Evacuazione chirurgica della cavità uterina: manovra ormai obsoleta? Dott.ssa Chiodo

Transcript

1 Dott.ssa Chiodo Dott. Galli Dott. Luerti

2 NO! Dati ISTAT 2006 ( pz) RCU (95%) Tp Med (3%) altro (2%)

3 Letteratura Cochrane Database Syst Rev Jan 20;(1. ) Medical treatments for incomplete miscarriage (less than 24 weeks). Neilson JP, Gyte GM, Hickey M, Vazquez JC, Dou L. Fifteen studies (2750 women) were included, there were no studies on women over 13 weeks' gestation. Studies addressed a number of comparisons and data are therefore limited. Three trials compared misoprostol treatment with expectant care. There was no significant difference in complete miscarriage or in the need for surgical evacuation. Nine studies involving 1766 women addressed the comparison of misoprostol with surgical evacuation. There was no statistically significant difference in complete miscarriage with success rate high for both methods. Overall, there were fewer surgical evacuations with misoprostol but more unplanned procedures

4 Letteratura Cochrane Database Syst Rev Jul 19;3:CD Medical treatment for early fetal death (less than 24 weeks). Neilson JP, Hickey M, Vazquez J. BACKGROUND: In most pregnancies that miscarry, treatment before 14 weeks has 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 treatment for early pregnancy failure (anembryonic pregnancies or embryonic and fetal deaths before 24 weeks).' CONCLUSIONS: Available evidence from randomised trials supports the use of vaginal misoprostol as a medical treatment to terminate non-viable pregnancies before 24 weeks. Further research is required to assess effectiveness and safety, optimal route of administration and dose. Conflicting findings about the value of mifepristone need to be resolved by additional study.

5 X? Efficacia/ gestione Costi/ prefere nza pz compli canze

6 COMPLICANZE ANESTESIOLOGICHE CHIRURGICHE POST-CHIRURGICHE IMMEDIATE POST-CHIRURGICHE TARDIVE

7 Letteratura J Am Assoc Gynecol Laparosc May;9(2): Intrauterine adhesions after conservative and surgical management of spontaneous abortion. Tam WH, 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 conception after 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 managed conservatively or by medical evacuation, whereas two cases (7.7%) of filmy IUA were detected in those managed by surgical evacuation.

8 Razionale EPITELIO: E IN GENERE CAPACE DI PROLIFERARE DOPO UNA FERITA RIPARANDO LA LESIONE STESSA TESSUTO MUSCOLARE LISCIO ESTESE PERDITE DI TESSUTO SONO DI SOLITO RIPARATE MEDIANTE LA FORMAZIONE DI UNA CICATRICE CONNETTIVALE

9 Razionale S A Z I O N E EB EF M

10 Studio RICERCA DI MIOCITI IN CAMPIONI OTTENUTI DA ISTEROSUZIONE E CURETTAGE ESEGUITI A SEGUITO DI ABORTO SPONTANEO DEL I TRIMESTRE IN 10 PAZIENTI

11 Razionale DANNO MIOMETRIALE ESTENSIONE DEL DANNO (EMBRIOISTEROSCPOPIA) SEQUELE???

12 Letteratura Best Pract Res Clin Obstet Gynaecol Mar 31. Obstetric performance following an induced abortion. Lowit A, Bhattacharya S, Bhattacharya S. Some data suggest that IA may be linked with an increased risk of low birth weight, miscarriage and placenta previa but could be protective for pre-eclampsia. Current evidence also suggests an association between IA and pre-term birth.

13 Conclusioni