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I. CLINICAL QUESTION In a patient in an incomplete miscarriage, are surgical procedures effective and safe to use to evacuate incomplete miscarriage? II. CITATION Surgical procedures to evacuate incomplete miscarriage III. STUDY CHARACTERISTICS 1. Patients included All trials enrolling women with incomplete abortion were eligible, regardless of the cause of the incomplete abortion. The included trials were relatively small, with 193 women in the Tan 1969 study and 357 women in the Verkuyl 1993 study. 2. Interventions compared Any type of vacuum aspiration versus dilatation and curettage (D& C) or simple curettage (without dilatation) Comparison of different types of vacuum aspiration including the use of different cannulas or different sources of vacuum pressure (manual/syringe, electric) Comparisons of types of anesthesia/analgesia and hospital versus outpatient care are not evaluated in this review. 3. Outcomes Monitored (1) Uterine perforation; (2) need for re-evacuation/procedure failure; (3) Duration of procedure; (4) post-abortal infection/sepsis; (5) Blood loss; (6) Duration of bleeding/vaginal discharge after procedure; (7) Side effects of procedure; (8) Need for anesthesia/analgesia; (9) Pain; (10) Need for blood transfusion; (11) need for additional uterotonics; (12) Length of hospital stay; (13) Patient satisfaction
Design Two trials were included. incompetent cervix and ectopic pregnancy following surgical management of incomplete abortion are relevant and important outcomes. University of North Carolina-Chapel Hill USA Duke University School of Medicine. require long term follow-up (years) and are not amenable to diagnosis unless the woman wants future pregnancies and the problems become apparent. adhesions of the uterine wall). METHODOLOGY/ DESIGN 1.90). in the single study that evaluated these outcomes. 4.87 minutes). less pain (relative risk (RR): 0. Data Sources External sources of support No sources of support supplied Internal sources of support HRP . 95% confidence interval (CI) -24 to -10 mls). It is therefore not easy (if not impossible) to evaluate these outcomes with the randomized controlled trial methodology.5 to -0.2 minutes weighted mean difference. Serious complications such as uterine perforation and other morbidity were rare and the sample sizes of the trials were not large enough to evaluate small or moderate differences. 3. 4.Outcomes such as Ashermann Syndrome (uterine synechiae. Vacuum aspiration was associated with statistically significantly decreased blood loss (-17 mls weighted mean difference.UNDP/UNFPA/WHO/World Bank Special Programme in Human Reproduction. DOES THE STUDY FOCUS ON A SIGNIFICANT PROBLEM IN CLINICAL PRACTICE? Effectiveness and safety procedures are where the study focused. 0.61. these are relatively infrequent. infertility. and shorter duration of procedure (-1. Setting The trials were conducted in Singapore (Tan 1969) and Zimbabwe (Verkuyl 1993).74. However. than sharp curettage. 95% CI -1. Methodology used Randomized trials 2. Geneva SWITZERLAND Department of Maternal & Child Health. North Carolina USA . IV. 95 0.
RESULTS OF THE STUDY The results of this study are that vacuum aspiration is at least as effective as sharp curettage. V. (2) Studies comparing different medical methods of termination of pregnancy. AUTHOR S CONCLUSIONS/ RECOMMENDATIONS 1. and should be recommended for use in the management of incomplete abortion. Verkuyl 1993 used plastic cannulae with suction pressure generated via a syringe. quick to perform.5. Subject Selection A. and less painful than sharp curettage. 6. VI. and Tan 1969 used metal cannulae with electrical power source for suction. The study indicates that vacuum aspiration is safe. No trial compared different cannula types in vacuum aspiration. Has the original study been replicated? No. or different sources of suction pressure. What were the risks and benefits of the nursing actions/ interventions tested in the study? Uterine perforation is a serious complication of surgical evacuation procedures which is relatively rare with either of the approaches. B. 7.e. elective termination of pregnancy). with 193 women in the Tan 1969 study and 357 women in the Verkuyl 1993 study. (3) Studies comparing surgical with medical methods for the management of incomplete abortion. It has been suggested that vacuum aspiration is more cost effective than sharp curettage. if not more effective in the management of incomplete abortion. and less painful than sharp curettage. Inclusion Criteria The included trials were relatively small. the study has not been replicated. What contribution to the client health status/ intervention make? Vacuum aspiration is safe. quicker to perform. . Both of the trials examined vacuum aspiration versus sharp metal curettage. Exclusion Criteria (1) Studies comparing different methods of induced abortions (i. The need for re-evacuation was slightly lower in the vacuum aspiration group. Since the pain seems to be less and procedure time is shorter efforts should be put into wider dissemination and use of the vacuum aspiration technology around the world.
vacuum aspiration advances more that dilatation and curettage because as what the study had discussed it is safe. Comparing the effectiveness of vacuum aspiration with sharp curettage could only be justified in the context of convincing health workers to use vacuum aspiration rather than sharp curettage. Both approaches is needed because this procedures removes what an incomplete miscarriage has left inside the woman s uterine. DOES THE STUDY PROVIDE A DIRECT ENOUGH ANSWER TO YOUR CLINICAL QUESTION IN TERMS OF TYPE OF PATIENTS. vacuum aspiration would be more recommended because not everyone in the country is capable of paying surgical procedures because it can be done without the use of any operating equipment. IS IT FEASIBLE TO CARRY OUT THE NURSING ACTION IN THE REAL WORLD? Carrying out both procedures in the real world is indeed realistic because in certain circumstances it is inevitable that incomplete abortion would happen. either to undergo dilatation and curettage or vacuum aspiration.2. 2. somewhat like that? I guess. What overall contribution to nursing knowledge does the study make? Different sources of vacuum pressure. and duration of hospital stay have not been evaluated here and deserve to be reviewed and further researched if necessary. REVIEWER S CONCLUSION/ COMMENTARY In this study. It would need less effort than sharp curettage because it doesn t need to go surgical procedure and could use hand-held manuals and it costs less. the study was too broad in what types of patient who are permitted to undergo with the procedure. it wasn t able to specify who these women who. In our country. they ve compared which must be which. and both approaches are considerably applicable to women who have had incomplete miscarriage. INTERVENTION AND OUTCOME? To some extent. methods of analgesia. cannula types. At some points. APPLICABILITY 1. Are all ages permissible to undergo such procedure. EVALUATING NURSING CARE PRACTICES 1. quick to perform. a manual operation probably would do. and less painful than sharp curettage. had their incomplete miscarriage are. VII. Safety . IX. but in type of patients. VIII. unfortunately. the study was able to provide answers in terms of intervention and outcome.
Efficiency The study has proven the efficiency of both procedures in managing incomplete miscarriage. 2. 5. vacuum aspiration is more effective than dilatation and curettage because it is safer. They must be knowledgeable enough to provide their client with the right interventions needed. upon the procedure there may be unnoticeably left equipments which may lead to another complication instead of curing the first one. 4. . Appropriateness The procedures are appropriate in managing incomplete miscarriage as these procedures are the interventions to safely remove the fetus which is no longer developing inside the uterus. incomplete miscarriage. 7. faster and cost effective. it would not require equipments to be able perform the procedure. In dilatation and curettage. 6. Accessibility One of the procedure may not be accessible enough to those who were financially incapable of paying hospital bills and surgical procedure like the dilatation and curettage. Effectiveness The study has proven the effectiveness of the procedures.Both procedures are safe. 3. unlike the vacuum aspiration. but between the two. Acceptability It is indeed acceptable because these approaches provide treatment for incomplete miscarriage. Competence of the care provider Competency of the health care provider is also required for it requires knowledge about the procedures in which success of the procedure would have higher chances. but vacuum aspiration is safer.
Romina Anna J.FAR EASTERN UNIVERSITY EVIDENCE BASED NURSING (Surgical Procedures to evacuate incomplete miscarriage) Submitted by: Cahucom. BSN 207/ Group 25-B .
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