Evacuazione chirurgica della cavità
uterina: manovra ormai obsoleta?
Dott.ssa
Chiodo
Dott. Galli
Dott. Luerti
Evacuazione chirurgica della cavità
uterina: manovra ormai obsoleta?
NO!
Dati ISTAT
2006
(66.308 pz)
RCU (95%)
Tp Med (3%)
altro (2%)
Evacuazione chirurgica della cavità
uterina: manovra ormai obsoleta?
Letteratura
Cochrane Database Syst Rev. 2010 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
Evacuazione chirurgica della cavità
uterina: manovra ormai obsoleta?
Letteratura
Cochrane Database Syst Rev. 2006 Jul 19;3:CD002253. 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.
Evacuazione chirurgica della cavità
uterina: manovra ormai obsoleta?
X’?
Costi/
prefere
nza pz
compli
canze
Efficacia/
gestione
Evacuazione chirurgica della cavità
uterina: manovra ormai obsoleta?
COMPLICANZE
ANESTESIOLOGICHE
CHIRURGICHE
POST-CHIRURGICHE
IMMEDIATE
POST-CHIRURGICHE
TARDIVE
Evacuazione chirurgica della cavità
uterina: manovra ormai obsoleta?
Letteratura
J Am Assoc Gynecol Laparosc. 2002 May;9(2):182-5. 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.
Evacuazione chirurgica della cavità
uterina: manovra ormai obsoleta?
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
Evacuazione chirurgica della cavità
uterina: manovra ormai obsoleta?
Razionale
S
M
A
Z
I
O
N
E
EB
EF
Evacuazione chirurgica della cavità
uterina: manovra ormai obsoleta?
Studio
RICERCA DI MIOCITI
IN CAMPIONI OTTENUTI DA
ISTEROSUZIONE E CURETTAGE
ESEGUITI A SEGUITO DI ABORTO
SPONTANEO DEL I TRIMESTRE
IN 10 PAZIENTI
Evacuazione chirurgica della cavità
uterina: manovra ormai obsoleta?
Razionale
DANNO MIOMETRIALE
ESTENSIONE DEL DANNO (EMBRIOISTEROSCPOPIA)
SEQUELE ???
Evacuazione chirurgica della cavità
uterina: manovra ormai obsoleta?
Letteratura
Best Pract Res Clin Obstet Gynaecol. 2010 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.
Evacuazione chirurgica della cavità
uterina: manovra ormai obsoleta?
Conclusioni