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Manual Uterine Aspiration in the Emergency Department as a First-Line Therapy for Early Pregnancy Loss: A Single-Centre Retrospective Study

Published:March 03, 2022DOI:https://doi.org/10.1016/j.jogc.2022.02.009

      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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