title: Lower complication rates with office-based D&C under ultrasound guidance for missed abortion.
abstract: BACKGROUND
  Missed abortion (MA) can be managed expectantly, medically or surgically. Surgical management has been performed safely in the office setting by suction dilation and curettage (D&C). Prior studies suggest that intraoperative ultrasound guidance (USG) may reduce complications for first-trimester therapeutic abortion. The aim of this study was to evaluate the safety of office D&C for MA using real-time USG.
  
  
  METHODS
  This retrospective cohort study included 255 patients who underwent office D&C under USG for first trimester MA at a single university-affiliated fertility clinic during January 2011-December 2013. Transabdominal USG was utilized during the procedure and was immediately followed by a transvaginal ultrasound examination to confirm full evacuation. Intra- and postoperative complication rates were compared to previously published data.
  
  
  RESULTS
  There were no intraoperative complications, including excessive blood loss or uterine perforation. Two of the 255 patients (0.87%) were diagnosed with RPOCs requiring uterine re-evacuation. This rate of RPOCs was superior to rates previously reported for D&Cs without USG (2.6-4.9%, P=0.046). There were no other post procedure complications identified.
  
  
  CONCLUSIONS
  We observed very low complications rate in Office-based D&C under USG, lower than those reported in the literature with unguided D&C.
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.|CReATe Fertility Centre, Toronto, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Chaikof
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.|CReATe Fertility Centre, Toronto, Canada.
authors.forename: Tal
authors.initials: T
authors.lastname: Lazer
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.|CReATe Fertility Centre, Toronto, Canada.|Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel.
authors.forename: Itai
authors.initials: I
authors.lastname: Gat
authors.affiliation: CReATe Fertility Centre, Toronto, Canada.
authors.forename: Kevin
authors.initials: K
authors.lastname: Quach
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.|CReATe Fertility Centre, Toronto, Canada.
authors.forename: Basheer
authors.initials: B
authors.lastname: Alkudmani
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.|CReATe Fertility Centre, Toronto, Canada.|Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel.
authors.forename: Khaled
authors.initials: K
authors.lastname: Zohni
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.|CReATe Fertility Centre, Toronto, Canada.|Department of Reproductive Health and Family Planning, National Research Centre, Cairo, Egypt.|Department of Gynecology, Women's College Hospital, Toronto, Canada.
authors.forename: Ari
authors.initials: A
authors.lastname: Baratz
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.|CReATe Fertility Centre, Toronto, Canada.|Department of Gynecology, Women's College Hospital, Toronto, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Glass
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.|CReATe Fertility Centre, Toronto, Canada.|Department of Gynecology, Women's College Hospital, Toronto, Canada.
authors.forename: Prati
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada - drlibrach@createivf.com.|CReATe Fertility Centre, Toronto, Canada.|Department of Gynecology, Women's College Hospital, Toronto, Canada.
authors.forename: Clifford
authors.initials: C
authors.lastname: Librach
mesh_terms: D000030:Abortion, Missed / Q000601:surgery*; D000328:Adult; D015331:Cohort Studies; D004107:Dilatation and Curettage / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008875:Middle Aged; D009819:Office Visits; D011183:Postoperative Complications / Q000453:epidemiology*; D011247:Pregnancy; D012189:Retrospective Studies; D018084:Ultrasonography, Interventional / Q000379:methods*; D055815:Young Adult