- Email: [email protected]
Suction Curettage as First Line Therapy for Cesarean Scar Pregnancy
S196
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 7). The median crown-rump-length at diagnosis correlated 6 + 0/7 weeks of gestation (range 5 + 5/7–9 + 3/7). Fetal heart-activity was detected in two cases. Mean βHCG at diagnosis was 5198 IU (142-14 580 IU). The lowest hemoglobin level at diagnosis was 10 mg/dl. In one case, suction curettage followed failed methotrexate trial. Only one case exerted excessive bleeding during the procedure which required further intervention with balloon tamponade for reaching haemostasis and mandated blood transfusion. No uterine rupture occurred and no other surgical interventions were mandatory in this case. All other women exerted no excess bleeding and no need of blood transfusion or any other complications. Conclusion: Suction curettage under ultrasound guidance might be a safe first line therapy for early diagnosed CSP in hemodynamically stable women.
Fig. 1. The trend of benign hysterectomy for inpatient vs. outpatient visits, 2008-2014.
597
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:27 PM – STATION C
Surgical Consent Form: Patient Comprehension of Associated Surgical Risk Based on Data Presenting Method Andrade F, James K, Alison C, Michael S-N, Joudi N, McCarter K, Carugno J. Obstetrics and Gynecology, MIS Unit, University of Miami, Miami, Florida
Fig. 2. The trend of surgical routes for benign hysterectomy among inpatient and outpatient visits, 2008-2014.
Conclusion: Patient and surgeon factors had greater impact in predicting outpatient benign hysterectomy. Surgical routes and surgeon’s previous experience of MIS in outpatient setting were more impactful individual factors. With the control for the preoperative factors at patient, surgeon, and hospital level, choice of RH in surgical route was associated with increased likelihood of outpatient BH.
596
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:27 PM – STATION B
Suction Curettage as First Line Therapy for Cesarean Scar Pregnancy Czeiger S, Oelsner G. Obstetrics & Gynecology, Maayanei-Hayeshua Medical-Center, Bnei-Brak, Tel Aviv, Israel Study Objective: To report our experience with suction curettage as a first line therapy for cesarean scar pregnancy (CSP). Design: A retrospective case-series. Setting: Obstetrics & Gynecology department, Mayanei-Hayeshua Medical-Center. Patients: Women admitted to our hospital between 2012–2017 who were diagnosed with CSP by transvaginal ultrasound (TVUS) demonstrating empty uterus and cervical canal; discontinuity and distortion of the anterior uterine wall; defect between the sac and the bladder wall; rich vascularity clearly surrounding the sac in Doppler examination. Intervention: Patients were treated with suction curettage under continuous ultrasound guidance, under general anesthesia, in operating room setup. Measurements and Main Results: Six women (mean age 33.2 ± 6.6 years) were found. Data on gestational-age, crown-rump-length, βHCG levels, hemoglobin levels, excessive bleeding, the need for further interventions or blood transfusion, uterine rupture, and other complications were collected . The median gestational age at diagnosis was 6 + 6/7 (range 5 + 5/7–12 + 3/
Study Objective: Surgical informed consent is a process of communication that involves the surgeon as the health care provider and the patient. It provides authority for an activity based upon understanding of what the activity entails and the risks, benefits and alternatives of treatment for any specific condition. It protects one of the most basic values in medicine and society: Autonomy. Currently, medical risk is often communicated to patients in the form of percentages, although there is no existing evidence that this is the most effective method to deliver this information. Study Objective: To evaluate the level of patient’s comprehension of surgical risk if presented as percentage (X% risk of complications), fraction (1/XX risk of complications) or both. Design: Single center prospective survey study. Setting: Outpatient gynecology clinic in an academic medical center. Patients: 190 patients presenting to the Gynecology Clinic. Intervention: A 10-questions survey with questions of hypothetical surgical risk presented as percentage, fraction or both. Descriptive statistics were used to analyze the data. Measurements and Main Results: 190 patients agreed to participate, 132 (69.5%) were Hispanic. Twenty-three (12.4%) had not completed high school. No significant difference in total number of correctly answered questions was found based on age group or race. There is a significant difference in the total number of questions answered correctly based on level of education (p = .0058). There was also a significant difference in education level and ability to answer percentage based survey questions (p = .004). No significant difference (p = .26) was found between education level and ability to answer questions that described risk in terms of fractions. Conclusion: When presenting surgical risk related information to patients, fractions compared to percentages, are more widely understood. We recommend expressing the surgical risk in fraction (Risk 1/XX) during preoperative patient’s surgical risk counseling.
598
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:27 PM – STATION D
Surgical Management Choices among the First 500 Patients in a Canadian Prospective Uterine Fibroid Registry: CAPTURE Kives S,1 Laberge PY,2 Leyland N,3 Polsky J,4 Singh SS,5 Vilos G,6 Belland L7. 1University of Toronto, Toronto, Ontario, Canada; 2Université Laval, Québec, Canada; 3McMaster University and Hamilton Health
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 7). The median crown-rump-length at diagnosis correlated 6 + 0/7 weeks of gestation (range 5 + 5/7–9 + 3/7). Fetal heart-activity was detected in two cases. Mean βHCG at diagnosis was 5198 IU (142-14 580 IU). The lowest hemoglobin level at diagnosis was 10 mg/dl. In one case, suction curettage followed failed methotrexate trial. Only one case exerted excessive bleeding during the procedure which required further intervention with balloon tamponade for reaching haemostasis and mandated blood transfusion. No uterine rupture occurred and no other surgical interventions were mandatory in this case. All other women exerted no excess bleeding and no need of blood transfusion or any other complications. Conclusion: Suction curettage under ultrasound guidance might be a safe first line therapy for early diagnosed CSP in hemodynamically stable women.
Fig. 1. The trend of benign hysterectomy for inpatient vs. outpatient visits, 2008-2014.
597
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:27 PM – STATION C
Surgical Consent Form: Patient Comprehension of Associated Surgical Risk Based on Data Presenting Method Andrade F, James K, Alison C, Michael S-N, Joudi N, McCarter K, Carugno J. Obstetrics and Gynecology, MIS Unit, University of Miami, Miami, Florida
Fig. 2. The trend of surgical routes for benign hysterectomy among inpatient and outpatient visits, 2008-2014.
Conclusion: Patient and surgeon factors had greater impact in predicting outpatient benign hysterectomy. Surgical routes and surgeon’s previous experience of MIS in outpatient setting were more impactful individual factors. With the control for the preoperative factors at patient, surgeon, and hospital level, choice of RH in surgical route was associated with increased likelihood of outpatient BH.
596
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:27 PM – STATION B
Suction Curettage as First Line Therapy for Cesarean Scar Pregnancy Czeiger S, Oelsner G. Obstetrics & Gynecology, Maayanei-Hayeshua Medical-Center, Bnei-Brak, Tel Aviv, Israel Study Objective: To report our experience with suction curettage as a first line therapy for cesarean scar pregnancy (CSP). Design: A retrospective case-series. Setting: Obstetrics & Gynecology department, Mayanei-Hayeshua Medical-Center. Patients: Women admitted to our hospital between 2012–2017 who were diagnosed with CSP by transvaginal ultrasound (TVUS) demonstrating empty uterus and cervical canal; discontinuity and distortion of the anterior uterine wall; defect between the sac and the bladder wall; rich vascularity clearly surrounding the sac in Doppler examination. Intervention: Patients were treated with suction curettage under continuous ultrasound guidance, under general anesthesia, in operating room setup. Measurements and Main Results: Six women (mean age 33.2 ± 6.6 years) were found. Data on gestational-age, crown-rump-length, βHCG levels, hemoglobin levels, excessive bleeding, the need for further interventions or blood transfusion, uterine rupture, and other complications were collected . The median gestational age at diagnosis was 6 + 6/7 (range 5 + 5/7–12 + 3/
Study Objective: Surgical informed consent is a process of communication that involves the surgeon as the health care provider and the patient. It provides authority for an activity based upon understanding of what the activity entails and the risks, benefits and alternatives of treatment for any specific condition. It protects one of the most basic values in medicine and society: Autonomy. Currently, medical risk is often communicated to patients in the form of percentages, although there is no existing evidence that this is the most effective method to deliver this information. Study Objective: To evaluate the level of patient’s comprehension of surgical risk if presented as percentage (X% risk of complications), fraction (1/XX risk of complications) or both. Design: Single center prospective survey study. Setting: Outpatient gynecology clinic in an academic medical center. Patients: 190 patients presenting to the Gynecology Clinic. Intervention: A 10-questions survey with questions of hypothetical surgical risk presented as percentage, fraction or both. Descriptive statistics were used to analyze the data. Measurements and Main Results: 190 patients agreed to participate, 132 (69.5%) were Hispanic. Twenty-three (12.4%) had not completed high school. No significant difference in total number of correctly answered questions was found based on age group or race. There is a significant difference in the total number of questions answered correctly based on level of education (p = .0058). There was also a significant difference in education level and ability to answer percentage based survey questions (p = .004). No significant difference (p = .26) was found between education level and ability to answer questions that described risk in terms of fractions. Conclusion: When presenting surgical risk related information to patients, fractions compared to percentages, are more widely understood. We recommend expressing the surgical risk in fraction (Risk 1/XX) during preoperative patient’s surgical risk counseling.
598
Virtual Posters – Session 4 (12:45 PM–1:45 PM) 1:27 PM – STATION D
Surgical Management Choices among the First 500 Patients in a Canadian Prospective Uterine Fibroid Registry: CAPTURE Kives S,1 Laberge PY,2 Leyland N,3 Polsky J,4 Singh SS,5 Vilos G,6 Belland L7. 1University of Toronto, Toronto, Ontario, Canada; 2Université Laval, Québec, Canada; 3McMaster University and Hamilton Health