Current Diagnosis & Treatment Obstetrics &Gynecology11th Edition
Current Diagnosis & Treatment Obstetrics & Gynecology 11th Edition pdf,I hope most of us are know about current diagnosis series and their books..so no need to describe the book.alternatively we can discuss some relevant topics in ob gynecology.
DILATION AND CURETTAGE
Early pregnancy failure is clinically recognized in 15% to 20% of pregnancies and can be managed surgically, medically, and expectantly. Many studies have compared the various treatment options, but differences in terminology, medical management, and definitions of failed treatment make comparison difficult.
However, medical management seems to be a possible and effective acceptable alternative to surgical curettage. The use of vaginal misoprostol 400 to 800 micrograms has been found to be 80% to 88% successful in achieving a complete miscarriage as compared to 96% to 100% of surgically managed pregnancy failures.
The primary side effects of medical herapy include nausea, vomiting, and diarrhea, and those with failed complete miscarriage often require suction D&C. As with any surgery, the risks and benefits of the surgery must be weighted.
The benefits ofsurgical management include high success rate and prompt treatment of pregnancy failure. As the gestational age of the abortion increases, so does the risk of complications. However, not all D&Csperformed are for obstetrical indications.
Gynecologic indications for D&C include evaluation ofdysfunctional bleeding, treatment of excessive bleeding, and treatment of cervical stenosis.
Surgical complications of D&Cs are rare and can be categorized as occurring in the immediate or delayed/late period (Table 2–1). D&Cs performed for obstetrical indications carry a slightly higher risk than nonobstetrical indications due to the increased risk of perforation/bleeding from the gravid
Ben-Baruch et al reported that the risk for nonobstetrical D&Cs varies between 0.5% and1.8%, depending on the indication. A recent retrospective study confirmed this low complication riskfor nonobstetrical D&Cs.