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Dr Pixel 2.0Women's imaging diagnosisDeveloped at the UNICAMP School of Medical Sciences

PLATFORM FOR EDUCATION AND DECISION SUPPORT IN WOMEN'S IMAGING

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Interactive flowchart

Absolute indications for curettage per international guidelines (ACOG, NICE/RCOG, FIGO):

Triage

Question 1 of 4

Infection (endometritis, sepsis)

Yes = criterion present. No = absent.

Ultrasound guidance

Ultrasound is an adjunct: in most cases it should not determine management in isolation. Sonographic findings alone have limited accuracy for predicting need for surgery. Endometrial thickness alone should not be used to mandate uterine evacuation—there is no reliable threshold.

Surgical technique (when indicated)
Prefer vacuum aspiration. Avoid sharp curettage as first-line (less pain, bleeding, and procedure time). [Tunçalp O et al., Cochrane 2010; Huchon C et al., JAMA 2023]
Full references (Vancouver style)
  1. Sporadic Miscarriage: Evidence to Provide Effective Care. Lancet. 2021. Coomarasamy A, Gallos ID, Papadopoulou A, et al.
  2. Treatment Options After a Diagnosis of Early Miscarriage: Expectant, Medical, and Surgical. Deutsches Arzteblatt International. 2021. Musik T, Grimm J, Juhasz-Böss I, Bäz E.
  3. Methods for Managing Miscarriage: A Network Meta-Analysis. The Cochrane Database of Systematic Reviews. 2021. Ghosh J, Papadopoulou A, Devall AJ, et al.
  4. Ultrasonographic Endometrial Thickness After Medical and Surgical Management of Early Pregnancy Failure. Obstetrics and Gynecology. 2008. Reeves MF, Lohr PA, Harwood BJ, Creinin MD.
  5. Endometrial Thickness Following Medical Abortion Is Not Predictive of Subsequent Surgical Intervention. Ultrasound in Obstetrics & Gynecology : The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2009. Reeves MF, Fox MC, Lohr PA, Creinin MD.
  6. Role of Transvaginal Sonography in the Diagnosis of Retained Products of Conception. Archives of Gynecology and Obstetrics. 2008. Ustunyurt E, Kaymak O, Iskender C, et al.
  7. The Value of Measuring Endometrial Thickness and Volume on Transvaginal Ultrasound Scan for the Diagnosis of Incomplete Miscarriage. Ultrasound in Obstetrics & Gynecology : The Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology. 2007. Sawyer E, Ofuasia E, Ofili-Yebovi D, et al.
  8. Expectant vs Medical Management for Retained Products of Conception After Medical Termination of Pregnancy: A Randomized Controlled Study. American Journal of Obstetrics and Gynecology. 2022. Tzur Y, Berkovitz-Shperling R, Goitein Inbar T, et al.
  9. Surgical Procedures for Evacuating Incomplete Miscarriage. The Cochrane Database of Systematic Reviews. 2010. Tunçalp O, Gülmezoglu AM, Souza JP.
  10. Operative Hysteroscopy vs Vacuum Aspiration for Incomplete Spontaneous Abortion: A Randomized Clinical Trial. The Journal of the American Medical Association. 2023. Huchon C, Drioueche H, Koskas M, et al.
  11. Complications of Unsafe and Self-Managed Abortion. The New England Journal of Medicine. 2020. Harris LH, Grossman D.

Educational tool. Does not replace local protocols or the responsible clinician’s judgement.