Abstract
Objectives
Manual uterine aspiration (MUA) is a currently underused management option for early
pregnancy loss (EPL) in the emergency department (ED). This study addresses the safety
and efficiency of MUA in the ED.
Methods
We performed a single-site retrospective observational chart review of pregnant women
presenting to the ED with vaginal bleeding and ED pathology submissions for products
of conception (POC) between 2012 and 2016. Patients were excluded for gestational
age >14 weeks, no evidence of pregnancy loss, uterine cavity anomaly, hemodynamic
instability, or hemoglobin <80 g/L. We compared the frequencies of complications (need
for blood transfusion, repeat ED visit, failed initial management, admission to hospital)
and ED utilization time between 4 management options: expectant, misoprostol, MUA,
and electric vacuum aspiration (EVA) outside the ED, as well as time to procedure
between MUA and EVA.
Results
A total of 162 patients were included with 123 (76%) having a pathology report positive
for POC. The mean patient and gestational ages were 30 ± 7 years and 66 ± 17 days,
respectively. One hundred nine patients were managed expectantly, 9 were given misoprostol,
23 underwent MUA, and 21 underwent EVA. Composite complication rates were 40%, 33%,
9%, and 10% (P = 0.001), and mean ED times were 5.4, 4.9, 7.3, and 6.0 hours (P = 0.01), for expectant, misoprostol, MUA, and EVA, respectively. The mean time to
procedure was 5.1 hours for MUA and 23.1 hours for EVA (p=0.002).
Conclusions
Integrating MUA in the ED has the potential to reduce health care resource utilization
while improving patient care.
Résumé
Objectifs
L’aspiration utérine manuelle (AUM) est une option actuellement sous-utilisée pour
la prise en charge de l’avortement spontané précoce au service des urgences (SU).
Cette étude porte sur l’innocuité et l’efficacité de l’AUM au SU.
Méthodologie
Nous avons effectué un examen observationnel rétrospectif des dossiers de femmes enceintes
avec saignements vaginaux ayant consulté le SU et des demandes d’examen anatomopathologiques
pour détection de produit de conception (PC) pour la période de 2012 à 2016. Les critères
d’exclusions étaient : âge gestationnel de > 14 semaines, absence de signes d’avortement
spontané, anomalie de la cavité utérine, instabilité hémodynamique et hémoglobine
à < 80 g/L. Nous avons comparé la fréquence des complications (besoin d’une transfusion
sanguine, consultation répétée au SU, échec de la prise en charge initiale, hospitalisation)
et le temps d’utilisation du SU entre 4 options de prise en charge : expectative,
misoprostol, AUM et aspiration électrique (AE) à l’extérieur du SU ainsi que le temps
d’attente pour l’AUM et l’AE.
Résultats
Au total, 162 patientes ont été incluses, dont 123 (76 %) ont eu un résultat positif
de PC à l’examen anatomopathologique. L’âge moyen des patientes était de 30 ± 97 ans
et l’âge gestationnel moyen était de 66 ± 17 jours. Au total, 109 patientes ont eu
une prise en charge par expectative, 9 ont reçu du misoprostol, 23 ont subi une AUM
et 21 ont subi une AE. Les taux de complications composites étaient de 40 %, 33 %,
9 % et 10 % (p = 0,001), et les temps d’utilisation moyens des SU étaient de 5,4, 4,9, 7,3 et 6,0
heures (p = 0,01) pour la prise en charge par expectative, le misoprostol, l’AUM et l’AE, respectivement.
Le temps d’attente moyen avant l’intervention était de 5,1 heures pour l’AUM et de
23,1 heures pour l’AE (p = 0,002).
Conclusions
L’intégration de l’AUM au SU pourrait permettre de réduire l’utilisation des ressources
du système de santé tout en améliorant les soins aux patientes.
Keywords
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Article info
Publication history
Published online: March 03, 2022
Accepted:
February 4,
2022
Received:
November 10,
2021
Footnotes
Disclosures: The authors declare they have nothing to disclose.
All authors have indicated they meet the journal’s requirements for authorship.
Identification
Copyright
© 2022 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
