Evacuazione chirurgica della cavità uterina: …...WH,Lau WC, Cheung LP, Yuen PM, Chung TK...

Evacuazione chirurgica della cavità uterina: manovra ormai obsoleta?

Dott.ssa Chiodo

Dott. LuertiDott. Galli


NO!

Dati ISTAT2006

(66.308 pz)

RCU (95%)

Tp Med (3%)

altro (2%)


LetteraturaCochrane Database Syst Rev. 2010 Jan 20;(1. )Medical treatments for incomplete miscarriage (less than 24 weeks). NeilsonJP, Gyte GM, Hickey M, Vazquez JC, Dou L.

Fifteen studies (2750 women) were included, there were no studies onwomen over 13 weeks' gestation. Studies addressed a number of comparisonsand data are therefore limited. Three trials compared misoprostol treatmentwith expectant care. There was no significant difference in completemiscarriage or in the need for surgical evacuation.Nine studies involving 1766 women addressed the comparison of misoprostolwith surgical evacuation. There was no statistically significant difference incomplete miscarriage with success rate high for both methods. Overall, therewere fewer surgical evacuations with misoprostol but more unplannedprocedures


LetteraturaCochrane Database Syst Rev. 2006 Jul 19;3:CD002253. Medical treatment forearly fetal death (less than 24 weeks). Neilson JP, Hickey M, Vazquez J.

BACKGROUND: In most pregnancies that miscarry, treatment before 14 weekshas traditionally been surgical but medical treatments may be effective, safe,and acceptable, as may be waiting for spontaneous miscarriage. OBJECTIVES:To assess the effectiveness, safety and acceptability of any medical treatmentfor early pregnancy failure (anembryonic pregnancies or embryonic and fetaldeaths before 24 weeks).' CONCLUSIONS: Available evidence from randomisedtrials supports the use of vaginal misoprostol as a medical treatment toterminate non-viable pregnancies before 24 weeks. Further research isrequired to assess effectiveness and safety, optimal route of administrationand dose. Conflicting findings about the value of mifepristone need to beresolved by additional study.


X’?

Efficacia/ gestione

complicanze

Costi/ preferenza pz


COMPLICANZE

POST-CHIRURGICHETARDIVE

POST-CHIRURGICHEIMMEDIATE

CHIRURGICHE

ANESTESIOLOGICHE


LetteraturaJ Am Assoc Gynecol Laparosc. 2002 May;9(2):182-5. Intrauterine adhesionsafter conservative and surgical management of spontaneous abortion. TamWH, Lau WC, Cheung LP, Yuen PM, Chung TK

Eighty-two women who had been treated with conservative management,medical evacuation, or surgical evacuation of retained products of conceptionafter spontaneous abortions in a randomized, controlled trial.Hysteroscopic diagnosis of IUA 6 months after initial treatment was the

primary outcome measure. No cases of IUA were found in patients managedconservatively or by medical evacuation, whereas two cases (7.7%) of filmyIUA were detected in those managed by surgical evacuation.


RazionaleEPITELIO: E’ IN GENERE CAPACE DI PROLIFERARE DOPO UNA FERITARIPARANDO LA LESIONE STESSA

TESSUTO MUSCOLARE LISCIO ESTESE PERDITE DI TESSUTO SONO DISOLITO RIPARATE MEDIANTE LA FORMAZIONE DI UNA CICATRICECONNETTIVALE


Razionale

EF

EB

M

S

AZIONE


StudioRICERCA DI MIOCITI

IN CAMPIONI OTTENUTI DA ISTEROSUZIONE E CURETTAGE

ESEGUITI A SEGUITO DI ABORTO SPONTANEO DEL I TRIMESTRE

IN 10 PAZIENTI


RazionaleDANNO MIOMETRIALE

ESTENSIONE DEL DANNO (EMBRIOISTEROSCPOPIA)

SEQUELE ???


Letteratura

Best Pract Res Clin Obstet Gynaecol. 2010 Mar 31.Obstetric performance following an induced abortion. LowitA, Bhattacharya S, Bhattacharya S.

Some data suggest that IA may be linked with an increasedrisk of low birth weight, miscarriage and placenta previa butcould be protective for pre-eclampsia. Current evidence alsosuggests an association between IA and pre-term birth.


Conclusioni

Evacuazione chirurgica della cavità uterina: …...WH,Lau WC, Cheung LP, Yuen PM, Chung TK...

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