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Results: 12

Paracervical local anaesthesia for cervical dilatation and uterine interventions

Paracervical block involves injection of local anaesthetic around the cervix to numb nearby nerves. Cervical dilatation and uterine interventions (such as hysteroscopy, endometrial biopsies, fractional curettage, and suction terminations) can be performed without any analgesia or anaesthesia; with regional anaesthetic injections as with paracervical block; using oral or intravenous analgesics and sedatives; or under general anaesthesia. Many gynaecologists use paracervical block for uterine intervention but it is unclear how effective and safe this method is. We included nine new studies in this updated review with a total of 26 studies involving 2790 women undergoing uterine interventions. The women were randomly allocated to paracervical block or an alternative. We found that, statistically, women had significantly less pain during cervical dilatation and uterine intervention with paracervical block than with placebo injection (saline or water) but clinically this difference may be unimportant. Paracervical block had no effect in five uncontrolled studies. There was no evidence that paracervical block reduced pain compared to alternative regional anaesthetic methods or systemic analgesics and sedatives. There was little information on important side effects. After updating, this review found that no local anaesthetic technique prevented pain as well as one would expect from general anaesthesia.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

The review found that both, D&C and vacuum aspiration, are safe and effective methods for first trimester termination of pregnancy and complications are rare.

There are several different surgical techniques for early termination of pregnancy (abortion in the first three months). These are dilatation and curettage (D&C to scrape out the contents of the uterus), vacuum aspiration (sucking out the contents of the uterus with a manual or power‐operated device). Hysterotomy (surgery through the uterus, like caesarean section) is not commonly used. The cervix (opening of the uterus) can be prepared beforehand with hormones to minimise the risk of damage. The review found that both, D&C and vacuum aspiration, are safe and effective methods for first trimester termination of pregnancy and complications are rare. The review does not reveal women's or surgeons' preference of one method over the other.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Gestational Trophoblastic Disease Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of gestational trophoblastic disease.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: December 2, 2013

Endometrial Cancer Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of endometrial cancer.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: April 22, 2014

Uterine Sarcoma Treatment (PDQ®): Patient Version

Expert-reviewed information summary about the treatment of uterine sarcomas.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: December 2, 2013

Surgical procedures to evacuate incomplete miscarriage

Vacuum aspiration is a safe and quick treatment for incomplete miscarriages.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Medical methods for early termination of pregnancy can be safe and effective

There are several different surgical techniques for abortion during the first three months. Several drugs can also be prescribed alone or in combination to terminate early pregnancy. This is called medical abortion, and uses the hormones prostaglandins and/or mifepristone (an antiprogesterone often called RU486), and/or methotrexate. This review of trials found that medical methods for abortion in early pregnancy can be safe and effective, with the most evidence of effectiveness for a combination of mifepristone and misoprostol (a prostaglandin). Almost all of the trials were done in well‐resourced settings where women returned for a check‐up.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Prophylactic (preventive) chemotherapy for hydatidiform mole (molar pregnancy) to prevent cancerous growth later

A molar pregnancy (hydatidiform mole) develops following an abnormal process of conception, whereby placental tissue overgrows inside the womb (uterus). Molar pregnancies are classified as complete (CM) or partial (PM) based on their appearance (gross and microscopic), and their chromosome pattern. Moles are usually suspected at the early pregnancy scan and women often present with bleeding, similar to a miscarriage. The molar tissue is removed by evacuation of retained products of conception (ERPC), also known as dilatation and curettage (D&C) and women generally make a full recovery. However, some women go on to develop a cancer in the womb (about 1 in every 5 women with a CM and 1 in 200 with a PM). Women are generally at a higher risk of getting this cancer, which is known as gestational trophoblastic neoplasia (GTN), if they are over 40 years old, have a large increase in the size of the womb, have large cysts in the ovaries or have high initial levels of β‐human chorionic gonadotrophin (hCG) (the pregnancy hormone) in their blood. Although treatment of the cancer with chemotherapy (anti‐cancer drugs) is almost always effective, it has been suggested that routinely giving women anti‐cancer drugs (P‐Chem) before or after the removal the molar tissue may reduce the risk of the cancerous tissue developing.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

First‐line treatment with anti‐cancer drugs for low risk gestational trophoblastic neoplasia

Gestational trophoblastic neoplasia (GTN) is a rare but curable disease whereby a malignant tumour develops in the womb after a normal or molar pregnancy (where tissue develops in the womb instead of a baby). Women with GTN are classified as having low‐ or high‐risk GTN using a specific scoring system. Virtually all women with low‐risk GTN are cured by treatment with chemotherapy (anti‐cancer drugs) after undergoing dilatation and curettage (D&C) of the womb. Methotrexate and dactinomycin are the two most commonly used drugs for first‐line treatment of low‐risk GTN, although methotrexate is favoured in Europe and North America. Sometimes the first‐line treatment fails to cure the disease or has side‐effects that require it be discontinued, and a secondary treatment has to be used. If methotrexate is the first drug used, dactinomycin is usually the secondary treatment, and vice versa. We undertook this review as it was not clear which drug, if any, was more likely to cure low‐risk disease in the first instance. Furthermore, it was not clear which, if any, caused more side‐effects.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Anti‐D administration after spontaneous miscarriage for preventing Rhesus alloimmunisation

A Rhesus‐negative (Rh‐negative) pregnant woman might develop Rh antibodies in her blood stream when she carries a Rh‐positive baby. The subsequent antibody formation has the potential to attack the red blood cells of a Rh‐positive baby during pregnancy. This might make the baby anaemic and in severe cases, the baby might die. Other Cochrane reviews provide clear evidence that giving anti‐D immunoglobulin (anti‐D) within 72 hours of the birth to a Rh‐negative mother of a Rh‐positive baby and during the third trimester reduces Rh antibody formation in future pregnancies. The chances of developing Rh antibodies may also be reduced if anti‐D is given to Rh‐negative women following a spontaneous miscarriage or a dilatation & curettage (D&C) for incomplete miscarriage after 12 weeks. However, our review only identified one poor quality randomised controlled trial (involving 48 women) that considered anti‐D administration after therapeutic D&C or spontaneous miscarriage for preventing Rh alloimmunisation (development of antibodies in response to antigens from a non‐self protein). The included study did not report any data on the review's primary or secondary outcomes. More high‐quality research is needed in this field.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Pre‐operative endometrial thinning agents before endometrial destruction for heavy menstrual bleeding

Cochrane authors reviewed evidence for the effectiveness and safety of medications used to thin the lining of the womb before surgery performed to destroy (ablate) this lining (endometrium) in premenopausal women with heavy menstrual bleeding.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Expectant care (waiting) versus surgical treatment for miscarriage

Miscarriage is pregnancy failure before 14 weeks, which is common in early pregnancy. Such a loss in early pregnancy can affect a woman’s physical and mental health. Doctors often suggest surgery such as dilation and curettage (D and C) or vacuum aspiration to complete the process. Surgery might cause problems such as trauma, heavy bleeding, or infection. Expectant management means waiting for the miscarriage to finish on its own, and may involve bed rest, examination by ultrasound, and antibiotics. This review looked at whether expectant management works as well as surgery for miscarriage.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

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