Ultrasound criteria for the follow-up of medical abortion

Details

Ressource 1 Under indefinite embargo.
UNIL restricted access
State: Public
Version: After imprimatur
License: Not specified
Serval ID
serval:BIB_FEF0186531EE
Type
A Master's thesis.
Publication sub-type
Master (thesis) (master)
Collection
Publications
Institution
Title
Ultrasound criteria for the follow-up of medical abortion
Author(s)
MERIGAY L.
Director(s)
RENTERIA S.-C.
Institution details
Université de Lausanne, Faculté de biologie et médecine
Publication state
Accepted
Issued date
2022
Language
english
Number of pages
30
Abstract
INTRO. Over the last 10 years, we have noticed a transition from surgical abortion to medical abortion. With medical abortion, 1-2% of women will have a continuing pregnancy while up to 4% will have an incomplete expulsion. Follow-up is important to exclude continuing pregnancy or retained products of conception, failure to diagnose the latter can lead to considerable bleeding or infection. It is equally important to have a reliable method of differentiating between patients who need further intervention, and those who do not to reduce the amount of unnecessary additional follow-up. OBJECTIVES. The goal of this study is to analyse the current state of medical abortion follow-up in literature and in practice, to find ways to limit the amount of additional interventions. MATERIALS AND METHODS. A thorough review of literature was conducted, looking at both the Pubmed and Embase databases, as well as an analysis of current theoretical instruction pertaining to the physiological evolution of the post abortion uterus. Finally, we analysed a summary of the ultrasound labels used in relationship to follow-up ultrasounds performed at the CHUV from April to February 2021 in the context of the follow-up after medical abortion. RESULTS. The presence of a uterine cavity, with an endometrial thickness less than 15mm and without doppler signal is the usual appearance of the uterine cavity after a medical abortion. Studies show that using doppler in conjunction with transvaginal sonography could make the ultrasound evaluation of the post abortion uterus more reliable. The analysis of the ultrasound labelings found that a third of the description of a “thickened endometrium”, with or without metric indications, led to the conclusion of an echographic suspicion of retained products of conception based on this observation. DISCUSSION. It is important to diagnose RPOC1 to avoid serious complications, however it is difficult to find a consensus in literature on how not to overdiagnose RPOC. Although the use of power doppler has proved useful in differentiating RPOC from blood clots, endometrial thickness alone is not powerful enough of a diagnostic tool to be used without a clinical evaluation. Some studies have also looked into the merit of an expectative approach. CONCLUSION. RPOC tend to be overdiagnosed, exposing the patients to unnecessary trauma by the surgical attempt to remove them or by additional unnecessary even noninvasive medical procedures. If there is no clear evidence, clinicians should consider conservative treatment of suspected RPOC in absence of accompanying symptoms such as infection, abdominal pain or excessive bleeding.
Keywords
Medical Abortion, Endometrial Thickness, Transvaginal Sonography
Create date
12/09/2023 14:52
Last modification date
25/07/2024 5:56
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