Reduction of complications during first trimester abortion with the use of sonography

• Published in: Ultrasound in obstetrics & gynecology Vol. 18; no. s1; p. P24
• Main Authors: Malvasi, A., Losito, A., Baldini, D., Mudoni, A., Traina, V.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science, Ltd 01.10.2001
• ISSN: 0960-7692; 1469-0705
• DOI: 10.1046/j.1469-0705.2001.abs26-25.x

Background:  In our reproductive medicine service, more than 3000 abortions have been practised every year, since 1978. The standard operation for legal abortion is executed, according to law 194/78 within 90 days. The technique in voluntary or spontaneous abortion provides D&C as well as hysterosuction with the patients in general anesthesia. In order to reduce the possible complications for this operation and the increasing legal cases, routine perioperative sonography has been used to evaluate sudden abortion complications. Methods:  Besides ordinary preoperative sonography assessing gestational age, evolution of pregnancy, pelvic disease, etc. the use of intraoperative sonography has been shown to be necessary. A permanent team of four operators performs the operation under sonographic guide by using an R–T 36600 General Electric apparatus owned by our medicine service. In a lapse of time of five years, 16804 abortions under sonographic guide were practised and in a retrospective way there was a statistically significant reduction of complications according to literature. The 16118 cases in the previous 5 years and within the two homogeneous groups. Results:  We registered 11 complete and 13 incomplete uterine perforations vs. 4 and 7 (P < 0.01), 18 cases of retention of ovule remainders vs. 6 (P < 0.05), which required hospital readmission for a further examination of uterine cavity. In addition, the group under sonographic guide has shown a lower rate of failures in operations, antibiotics administrations (P < 0.001), endovaginal prostaglandin use (P < 0.005), anesthetics use (P < 0.05) and hospital stay (P < 0.01). If for the 24 previous uterine perforations in 19 cases the operation was delayed (11 ± days later) 13, when intraoperative sonography was used, it occurred only in three cases, for the other patients under sonographic guide, the uterine cavity was completely cleared with no complications at all (P < 0.001). Conclusions:  In our service, as well as according to literature, intraoperative sonography during abortions, led to a great reduction of complications with a better compliance for the patient and a significant reduction of costs. In particular, thanks to the use of sonography, complete and incomplete uterine perforations descreased, in 91% cases under sonographic guide the uterine cavity was emptied with no complications for the patients. Because of the favorable relationship between costs and benefits, the intervention can be performed under sonographic guide.