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El presente trabajo de investigación surge a raíz de la resistencia, temor y la falta de compromiso del personal médico del HNDM (Hospital Nacional Dos de Mayo) para incorporar el Misoprostol como primera alternativa en el tratamiento del aborto incompleto precoz, esto quizás por el miedo a las complicaciones y por ende a los problemas médico legales a pesar de que existen varias revisiones sistemáticas quienes demuestran fehacientemente la efectividad del Misoprostol en el tratamiento del aborto incompleto precoz. Este trabajo de investigación es mediante un estudio Descriptivo, Transversal y retrospectivo el cual nos permitirá demostrar una vez más la efectividad y beneficios del Misoprostol en pacientes que acudieron al HNDM y que fueron diagnosticados de aborto incompleto y recibieron tratamiento médico con Misoprostol en relación al Tx quirúrgico, esto permitirá motivar al personal de salud del HNDM a incorporar al Misoprostol como tratamiento de primera línea en el aborto incompleto precoz. El número total de abortos en general en el Hospital Nacional Dos de Mayo en el periodo de Enero a Diciembre del 2012 fue 496 de los cuales 322 (65 por ciento) fueron aborto incompleto que cumplían los criterios para el TX médico, y solo 111 (34 por ciento) recibieron tratamiento médico con misoprostol 600 mcg vía oral en dosis única y 153 (48 por ciento) termino en AMEU y 58 (18 por ciento) en EBA más LU. El servicio de Gineco Obstetricia del HNDM cuenta con 28 Gíneco Obstetras de los cuales solo 12 (43 por ciento) realiza tratamiento médico con misoprostol y 16 (57 por ciento) tratamiento quirúrgico (AMEU-LU) a pacientes con aborto incompleto que cumplen los criterios para TX médico, siendo las principales causas: resistencia al cambio 56 por ciento, temor a las complicaciones 31 por ciento y falta de capacitación 13 por ciento. De un total de 111 HCL con abortos incompletos que reciben tratamiento médico con misoprostol el 78 por ciento son menores de 30 años y el...

The present research stems from the resistance, fear and lack of commitment HNDM medical staff to incorporate Misoprostol as first aIternate in the earIy treatment of incompIete abortion, that perhaps the fear of compIications and hence medico-legal probIems even though there are several systematic reviews who clearly demonstrate the effectiveness of MisoprostoI in the treatment of earIy incomplete abortion. This research is a descriptive, transversal and retrospective which will allow us to further demonstrate the effectiveness of Misoprostol in patients attending the HNDM and who were diagnosed with incomplete abortion with Misoprostol received medical treatment, this will allow us to motivate the HNDM health staff to incorporate the Misoprostol as first line treatment of incomplete abortion in earIy. The total number of abortions in general in the National Hospital Dos de Mayo in the period from January to December 2012 was 496 of which 322 (65 per cent) were incomplete abortion that met the criteria for the TX doctor, and only 111 (34 per cent) received medical treatment with Misoprostol 600 mcg orally in a single dose and 153 (48 per cent) ended in MV A and 58 (18 per cent) in aduIt education more LV The Department of Obstetrics and Gynecology of the HNDM account with 28 Ob/gyns of which only 12 (43 per cent) performs medical treatment with Misoprostol and 16 (57 per cent) TX in surgical patients with incomplete abortion that meet the criteria for TX doctor, being the main causes: resistance to change 56 per cent, fear of complications 31 per cent and lack of training 13 per cent. A total of 111 HCL with incomplete abortions that receive medical treatment with Misoprostol 78 per cent are under 30 years of age and 39 per cent and 33 per cent come from the District of Lima and Victory respectively, 52 per cent have full high school education and 31 per cent complete primary school, on the other hand, the 41 per cent are housewife and 53 per cent merchant...

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OBJETIVO: Analisar a eficácia e a ocorrência de complicações, além do tempo de permanência hospitalar e as perdas sanguíneas. MÉTODOS: Trinta pacientes foram selecionadas, alternada e consecutivamente, em um dos grupos (15 no Grupo Curetagem e 15 no Grupo de Aspiração manual intrauterina). As variáveis analisadas foram: eficácia do método, ocorrência de complicações, tempo pré-procedimento, tempo de execução do procedimento, tempo pós-procedimento e tempo total de permanência hospitalar, além de hematócrito e hemoglobina, medidas antes e após o procedimento. As pacientes foram avaliadas clinicamente 10 a 14 dias após o procedimento. Para a análise estatística, foram aplicados testes paramétricos e não-paramétricos e o nível de significância admitido foi de p>0,05. RESULTADOS: Ambos os métodos foram eficazes e não foi registrada nenhuma complicação. As perdas sanguíneas foram semelhantes e o tempo de permanência hospitalar foi significativamente menor no Grupo de Aspiração Manual Intrauterina (p=0,03). CONCLUSÃO: a aspiração manual intrauterina é tão eficaz e segura quanto à curetagem uterina, com a vantagem de necessitar menor tempo de permanência hospitalar, o que aumenta a resolutividade do método, melhorando a qualidade da assistência a essas pacientes.

PURPOSE: To analyze the effectiveness and occurrence of complications, in addition to hospitalization time and blood losses. METHODS: Thirty patients were assigned alternatively and consecutively to one of two groups (15 to the Curettage Group and 15 to the Manual Vacuum Aspiration Group). The following variables were analyzed: effectiveness of the method, occurrence of complications, time before the procedure, time of execution of the procedure, time after the procedure, and total time of hospital permanence, in addition to hematocrit and hemoglobin, which were measured before and after the procedure. Patients were evaluated clinically 10 to 14 days after the procedure. Parametric and nonparametric tests were used for statistical analysis, with the level of significance set at p>0.05. RESULTS: Both methods were efficient and no complications were recorded. Blood losses were similar in the two groups, but the hospitalization time was significantly shorter for the Manual Vacuum Aspiration Group (p=0.03). CONCLUSION: Manual vacuum aspiration is as efficient and safe as uterine curettage, with the advantage of requiring shorter hospitalization, which increases the resolution of the method, improving the quality of care for these patients.

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OBJECTIVE: To assess the feasibility of introducing misoprostol for the treatment of incomplete abortion in Quito, Ecuador. METHODS: In a randomized prospective study conducted at a large tertiary-level maternity hospital and a private secondary-level clinic between November 2006 and November 2007, women with incomplete abortion were treated with either 600 µg of oral misoprostol (n=122) or manual vacuum aspiration (MVA) (n=120). All participants were requested to return for follow-up care on day 7 to determine the success of the treatment and to document their satisfaction with the method and the adverse effects experienced. RESULTS: Sixteen percent of women (39/242) did not return for their follow-up visit and their outcomes are unknown. Among those who did return, 94% (100/106) of women showed successful completion of abortion after treatment with misoprostol, as compared with 100% (97/97) of women treated with MVA. Most women described their adverse effects after treatment as tolerable (misoprostol, 95%; MVA, 91%). Nearly all women reported being satisfied with their treatment (196/203); there were no differences among the women's reports of satisfaction according to treatment received. CONCLUSION: An oral dose of 600 µg of misoprostol was found to be an acceptable and effective non-surgical option for treating incomplete abortion. Clinical trials.gov NCT00674232.

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PURPOSE: To analyze the effectiveness and occurrence of complications, in addition to hospitalization time and blood losses. METHODS: Thirty patients were assigned alternatively and consecutively to one of two groups (15 to the Curettage Group and 15 to the Manual Vacuum Aspiration Group). The following variables were analyzed: effectiveness of the method, occurrence of complications, time before the procedure, time of execution of the procedure, time after the procedure, and total time of hospital permanence, in addition to hematocrit and hemoglobin, which were measured before and after the procedure. Patients were evaluated clinically 10 to 14 days after the procedure. Parametric and nonparametric tests were used for statistical analysis, with the level of significance set at p>0.05. RESULTS: Both methods were efficient and no complications were recorded. Blood losses were similar in the two groups, but the hospitalization time was significantly shorter for the Manual Vacuum Aspiration Group (p=0.03). CONCLUSION: Manual vacuum aspiration is as efficient and safe as uterine curettage, with the advantage of requiring shorter hospitalization, which increases the resolution of the method, improving the quality of care for these patients.

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CONTEXT AND OBJECTIVE: Intrauterine adhesion (IUA) is a possible complication of uterine curettage following abortion. Because IUA is an important cause of infertility, some investigators have been advocating its inclusion in the routine investigational workup after every abortion curettage procedure. The aim of this study was to evaluate the uterine cavity of patients subjected to abortion curettage, in order to ascertain the prevalence of IUA and its association with social and clinical factors. DESIGN AND SETTING: This was a cross-sectional study at the Human Reproduction Unit, Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (Unicamp). METHODS: A total of 109 women were enrolled. The investigators searched the records of Unicamp's hospital for patients who had been subjected to uterine curettage following abortion. The hysteroscopy was performed 3 to 12 months after the curettage. The correlations between patients' characteristics and the prevalence of IUA were assessed by means of chi-squared and Fisher's exact test calculations. RESULTS: The prevalence of IUA was 37.6%. The number of previous abortions and curettage procedures did not correlate with the presence of IUA. Most of the women (56.1%) presented IUA grade I. CONCLUSIONS: In the present study, 37.6% of the women subjected to curettage following abortion had IUA, which was mostly mucous and grade I. None of the demographic and clinic characteristics evaluated were found to be associated with IUA. From this study, there is no firm evidence to justify carrying out routine diagnostic hysteroscopy following abortion evacuation.

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CONTEXT AND OBJECTIVE: Intrauterine adhesion (IUA) is a possible complication of uterine curettage following abortion. Because IUA is an important cause of infertility, some investigators have been advocating its inclusion in the routine investigational workup after every abortion curettage procedure. The aim of this study was to evaluate the uterine cavity of patients subjected to abortion curettage, in order to ascertain the prevalence of IUA and its association with social and clinical factors. DESIGN AND SETTING: This was a cross-sectional study at the Human Reproduction Unit, Department of Obstetrics and Gynecology, Universidade Estadual de Campinas (Unicamp). METHODS: A total of 109 women were enrolled. The investigators searched the records of Unicamp's hospital for patients who had been subjected to uterine curettage following abortion. The hysteroscopy was performed 3 to 12 months after the curettage. The correlations between patients' characteristics and the prevalence of IUA were assessed by means of chi-squared and Fisher's exact test calculations. RESULTS: The prevalence of IUA was 37.6 percent. The number of previous abortions and curettage procedures did not correlate with the presence of IUA. Most of the women (56.1 percent) presented IUA grade I. CONCLUSIONS: In the present study, 37.6 percent of the women subjected to curettage following abortion had IUA, which was mostly mucous and grade I. None of the demographic and clinic characteristics evaluated were found to be associated with IUA. From this study, there is no firm evidence to justify carrying out routine diagnostic hysteroscopy following abortion evacuation.

CONTEXTO E OBJETIVO: As sinéquias uterinas são complicações que podem ocorrer após curetagem uterina por aborto. Como se trata de causa importante de infertilidade, muitos autores têm indicado uma investigação rotineira após curetagens uterinas por aborto. O objetivo do estudo foi avaliar a cavidade uterina de pacientes submetidas a curetagem após aborto para detectar a prevalência das sinéquias e a possível associação com alguns fatores sociais e clínicos. TIPO DE ESTUDO E LOCAL: Estudo de corte transversal, realizado na Unidade de Reprodução Humana do Departamento de Ginecologia e Obstetrícia da Universidade Estadual de Campinas (Unicamp). MÉTODOS: 109 mulheres foram submetidas a histeroscopia diagnóstica ambulatorial 3 a 12 meses após curetagem por aborto. Dados clínicos foram obtidos dos prontuários médicos. As correlações entre as características clínicas e a prevalência de sinéquias uterinas foram testadas através do cálculo do qui-quadrado e do teste exato de Fisher. RESULTADOS: A prevalência de sinéquias foi de 37,6 por cento. O número de abortos anteriores e de curetagens não se correlacionou com a presença de sinéquias. A maioria das mulheres (56,1 por cento) apresentou sinéquias grau I. CONCLUSÕES: Neste estudo, 37,6 por cento das mulheres submetidas a curetagem por aborto apresentaram sinéquias, a maioria delas do tipo mucoso e de grau I. Nenhuma das características clínicas e demográficas avaliadas associou-se às sinéquias. Os resultados deste estudo não autorizam indicação rotineira de histeroscopia diagnóstica em pacientes submetidas a curetagem uterina por aborto.

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OBJECTIVE: To estimate the effectiveness of different methods of analgesia among women treated with manual vacuum aspiration for spontaneous abortion. MATERIALS AND METHODS: The 113 patients diagnosed with incomplete abortion and considered candidates for manual vacuum aspiration were randomly assigned to 3 groups of analgesic administration: diclofenac plus paracervical block; meperidine plus diclofenac; and meperidine alone. Pain levels were evaluated using the Wong Scale of Pain. RESULTS: The mean pain scores for the three groups were: diclofenac and paracervical block 5.4; meperidine plus diclofenac 5.0; meperidine 5.7 (P=0.57). Analysis of pain using the levels mild (0-3), moderate (4-6), and severe (7-10) showed no statistical significance among the 3 groups of analgesics. Adverse effects were more common in the groups using analgesia containing meperidine. CONCLUSIONS: There was no significant difference between the analgesics used among the 3 groups. Most of the patients, regardless of the analgesic used, reported moderate pain.

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OBJECTIVES: To compare manual vacuum aspiration (MVA) and uterine curettage (D and C) for first trimester abortions, in terms of the efficiency of eliminating ovular remnants, frequency of complications, duration of the procedure, and duration of patients' hospitalization. METHODS: In a prospective study, 50 patients in the MVA group and 50 in the D&C group were randomly included. Inclusion criteria were: spontaneous abortion, gestational age less than 13 weeks, patent cervix, endometrial thickness >15 mm, afebrile state, and hemoglobin >10 g/dl. Blood samples were collected before and after surgical procedures for control of hemoglobin levels. Anesthesia was performed in all cases. The time required for each surgical procedure was recorded. RESULTS: Groups were similar regarding gestational age (9.93 +/- 2.40 vs 9.73 +/- 2.58 weeks; p = 0.71) and endometrial thickness before surgery (22.14 +/- 4.80 vs 22.68 +/- 5.68 mm; p = 0.65). There were no surgical or anesthetic complications in either group. Durations of the procedure and of hospitalization were significantly shorter in the MVA group (3.71 vs 10.18 min, p < 0.001, and 14.18 vs 23.06 h, p = 0.03, respectively). Decrease of hemoglobin levels was greater after the surgical procedure in the D and C group (p = 0.02). CONCLUSION: MVA caused less blood loss, was less time consuming, and resulted in shorter hospitalization. However, both surgical procedures were found to be efficient for treatment of incomplete abortions during the first trimester of pregnancy, with no complications after both treatments.

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OBJETIVOS: Comparar aspiração manual intra-uterina (AMIU) com curetagem uterina (D&C) em abortamentos no primeiro trimestre no que se refere a eficiência para eliminar restos ovulares do método de aspiração manual intra-uterina com a dilatação e curetagem, ocorrência de complicações (perfuração uterina, laceração cervical, hemorragia pós-tratamento), tempo duração dos procedimentos e tempo de internação das pacientes. MÉTODOS: Cinqüenta pacientes no grupo AMIU e 50 pacientes no grupo D&C foram incluídas prospectivamente de maneira aleatória. Critérios de inclusão: abortamento espontâneo, idade gestacional de até 13 semanas, colo pérvio, espessura endometrial maior que 15 mm, estado afebril, hemoglobina superior a 10 g/dl. Amostras sangüíneas foram colhidas antes e após os procedimentos cirúrgicos para controle dos níveis de hemoglobina; anestesia foi realizada em todos os casos. O tempo para realização de cada procedimento cirúrgico foi cronometrado. RESULTADOS: Os grupos eram semelhantes quanto à idade gestacional (9,93±2,40; 9,73±2,58, p 0,71), espessura endometrial antes da cirurgia (22,14±4,80; 22,68±5,68, p 0,65). Não foram observadas complicações cirúrgicas ou anestésicas em nenhum grupo. Os tempos de realização do procedimento e internação foram significativamente menores nas pacientes do grupo AMIU (3,71; 10,18 min, p < 0,001) (14,18; 23,06 h, p 0,03). O decréscimo nos níveis de hemoglobina após o procedimento cirúrgico foi maior no grupo D&C (p= 0,02). CONCLUSÃO: A AMIU possibilita menor perda sangüínea, requer menor tempo de realização do procedimento e menor tempo de internação hospitalar. Entretanto, ambos os procedimentos cirúrgicos mostraram-se eficientes para o tratamento de abortamentos incompletos no primeiro trimestre da gestação, não havendo complicações após a realização dos tratamentos.

OBJECTIVES: To compare manual vacuum aspiration (MVA) and uterine curettage (D&C) for first trimester abortions, in terms of the efficiency of eliminating ovular remnants, frequency of complications, duration of the procedure, and duration of patients' hospitalization. METHODS: In a prospective study, 50 patients in the MVA group and 50 in the D&C group were randomly included. Inclusion criteria were: spontaneous abortion, gestational age less than 13 weeks, patent cervix, endometrial thickness >15 mm, afebrile state, and hemoglobin >10 g/dl. Blood samples were collected before and after surgical procedures for control of hemoglobin levels. Anesthesia was performed in all cases. The time required for each surgical procedure was recorded. RESULTS: Groups were similar regarding gestational age (9.93 ± 2.40 vs 9.73 ± 2.58 weeks; p = 0.71) and endometrial thickness before surgery (22.14 ± 4.80 vs 22.68 ± 5.68 mm; p = 0.65). There were no surgical or anesthetic complications in either group. Durations of the procedure and of hospitalization were significantly shorter in the MVA group (3.71 vs 10.18 min, p < 0.001, and 14.18 vs 23.06 h, p = 0.03, respectively). Decrease of hemoglobin levels was greater after the surgical procedure in the D&C group (p = 0.02). CONCLUSION: MVA caused less blood loss, was less time consuming, and resulted in shorter hospitalization. However, both surgical procedures were found to be efficient for treatment of incomplete abortions during the first trimester of pregnancy, with no complications after both treatments.

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Objetivo. Determinar algunas características sociodemográficas, económicas y clínicas, de una muestra de pacientes atendidas por aborto en el Hospital del Instituto Hondureño de Seguridad Social de San Pedro Sula. METODOS. Se encuestaron 46 pacientes con diagnósticos de aborto incompleto en quienes se practicó legrado intrauterino. RESULTADOS. La edad promedio fue de 27 años (rango 20-40 años). La mayoría procedía de San Pedro Sula(39.1 por ciento), Choloma(19.6 por ciento) y Villanueva (17.4 por ciento),e informó trabajar como operaria de maquila (63.0 por ciento), en posición de pie (58.7 por ciento) y con un salario mensual inferior o igual a L 5,000.00 (aprox. US$270). El 58.7 por ciento informó estar practicando algún método de planificación familiar. El espacio intergenético promedio fue de 5 años (DS = 3 años), el (67.4 por ciento) respondió que el embarazo era deseado y el 54.3 por ciento, informó haber iniciado control prenatal. CONCLUSIONES. El bajo nivel de escolaridad detectado, 54.3 por ciento con educación primaria incompleta o ninguna educación formal, podría ser la causa del uso incorrecto de los métodos de planificación. La educación y cultura general de la mujer son determinantes en la salud sexual y reproductiva de ella misma y de su familia. Por lo tanto, las intevenciones educativas en grupos con estas características requieren atención especial

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