RESUMEN
OBJECTIVES: To increase awareness of the possible existence of a morbidly adherent placenta in case of failed early medical abortion. CASE: We report a case of placenta increta which caused a massive haemorrhage during surgical aspiration following a failed medical abortion. CONCLUSION: Women with a history of caesarean section, who do not respond to a medical regimen for early termination of pregnancy should undergo an ultrasound examination to establish whether this may be due to a placenta accreta, increta or percreta.
Asunto(s)
Aborto Inducido/efectos adversos , Placenta Accreta , Hemorragia Posparto/etiología , Hemorragia Posparto/terapia , Adulto , Femenino , Edad Gestacional , Humanos , Dispositivos Intrauterinos Medicados/efectos adversos , Placenta Accreta/terapia , Embarazo , Complicaciones del Embarazo , Primer Trimestre del Embarazo , Resultado del TratamientoRESUMEN
BACKGROUND: The study was conducted to evaluate the effectiveness of oxygen/nitrous oxide (O(2)/N(2)O) in elective abortions by vacuum aspiration with paracervical block and intravenous paracetamol. DESIGN: This single-center double-blinded randomized study tested O(2)/N(2)O (n=36) and placebo (air, n=36) for additional analgesia in elective abortions with paracervical block and intravenous paracetamol. We assessed intra- and postoperative pain according to both a visual analogic scale rated from 0 to 10 and postoperative analgesic requirements. RESULTS: Mean (±SD) intraoperative, immediate postoperative and late postoperative pain did not differ significantly for patients with O(2)/N(2)O and with air [3.4±2.6 vs. 3.7±3.05 (p=.75), 1.89±2.4 vs. 1.56±2.03 (p=.78), 0.5±0.8 vs. 0.75±1.2 (p=.45)]. The number of patients with scores for low (0-4), moderate (4-7) and severe (7-10) intraoperative, immediate postoperative and late postoperative pain did not differ significantly between the groups. Total adverse effects were significantly higher in the O(2)/N(2)O group [35/180 (19.4%) vs. 18/180 (10%), p=.01]. CONCLUSION: O(2)/N(2)O did not reduce intraoperative or postoperative pain in elective abortions by vacuum aspiration with paracervical analgesia and intravenous paracetamol, and its adverse effect rate was substantial.