- R3.5 million for 1994. An estimated R9.74 million +/- R1.3 million of this was spent treating women with 'unsafe' incomplete abortions. CONCLUSIONS: The management of incomplete abortion requires significant public sector expenditure. The long-term indirect costs to women, their families and communities are discussed and treatment costs estimated so that unmet needs for medical care resulting from unsafe abortions can be addressed.

Abortion, Incomplete↗
PubMed2000

Antibiotics for incomplete abortion.

OBJECTIVES: The value of routine antibiotics before surgical evacuation of the uterus in women incomplete abortion is controversial. In some health centres antibiotic prophylaxis is advised in others antibiotics are only prescribed when there is signs of infection. The objective of this review is to evaluate the effectiveness of routine antibiotic prophylaxis to women with incomplete abortion. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register, MEDLINE and Popline. Date of last search: January 1999. SELECTION CRITERIA: Randomised trials comparing a policy of routine antibiotic prophylaxis with no routine prophylaxis were eligible for inclusion. DATA COLLECTION AND ANALYSIS: Data extraction was conducted by two reviewers independently. Trial quality was assessed. MAIN RESULTS: One study involving 140 women was included. A second well-conducted trial was excluded because of high losses to follow-up. No differences were detected in postabortal infection rates with routine prophylaxis or control. However, compliance with antibiotic treatment was also low. REVIEWER'S CONCLUSIONS: There is not enough evidence to evaluate a policy of routine antibiotic prophylaxis to women with incomplete abortion.

Abortion, Incomplete↗
PubMed2003

Management of incomplete abortion in South African public hospitals.

OBJECTIVE: To describe the current management of incomplete abortion in South African public hospitals and to discuss the extent to which management is clinically appropriate. DESIGN: A multicentre, prospective descriptive study. SETTING: South African public hospitals that manage gynaecological emergencies. SAMPLE: Hospitals were selected using a stratified random sampling method. All women who presented to the above sampled hospitals with incomplete abortion during the three week data collection period in 2000 were included. METHODS: A data collection sheet was completed at the time of discharge for each woman admitted with a diagnosis of incomplete, complete, missed or inevitable abortion during the study period. Information gathered included demographic data, clinical signs and symptoms at admission, medical management, surgical management, anaestetic management, use of blood products and antibiotics and complications. Three clinical severity categories were used for the purpose of data analysis and interpretation. MAIN OUTCOME MEASURES: Detail of medical management, detail of surgical management, use of blood products and antibiotics, methods of analgesia and anaesthesia used, and use of abortifacients. RESULTS: There is a trend towards low cost technology such as the use of manual vacuum aspiration and sedation anaesthesia; however, this is mainly limited to the better resourced tertiary hospitals linked to academic units. The use of antibiotics and blood products has decreased but much of the use is inappropriate. The use of abortifacients does include some use of misoprostol but merely as an adjunct to surgical evacuation. CONCLUSIONS: The management of incomplete abortion remains a problem in South Africa, a low income country that is still managing a common clinical problem with costly interventions. The evidence of a trend towards low cost technology is promising, albeit limited to tertiary centres. This study has given us information as how to best address this problem. More training in low cost methods is needed, targeting in particular the district and regional hospitals, and reinforced by skills training focussed mainly on undergraduates and midwife post-abortion care programmes.

Abortifacient Agents↗
PubMed1997

[Use of manual vacuum aspiration in reducing cost and duration of hospitalization due to incomplete abortion in an urban area of northeastern Brazil].

INTRODUCTION: In most developed countries vacuum aspiration has been shown to be safer and less costly than sharp curettage (SC) for uterine evacuation. In many of the developing countries, including Brazil, sharp curettage (SC) is the most commonly used technique for treating cases of incomplete abortion admitted to hospital. The procedure often involves light to heavy sedation for pain control and an overnight hospital stay for patient recuperation and monitoring. Two hypotheses are examined: the first, that the use of manual vacuum aspiration (MVA)--a variation of the vacuum aspiration, would be less costly than SC for the treatment of cases of incomplete abortion admitted to hospital; and the second, that the treatment of incomplete abortion with MVA would substantially reduce the length of hospital stay. METHODOLOGY: Thirty women with diagnosis of first trimester incomplete abortion were randomly allocated to the SC or MVA group. Rapid-assessment data collection techniques were used to identify factors that contributed to cost reduction and hospital stay. RESULTS AND CONCLUSION: The results of the study show that, overall, patients treated for incomplete abortion with MVA spent 77% less time in the hospital and consumed 41% fewer resources than similarly diagnosed patients treated with SC. Recommendations are made as to the need of certain changes in patient management. Particularly necessary is information regarding cultural perception and concepts of abortion treatment.

Abortion, Incomplete↗
PubMed1995

A randomized trial of prophylactic doxycycline for curettage in incomplete abortion.

OBJECTIVE: To determine whether prophylactic doxycycline at suction curettage for incomplete abortion decreases the rate of postoperative pelvic infection. METHODS: We randomized 240 patients to receive intravenous doxycycline or placebo at curettage. Cervical specimens for gonorrhea and chlamydia were obtained preoperatively. Two weeks post-procedure, we evaluated all patients for infectious morbidity and repeated gonorrhea and chlamydia cultures. Statistical analysis used Mann-Whitney U test, McNemar test, or Fisher exact test, as appropriate. RESULTS: There were no statistically significant differences in age, parity, gestational age, history of sexually transmitted disease, pelvic inflammatory disease, or multiple sex partners between the doxycycline and placebo groups. Preoperative gonorrhea or chlamydia isolates were positive in five (4.2%) and six (5%) of 120 doxycycline patients and four (3.3%) and eight (6.6%) of 120 controls (not significant). All preoperative gonorrhea isolates remained positive postoperatively. Seven (5.8%) controls had positive postoperative chlamydia isolates, as did one (0.8%) in the doxycycline group (P = .06). We diagnosed eight (6.6%) of 120 doxycycline patients and seven (5.8%) of 120 controls with infectious morbidity (not significant). CONCLUSION: In our population of patients with incomplete abortion, the prevalence of gonorrhea and chlamydia was low, and prophylactic doxycycline did not decrease the rate of postoperative febrile morbidity.

Abortion, Incomplete↗
PubMed2005

A randomized controlled study comparing 600 versus 1,200 microg oral misoprostol for medical management of incomplete abortion.

OBJECTIVES: Although a number of studies have shown misoprostol's promise as a nonsurgical treatment for incomplete abortion, few have systematically examined treatment protocols. This study documents the effectiveness of 600 versus 1,200 microg oral misoprostol for this indication. METHODS: From May 2002 to January 2003, 300 women with incomplete abortion were recruited at a large tertiary facility in Vietnam and randomized to either a single-dose (600 microg) or a repeated-dose (600 microg x 2) regimen of oral misoprostol for the treatment of their condition. RESULTS: Misoprostol effectively evacuated the uterus for nearly all women (94.6%; n=279), with most reporting bleeding for 4 days (+/-2.3) and pain/cramps lasting 1 day (+/-1.0). Women indicated that the side effects were tolerable (96%) and that their experience was satisfactory (95%). CONCLUSIONS: Oral misoprostol (600 or 1,200 microg) offers a safe, effective and acceptable treatment for incomplete abortion. Larger studies to assess the advantages and disadvantages of misoprostol as compared with standard surgical care are needed to assess its role in postabortion care programs worldwide.

Abortifacient Agents, Nonsteroidal↗