RLLR

Suction curettage is the most commonly used method to surgically complete a first trimester miscarriage in the United States. This procedure can safely be used up to 13 menstrual weeks; after this gestation, extraction procedures are often needed to successfully complete a miscarriage surgically. Surgical dilatation is not always necessary in cases of spontaneous abortion, as the cervix is often already dilated. The diameter of the suction cannula can usually be correlated to the gestational weeks; for example, at eight weeks an 8-mm cannula

Table 1 Disorders Leading to Acute Pelvic Pain That Can Be Treated Surgically

Gynecological Abortion Adnexal torsion Degenerating leiomyoma Ectopic pregnancy Endometriosis Ovarian tumor Pelvic inflammatory disease Ruptured ovarian cyst

Table 2 Gynecological Disorders Leading to Recurrent Pelvic Pain That May Be Treated Surgically

Adnexal torsion Endometriosis Primary dysmenorrhea Uterine retroversion

can be used. In early miscarriages, a 50-or 60-mL syringe can be attached to the cannula for aspiration of the products of conception (Fig. 2). Electrical vacuum devices are preferable at 10 or more weeks of gestation. The cannula is introduced without suction, and the vacuum suction is applied to about

Table 3 Gynecological Disorders Associated with Chronic Pelvic Pain That May Be Treated Surgically

Adenomyosisa

Adhesionsb

Adnexal cysts (nonendometriotic)a

Benign cystic mesotheliomab

Cervical stenosisa

Endometrial or cervical polypsa

Endometriosisc

Endosalpingiosisa

Gynecological malignancies (especially late stage)c

Leiomyomatab

Ovarian remnant syndromec

Ovarian retention syndrome (residual ovary syndrome)c

Pelvic congestion syndromec

Pelvic inflammatory diseasec

Postoperative peritoneal cystsb

Residual accessory ovarya

Symptomatic pelvic relaxation (genital prolapse)a

Tuberculous salpingitisc

aLevel C: causal relationship to chronic pelvic pain based on expert opinions. bLevel B: limited or inconsistent scientific evidence of causal relationship to chronic pelvic pain. cLevel A: good and consistent scientific evidence of causal relationship to chronic pelvic pain.