Several reports have shown that vaginal examination, uterine curettage
specimens, ultrasonography, and hysterography are usually uninformative.
Many clinicians (and malpractice attorneys) are familiar with unfortunate cases of women who underwent uterine curettage
or were given methotrexate, based on an hCG level found to be in the discriminatory zone without accompanying evidence of intrauterine pregnancy, only to lose what was, in fact, a potentially viable pregnancy.
49% had uterine curettage
, and 26% had hysteroscopy.
The greatest risk factors include anything that may cause scarring of the endometrial cavity, such as grand multiparity, previous cesarean delivery, uterine curettage
, myomectomy and Asherman syndrome (a disease that causes intrauterine adhesions).
Appropriate statistical tests were used to assess differences in continuous and discrete characteristics between women whose posttermination fDNA concentrations were increased and those whose concentrations were decreased as follows: the Mann-Whitney-Wilcoxon test was used to assess the differences in median pretermination fDNA concentrations, median time interval between TOP and post-TOP blood draw, and median gestational age between the two groups; the [chi square] test was used to estimate the difference between groups in the percentage of women who received sharp uterine curettage
; and the Fisher exact test was used to assess the difference in the percentages of the women in the two groups who had vaginal bleeding before the procedure.
These include grand multiparity; Asherman's syndrome; and previous cesarean delivery, uterine curettage
, myomectomy, or uterine reconstructive surgery.
For the patient with persistent cytologic atypia, cervical conization or uterine curettage
or both may be necessary.
Several risk factors have been identified for the development of placenta accreta, including previous cesarean delivery, advanced maternal age, high gravidity, multiparity, previous uterine curettage
, and placenta previa .
Manyou and Phupong found that administration of 120mg oral etoricoxib 30 minutes before the procedure slightly reduced pain during fractional curettage under a paracervical block.28 However, in another trial by Poomtavorn et al., the administration of 50mg rofecoxib 60minutes before procedure was ineffective at reducing pain during uterine curettage
.29 Dogan et al.
It is generally accepted that a detailed history, careful general and pelvic examination, cervical smear, uterine curettage
, hysteroscopy or at least an endometrial biopsy are essential to exclude organic disease.