CONTEXT: Approximately 50 million abortions are performed worldwide each year, and the majority of them are surgical terminations of pregnancy (STOP). Therefore, the safety of this procedure is a global public health concern. It is not known whether routine use of intraoperative ultrasound guidance improves the outcome of first trimester STOP. OBJECTIVE: To investigate whether surgical termination of pregnancy in the first trimester with continuous ultrasound guidance is safer than the conventional procedure without ultrasound guidance. DESIGN: A randomized controlled trial. SETTING: A teaching hospital in London, UK. PARTICIPANTS: Women undergoing STOP in the first trimester. INTERVENTION: PARTICIPANTS were randomized to have the procedure with or without continuous ultrasound guidance. OUTCOME MEASURES: The primary outcome measures were intraoperative and short-term complications (anaesthetic complication, haemorrhage, ongoing pregnancy, cervical trauma, uterine perforation, need for laparoscopy and/or laparotomy, repeat evacuation, and infection). The secondary outcomes were the blood loss, procedure time, and convalescence time. RESULTS: A total of 230 women (115 in each arm of the trial) participated in the study. Follow-up data were available for analysis in all but 15 (8 in control group and 7 in intervention group) cases. Baseline characteristics were similar in both groups. The overall complication rate was 9.8 percent. STOP under ultrasound guidance had a complication rate of 3.7% (4/108) in comparison to 15.9% (17/107) without ultrasound (RR 0.23, 95% CI 0.08-0.67). Intraoperative ultrasound guidance also had a statistically significant beneficial effect in reducing the blood loss, procedure time, and convalescence time. CONCLUSION: STOP in the first trimester under continuous ultrasound guidance was associated with a lower rate of complications than the conventional procedure without ultrasound.
RCT Entities:
CONTEXT: Approximately 50 million abortions are performed worldwide each year, and the majority of them are surgical terminations of pregnancy (STOP). Therefore, the safety of this procedure is a global public health concern. It is not known whether routine use of intraoperative ultrasound guidance improves the outcome of first trimester STOP. OBJECTIVE: To investigate whether surgical termination of pregnancy in the first trimester with continuous ultrasound guidance is safer than the conventional procedure without ultrasound guidance. DESIGN: A randomized controlled trial. SETTING: A teaching hospital in London, UK. PARTICIPANTS: Women undergoing STOP in the first trimester. INTERVENTION: PARTICIPANTS were randomized to have the procedure with or without continuous ultrasound guidance. OUTCOME MEASURES: The primary outcome measures were intraoperative and short-term complications (anaesthetic complication, haemorrhage, ongoing pregnancy, cervical trauma, uterine perforation, need for laparoscopy and/or laparotomy, repeat evacuation, and infection). The secondary outcomes were the blood loss, procedure time, and convalescence time. RESULTS: A total of 230 women (115 in each arm of the trial) participated in the study. Follow-up data were available for analysis in all but 15 (8 in control group and 7 in intervention group) cases. Baseline characteristics were similar in both groups. The overall complication rate was 9.8 percent. STOP under ultrasound guidance had a complication rate of 3.7% (4/108) in comparison to 15.9% (17/107) without ultrasound (RR 0.23, 95% CI 0.08-0.67). Intraoperative ultrasound guidance also had a statistically significant beneficial effect in reducing the blood loss, procedure time, and convalescence time. CONCLUSION: STOP in the first trimester under continuous ultrasound guidance was associated with a lower rate of complications than the conventional procedure without ultrasound.
Authors: Karen Grewal; Benjamin Jones; Ariadne L'Heveder; Sita Jindal; Nicolas Galazis; Srdjan Saso; Joseph Yazbek Journal: Future Sci OA Date: 2021-01-12