RESUMEN
OBJECTIVE: Ultrasonographic features of the endometrium are often assessed when deciding the necessity of surgical intervention following early medical abortion. Knowledge is therefore needed on the ultrasonographic appearance of the endometrium following successful medical abortion in order to avoid unnecessary surgical interventions. We aimed to assess endometrial thickness and echogenicity at multiple time points following successful early medical abortion. STUDY DESIGN: We conducted a retrospective study in the largest office-based abortion providing clinic in Denmark. Using archived ultrasonographic images, we assessed endometrial thickness and echogenicity following all early medical abortions that did not need surgical intervention or repeated medication for completion during the years 2014-2017. RESULTS: Ultrasonographic endometrial features were assessed 1854 times following 1074 early medical abortions. Median endometrial thickness in the 1st week from induction was 13 milimeters (mm; lower-upper quartile 11-17 mm). For the 2nd, 3rd, 4th, and >4th week, the median endometrial thickness was found to be 11 mm (9-15 mm), 11 mm (8-14 mm), 12 mm (9-16 mm), and 11 mm (8-14 mm), respectively. Of the ultrasonographic examinations performed in the 1st week from medical induction, 24.7 % showed a heterogenous endometrium. For 2nd, 3rd, 4th, >4th week, the frequency of heterogeneity was 23.9 %, 16.3 %, 21.3 %, 18.9 %, respectively. A total of 151 abortions (14.1 %) were each examined three times, median time of examination being day 7, 15, and 26 following induction. Among these abortions, the three most common patterns of change in endometrial thickness were "decreasing" (37.7 %), "increasing-decreasing" (23.2 %), and "decreasing-increasing" (21.9 %). Further, 49.7 % of the 151 abortions showed a homogenous endometrium at all three examinations, 17.2 % showed a heterogenous endometrium at first examination and a homogenous endometrium the following two examinations, and 9.9 % showed a heterogenous endometrium at the first two examinations followed by a homogenous endometrium. CONCLUSION: In early medical abortions completed without secondary intervention, endometrial thickness and echogenicity varied clinically significantly for weeks following the medical induction. Every possible pattern of change in endometrial thickness and echogenicity was observed.
Asunto(s)
Aborto Inducido , Aborto Espontáneo , Embarazo , Femenino , Humanos , Estudios Retrospectivos , Endometrio/diagnóstico por imagen , Aborto Espontáneo/diagnóstico por imagen , UltrasonografíaRESUMEN
OBJECTIVE: To evaluate the time trend in risk of surgical intervention following early medical abortion. STUDY DESIGN: We conducted a retrospective observational study including all medical abortions induced before a gestational age of 63 days during the period 2008-2012 in a Danish gynecology clinic with a single provider deciding the necessity of subsequent surgical intervention. All included abortions were followed for 8 weeks from first medical administration. We extracted information on surgical intervention during follow-up and potential confounding variables from local and national health registers and assessed these according to calendar time. Multiple logistic regression provided an adjusted odds ratio of the association between calendar time and risk of surgical intervention. RESULTS: A total of 1372 abortions were induced on site during the study period. Surgical interventions on site decreased from 10.2% in 2008 to 2.6% in 2012 (p < 0.001). The decline was significant after adjustment of gestational age, maternal age, and reproductive history, odds ratio for 1-year increase 0.71 (95% CI: 0.59-0.86). CONCLUSION: Risk of surgical intervention following early medical abortion declined by time independent of known risk factors for surgical intervention in a setting with a single provider deciding the necessity of surgical intervention. IMPLICATIONS: Risk of surgical intervention following early medical abortion declined over time during a period without procedure changes and with no variations in known determinants of surgical intervention. This finding may indicate the effect of increasing provider experience in the reduction of risk of surgical intervention following early medical abortion.