OC37.03: Routine use of ultrasound guided curettage for incomplete abortion or missed abortion—five years experience

Many incomplete spontaneous abortions require dilation and curettage, which maybe complicated by hemorrhage, perforation, infection, and retained products. We tested the premise that intraoperative ultrasound guidance to guide the surgeon in cases where the uterine position, anatomy or configurational distortion might render the abortion difficult or hazardous would reduce the procedures complications. Ultrasound guided curettage was routinely performed during a 5-year period July 1, 2000 to December 31, 2004. After induction of general anesthesia, a 3.5 MHz curved array probe was placed longitudinally on the patient's abdomen and the uterus scanned longitudinally from the cervix to the fundus. The entire procedure was conduced under ultrasound guidance if necessary. The surgery was considered complete when the endometrial cavity appeared as a regular echogenic line. The prevalence of complications was tabulated. Ultrasound guided curettage was performed in 386 patients. There were no perforations or episodes of hemorrhage. A failed or incomplete procedure occurred in 02 instances (0, 5%) requiring a repeated curettage. These two women had only residual trophoblastic tissue. During the 5-year period preceding use of ultrasound the same complications occurred in 3.7% (failed or incomplete procedure), 1.2% (hemorrhage) and 0.9% (uterine perforation). Routine intraoperative real-time sector ultrasound performed by an experienced scanner is safe and expedient adjunct for the performance of a dilation and curettage.