Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Acta Obstet Gynecol Scand. 2021 Nov;100(11):2076-2081. doi: 10.1111/aogs.14245. Epub 2021 Aug 31.
Missed abortion can be treated with medication or aspiration curettage. A Karman aspiration cannula is another option. We evaluated its success in evacuating retained products of conception (RPOC) based on symptoms, endometrial thickness, endometrial irregularity, and blood flow seen on Doppler ultrasound (indicative of placenta).
This prospective, randomized, nonblinded trial was conducted in a university-affiliated medical center. It included 40 women diagnosed with missed abortion and two failed courses of 600 µg buccal misoprostol, one week apart, randomly assigned to treatment or controls. One week after the second misoprostol course, immediately after evaluating endometrial thickness, endometrial irregularity using Doppler ultrasound, and with blood flow indicative of RPOC, women in the aspiration group underwent endometrial suction with a Karman aspiration cannula. The 5-6 mm cannula attached to a 60 mL syringe was inserted into the uterus under ultrasound guidance. The contents were aspirated until the uterus was empty. Control group patients did not receive additional treatment. All were scheduled for ambulatory, operative hysteroscopy under anesthesia 1 month later (departmental protocol). On that day, all women with RPOC on Doppler ultrasound underwent hysteroscopy. Bleeding days, days with pain, pain according to visual analog scale, length of hospitalization, and infection rate were recorded. NIH clinical trial registration number NCT02917785.
In the study group, 90% did not need hysteroscopy, compared with 50% of controls (p = 0.014). No complications were noted. At all visits, we used Doppler ultrasound to exclude or confirm RPOC. Pathology revealed RPOC in all women who underwent aspiration. Average visual analog scale score for office aspiration (n = 20) was 4.9 ± 3.6. vs. 6.3 ± 3.4 for the first (p = 0.157) and 4.7 ± 3.3 for the second (p = 0.836) misoprostol treatment cycle. The treatment group experienced 6.1 days of bleeding and the control group experienced 1.4 days (p = .006).
Based on our criteria of diagnosing RPOC according to symptoms, endometrial thickness, endometrial irregularity, and blood flow indicative of placental tissue seen on Doppler ultrasound and histo-pathological confirmation, aspiration using Karman cannula can be an effective therapeutic approach. It may be a safe alternative for women with RPOC after misoprostol failure.
稽留流产可以通过药物治疗或吸引刮宫术进行治疗。卡曼吸引管也是一种选择。我们根据症状、子宫内膜厚度、子宫内膜不规则和多普勒超声显示的血流（提示胎盘）评估其在排空残留妊娠产物（RPOC）方面的成功。
这是一项在大学附属医院进行的前瞻性、随机、非盲试验。它包括 40 名被诊断为稽留流产且两次 600µg 颊部米索前列醇治疗失败的患者，间隔一周，随机分为治疗组或对照组。在第二次米索前列醇治疗后一周，在评估子宫内膜厚度、多普勒超声下子宫内膜不规则和提示 RPOC 的血流后，立即进行卡曼吸引管子宫内膜抽吸术。将 5-6mm 的套管连接到 60ml 的注射器上，在超声引导下插入子宫。将内容物吸出，直到子宫排空。对照组患者未接受额外治疗。所有患者均在 1 个月后（科室方案）安排在门诊全身麻醉下行宫腔镜检查。当天，所有多普勒超声提示 RPOC 的患者均进行宫腔镜检查。记录出血天数、疼痛天数、疼痛视觉模拟评分、住院时间和感染率。美国国立卫生研究院临床试验注册号 NCT02917785。
研究组 90%的患者无需宫腔镜检查，而对照组为 50%（p=0.014）。未观察到并发症。在所有就诊时，我们均使用多普勒超声排除或确认 RPOC。所有接受抽吸术的患者的病理均显示 RPOC。20 例行门诊抽吸术的患者的平均视觉模拟评分（n=20）为 4.9±3.6。第一次（p=0.157）和第二次（p=0.836）米索前列醇治疗周期的平均视觉模拟评分分别为 6.3±3.4 和 4.7±3.3。治疗组出血 6.1 天，对照组出血 1.4 天（p=0.006）。
根据我们根据症状、子宫内膜厚度、子宫内膜不规则和多普勒超声显示的血流（提示胎盘组织）以及组织病理学确认来诊断 RPOC 的标准，卡曼管抽吸术可以是一种有效的治疗方法。对于米索前列醇治疗失败后的 RPOC 患者，它可能是一种安全的替代方法。
